Sundowner's and Tough Love

We’ve had an Alzheimer’s client for the past three years whom we’ve lovingly cared for and have educated her boomer adult children in all aspects of the disease. Sometimes they listened and sometimes they made poor choices. But just recently she has developed sundowners behaviors and becomes quite irritated at approximately five every afternoon. Her caregiver who tends to her from 10 – 5 each day cannot stay past five pm and the client starts calling our offices pleading not to be left alone. Two days ago, our nurse stayed with her for hours until her medication took effect and last night she called me at 6PM asking if I could stay with her - - she was afraid to be alone. I picked her up and took her to the beach where we fed the birds, walked in the warm sand, ate ice cream and then drove her home. Once home she became agitated again. I asked her to take her evening medications and redirected her attention away from her latest troubles. After about one hour of reading to her from the Oprah Magazine and discussing the latest celebrity interview, she began to relax stating she would be ok for the night.

The problem is that she needs continuous supervision because she has suicidal ideations, has been known to wander, is depressed, and now has sundowner’s syndrome. We orchestrated a team effort organizing a crew consisting of the new evening aide, a nurse practitioner from her psychiatrist’s office, our nurse care manager, her daytime aide, and asked her children not to answer the phone for a few hours until the task was done. Yes, this was tough love, but it has now become apparent that her safety is more important than her reliance on our staff alone for her needs. If she is going to age-in-place at home, she will need either a live-in caregiver or round the clock certified nursing assistants to keep her safe. I’ve just heard that she didn’t throw out the aide, her medication has started to work, and all is well with her world. This story promises to have another happy ending. One I hope will last but will continue to monitor in the event it doesn't.