Overnight Program Helps "Sundowning" Dementia Patients

It's known as "Sundowner's syndrome," and countless families caring for someone with dementia live in constant fear of it.

For reasons that aren't entirely clear, about twenty percent of all dementia patients, most of whom are diagnosed with Alzheimer's disease, become particularly agitated after sunset.   Sundowning dementia patients may "shadow" their caregivers, ask questions over and over again, become angry or agitated, and may even show more serious symptoms such as hallucinations, paranoia, wandering (leaving the house unescorted), and even become violent.   Potential causes include becoming fatigued after being awake all day or hormonal changes caused by lack of sunlight.  Whatever the cause, finding a solution is never easy and caregivers are often strained to the breaking point as a result. 

An innovative program offered at the Hebrew Home geriatric care facility in Riverdale, New York has been offering day and night programs for the elderly across the Greater New York area.  Their evening program, known as Elderserve at Night, is especially designed to help deal with sundowning dementia patients.  First established by Hebrew Home Executive Director David Pomeranz in 1996, the Eldercare at Night program offers a range of activities including arts and crafts, cooking, yoga, games, Zumba, and even live music.  The flexible nature of the Elderserve at Night program means that dementia patients can stay on even when their condition worsens.  For patients with more advanced dementia, there are quiet rooms where they can work on puzzles while supervised by a caretaker.  

“Here, their behaviors are normalized,” Pomeranz explained in an interview with The Atlantic. “Everything is OK. Activities are structured for them to be successful. They eat, they relax—they can be themselves. To us is this is who they are. We’re not the family members who are dealing with that incredible loss of seeing someone who was and isn’t any more.”  

Though Pomeranz reports difficulty in finding staff willing to work the night shift, which helps explaining why overnight programs haven't caught on so far, the costs for placing a patient in the Elderserve at Night program is still less than the cost of housing patients in full-time care facilities.   Public programs such as New York Medicaid pays an average of $320 a day to keep dementia patients in nursing homes while Elderserve at Night only charges $200 a day.   The cost of the program can also be covered by some private health plans. 

On average, there are about forty clients per week in the Eldercare program.   The program runs throughout the evening hours with the patients receiving breakfast in the morning before being returned to their families.   Those family members with relatives in the program have nothing but positive things to say about the evening program.   The Atlantic article describes one woman, an immigrant with dementia who has become increasingly active since starting in the program. 

"She was very weak when she started there. We had to carry her up and down [the stairs]. But now she walks up and down. She walks to Broadway,” her daughter says. “She would not react to any of the conversation. Now she does. She’s a totally new person. I would say she’s 200 percent better.”

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