Jun 29, 2011

Sundowning at 9:37 PM

First, I don't wait for the repetitive behavior to happen. I take action before it happens -- get out in front. Get out in front, take action before the behavior occurs or starts to happen.

Second, I am trying to substitute a new positive pattern for the old "disconcerting" pattern.

By Bob DeMarco
Alzheimer's Reading Room

Earlier today we published, Sundowning, an Anxiety Syndrome in Elderly Dementia Patients.

Our reader Julie wrote to me and asked,
"You mention you were able to change your mother's sundowning behavior but didn't give details on how you managed to do that. Could you please explain what you did?

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My mother had a series of behaviors that came after sundown. Right now, I'll stick to the one that occurred at 9:37 PM. When I say 9:37 PM, I mean 9:37 PM plus or minus a few minutes every night.

Dotty would get up and announce she needed to clean our home, and then would proceed to start cleaning. This was odd to me at the time because she made little attempt to do any cleaning during the day.

I remember clearly how disconcerting this behavior was to me. It really bent me out of shape. Of course, initially I tried to reason with my mother. I didn't know any better. Trying to reason with a person with Alzheimer's disease is usually an exercise in futility. It was in this situation.

Trying to reason with Dotty with no result, only made me feel more frustrated, anxiety filled, and made the situation seem that much more dire -- worse.

I went on for quite a bit of time before I really started to focus on the problem in a new and different way. I was well aware that the behavior happened at the same time of night. At first, all that did was make me hope as the time care near that it wouldn't happen that night. Well it did happen that night over and over.

The anticipation of this sundowning occurrence filled me with more and more anxiety as the time approached. It was cumulative. I mean by 9 PM I was started to dread the time. I guess you could say it was like making tea. The teapot, me, would get hotter and hotter ready to boil over. No I wasn't getting angry, I was getting anxiety ridden. Real dread.

At first, it seemed like there was nothing I could do. I couldn't change the occurence. I couldn't change the situation. When I tried harder to reason with Dotty it only made the situation worse, for both of us.

Finally, I actually thought to myself -- I have to get out in front of this situaion. Getting out in front of situation became a part of my overall strategy, and this now includes dealing with any and all repetitive question and behaviors if I can see a pattern.

Getting out in front in this situation meant, I had to do something before 9:37 PM and for a period of time that went well beyond 9:37 PM.

The answer? Ice cream, pee pee, and pajamas.

Here is more or less what I decided I needed to do. I needed to use ice cream and a series of events that lead up to bed time to change the existing pattern, sundowning behavior, into a new and different behavior.

So around 8 PM or so, I would start saying to Dotty, it is going to be ice cream time soon. I would say this several times during the next hour.

Around 9 PM I would say, lets get your pajama's on and get ready for ice cream.

I kept saying the word ice cream over and over.

Before you get in your pajama's and have some ice cream, let's take a pee and then have some ice cream.

So by the time I got Dotty up, into the bathroom, and got her pajamas on it was close to 9:30.

I should clarify here. I didn't actually put Dotty's pajamas on, or go in the bathroom with her. I more or less acted as the director of this movie.

I did help Dotty get up, and I did lead her to the bedroom and ultimately to the door of the bathroom. I would also lay our her pajamas. If Dotty were to get distracted a bit along the way, this did happen, that was okay. As long as she peed and put her PJs on we were ready to rock.

I wanted her in her chair in the kitchen with the ice cream in front of her by 9:30 PM

It worked.

Now some people will say that is redirection and I guess in a sense it is.

Here are the differences. First, I don't wait for the repetitive behavior to happen. I take action before it happens -- get out in front. Get out in front, take action before the behavior occurs or starts to happen.

Second, I am trying to substitute a new positive pattern for the old "disconcerting" pattern. I am not trying to change what was happening, Dotty wanted to clean at 9:37 PM. I am trying to substitute a new and different behavior into that specific time slot. Replace one pattern with another pattern.

It worked.

This took place long before I finally realized that what I needed to do to defeat all or most of the things that were driving me crazy, pee, poop, etc., was introduce new patterns of behavior to replace the undesirable patterns of behavior.

After many years, I finally came to understand that what I really needed to do was create a pattern for our entire day. Do the same things around the same time of day every day. And, only do things that were desirable.

Get up, read the paper, discuss the paper, have Dotty look at the crossword puzzle, get breakfast, go watch Ellen, etc etc. The morning pattern.

Tonight at 9:15 Dotty said to my sister Joanne who is here visiting, "ask Bobby if its ice cream time".

There you go.

I'll have more to say about this. But, let me leave you with this advice.

Try to write down what is happening and what time it is happening. Try to get a good handle on one situation at a time. Try to think about how you might substitute a new routine, pattern, for the one you would like to get rid of.

Don't get frustrated. If you can't think of something you can do immediately, brainstorm with other caregivers until you finally hit on possible solutions.

If you want the person to go to bed then try to start working on this hours ahead of time. In other words, build a series of patterns (events) that culminate and lead to bed time. Like a series of building blocks. Do it the same exact way every day, over and over.

You could also consider getting a repeat parrot and working the parrot into the equation. Believe it or not, I am now talking to the parrot along with Dotty more than you might be ready to believe. I also sing my pee pee and poop songs to the parrot who in turn sings them to Dotty. I am not sure, but in some circumstances Dotty is more likely to do something if the parrot encourages her to do.

Fine by me. It is the result that counts.

If you have questions put them in the Add New Comment section down below.

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Original content Bob DeMarco, the Alzheimer's Reading Room