Over the years, I’ve spent countless hours in the lamp-lit living rooms of seniors, each with their own stories and struggles. But often, as the sun would start to lower in the horizon, I often witnessed a shift in their demeanor. The calm, cheerful conversations of the afternoon would sometimes spiral into evenings filled with restlessness, aggressiveness and confusion. This phenomenon, known as sundowning, brought out challenging behaviors in many of the wonderful people I cared for. Caregiving can be a challenge in the best of circumstances but add in these negative behaviors and coping with the stress is uniquely challenging. From heightened agitation to profound disorientation, these symptoms stretched my understanding and skills as a caregiver. It was through these experiences that I learned the importance of gentle persistence and innovative strategies to create a calming environment that could ease the anxiety and unrest felt by those under my care.
Caring for an aging parent or relative who exhibits challenging behaviors due to conditions like dementia, urinary tract infections (UTIs), or sundowning can be particularly demanding. Sundowning refers to the increase in restlessness, confusion, and irritability that typically occurs in the late afternoon and evening in some individuals with dementia. Think about sundowning like having an older phone. The phone never charges up to 100% anymore and the daily tasks you ask it to run use up more of the battery than it used to. Now when the battery gets low from running those regular tasks (getting dressed, morning hygiene, eating breakfast, etc) all the apps on the phone begin to act wonky. As the battery keeps draining, the phone starts acting cranky. Try to take a video longer than a few seconds and the phone warns you it is overheating.
Here’s some tips on how to more effectively manage these situations:
Communicating Effectively with an Agitated Senior
- Stay calm and patient: Understand that you just as if you were working with a compromised phone to get your stuff done, a senior exhibiting this behavior is not doing it on purpose. Use a soothing tone and simple sentences. If they are upset, maintain a calm demeanor and avoid confrontational body language.
- Use positive reinforcement: Recognize and commend positive behavior. This can encourage more of it and help shift their focus from negative patterns.
- Diversion and redirection: If they become agitated or start to sundown, gently guide their attention to different, more calming activities like looking through photo albums, listening to soothing music, or a favorite video. I’ve seen stuffed animals, baby dolls and even robotic pets recently as a way to divert attention.
How to Deal with a Senior Who is Sundowning
- Sundowning, also known as “late-day confusion,” affects some individuals with dementia during the late afternoon and evening hours, manifesting as confusion, restlessness, and agitation.
- Maintain a stable environment: Keep the home environment calm and quiet as evening approaches to help reduce agitation.
- Increase light exposure: Ensure living spaces are well-lit in the evening to minimize shadows and reduce confusion.
- Establish a routine: Consistent daily routines, especially around meal times and bedtime, can provide comfort and structure.
- Encourage daytime activity: Engage them in suitable physical and mental activities throughout the day to prevent excessive restlessness at night.
- Create a soothing evening routine: Activities like listening to soft music or gentle stretching can help wind down the day.
Learn to Set Boundaries with Your Loved One
Boundaries help define where your limits lie and ensure that you can care for your loved one without sacrificing your own health and well-being. They help manage expectations and foster a sense of mutual respect between you and your senior parent.
Steps to Set Effective Boundaries
- Communicate openly and clearly: Start by having an open conversation about your limits. Be clear about what you are able and unable to do. For example, you might set specific times for care-related activities and designate personal time for your own needs.
- Consider implementing the Grey Rock Communication Method: This communication strategy involves becoming emotionally non-responsive and uninteresting (like a “grey rock”) to avoid engaging with a narcissistic individual’s attempts to manipulate or provoke emotional reactions. This method can help maintain peace and minimize conflict in interactions with a narcissistic parent.
- Be consistent: Once you set boundaries, it’s important to stick to them. Consistency helps your parent understand and respect these limits over time, even if they initially struggle with the changes.
- Involve them in the process: Whenever possible, involve your parent in discussions about boundaries. Ask for their input and try to accommodate their preferences, which can make them feel respected and valued.
- Use affirming language: When discussing boundaries, use language that affirms your care and commitment to their well-being, but also emphasizes your needs. For example, “I want to be here for you in the best way possible, but I also need to take care of my health so I can be a good caregiver.”
- Educate on the reasons: Especially with cognitive decline, explaining why certain boundaries are set can help them understand and accept them better. For instance, explain that resting periods are essential for you to recharge and provide the best care possible.
- Seek professional guidance: If setting boundaries leads to conflict or if you’re struggling to enforce them, consider seeking help from a therapist or a social worker. They can offer strategies tailored to your specific situation.
Adjusting Boundaries Over Time
- Review and adjust regularly: As your parent’s condition changes, so too might your boundaries need to adjust. Regularly review the boundaries you’ve set and modify them as necessary to better suit the changing circumstances.
- Monitor your stress levels: Keep an eye on your own health and stress levels. If you find that despite existing boundaries you are overwhelmed, it may be time to set more stringent limits or seek additional support.
- Increase support when needed: If the care needs exceed your boundaries, look for additional support. This could involve enlisting the help of other family members, hiring professional caregivers, or exploring senior care options.
Setting boundaries is not about creating distance; it’s about fostering a sustainable caregiving environment where both you and your senior parent can thrive. It’s a crucial step in managing the complex dynamics of family caregiving with compassion and respect.
When They Refuse Help
- Offer choices: More options can provide a sense of control. For example, ask if they would prefer to take their medication with apple juice or water.
- Introduce changes slowly: If bringing in new caregivers, start with short, supervised visits to build familiarity and trust.
Redirection Techniques
- Engage in activities: Involve them in simple, failure-free activities they enjoy. This can be anything from folding laundry to coloring.
- Use favorite topics: If they begin to get agitated, steer the conversation towards something they enjoy or find comforting, such as a cherished memory or loved one.
- Walk or physical activity: Sometimes, a short walk or a change of scenery can help reduce agitation and redirect energy more positively.
Addressing New vs. Long-standing Behaviors
- Check for physical causes: New behaviors could be due to discomfort or medical issues. Consult healthcare providers to explore potential physical triggers.
- Consult professionals for chronic behaviors: For ongoing issues, behavioral therapy or adjustments in care approach might be necessary.
Understanding Triggers
- Consider their background: Knowing their past, including how they were raised and their values, can clue you into potential triggers.
- Minimize or avoid triggers: If specific situations or topics tend to lead to agitation, try to avoid them or prepare to handle the reactions better.
Caregiving Tips to Manage Difficult Seniors
- Learn about the condition: The more you understand about dementia and sundowning, the better prepared you will be to handle difficult situations.
- Insight into narcissistic behaviors: “Children of the Self-Absorbed: A Grown-Up’s Guide to Getting Over Narcissistic Parents” provides valuable insights into recognizing and understanding the specific behaviors and patterns exhibited by narcissistic parents. This understanding is crucial for adult children in setting realistic expectations and boundaries.
- Prioritize self-care: Managing these behaviors is challenging. Make sure you have support and take breaks when needed, possibly exploring respite care options.
Handling situations where a senior becomes verbally or physically abusive requires careful consideration, as these behaviors can be distressing and challenging for caregivers. Here are some strategies to effectively manage such situations:
Managing Verbal or Physical Aggression
- Stay calm and do not retaliate: Responding with calmness can help de-escalate the situation. A gentle, reassuring voice or familiar music can calm the person down. Use their name, make eye contact if it seems to help, and speak reassuringly.
- Avoid raising your voice or responding aggressively, as this can worsen the behavior.
- Ensure safety: If the senior poses a risk to themselves or others, prioritize safety by ensuring you have a clear path to exit the room if needed. Remove any objects that could be used as weapons.
- Use a soothing tone: Often, Redirect attention: Try to divert their attention to a different activity or topic that is calming or of interest to them. This might involve moving to a different space or introducing a new subject to focus on.
- Establish boundaries: Clearly communicate that aggressive behavior is not acceptable. You can acknowledge their feelings (“I see that you’re upset”) while setting limits (“but it’s not okay to hit”).
- Seek professional advice: Persistent aggressive behavior might require intervention from medical professionals. A healthcare provider can assess whether there is a medical reason for the aggression, such as pain or medication side effects, and adjust treatment as necessary.
- Document the behavior: Keep a record of aggressive incidents, including what led up to the behavior, how it was handled, and the outcome. This information can be valuable for healthcare providers in managing the condition.
- Train in de-escalation techniques: Consider training for yourself and other caregivers on how to de-escalate aggressive situations safely and effectively. Local organizations or care agencies may offer resources or workshops.
When to Seek Help
- Immediate danger: If at any point the behavior escalates to where you feel you or the senior are in danger, do not hesitate to call for help, whether it’s from other family members, neighbors, or emergency services.
- Professional support: Regularly consult with healthcare professionals to adjust care plans and explore options like therapy, which can provide strategies for managing aggression.
- Support groups: Engaging with support groups can provide practical advice and emotional support from others who have faced similar challenges.
Balancing compassion with effective management strategies is key to handling aggressive behavior in seniors with dementia or other cognitive impairments. It’s important to take care of your well-being too, as dealing with aggression can be emotionally and physically draining.
Adapting these approaches to fit your loved one’s personality and needs can help create a more positive environment for both of you. Remember, flexibility and patience are key in managing the complex behaviors associated with dementia and related conditions.
From a young age, Stacey’s link to the senior care industry grew alongside her mother’s work at a nursing home, where she often accompanied her. By her early teens, she secured her first official job at a nursing home, laying the foundation for a profound journey in senior care spanning over four decades. Her roles varied from opening assisted living and memory care residences to working in nursing homes and independent senior living communities. As the former Director of Fun for 300 independent seniors, she expertly organized daily events and trips. Stacey’s unwavering passion, nurtured by her family, and professional dedication as a recreation therapist, reflect her deep commitment to preserving the dignity and well-being of seniors.
Stacey’s senior care expertise has been recognized by the media including U.S. News and World Report and Care.com.
Stacey and her husband Bryan are the owners of the senior in-home care agency A Place At Home – North Austin.
