Alzheimer's & disruptive behaviors... Insights?

[Turquoises]

Hi guys. I would love to get everyone's input on a couple of things, especially for those of you who have directly been involved in caring for Alzheimer's patients in long-term settings. I was a CNA for 3 years in a specialized Alzheimer's unit, and went on to get my LPN a couple of years ago. However, I've recently gone back to school for my MPH and am currently conducting a small research study revolving around the Sundowning phenomenon. Believe it or not, there is not a lot of research despite how prevalent it is in dementia care. It's a very subjective symptom, and there isn't a lot of agreement on it.

This research is going to be a part of something that is much bigger, and your information will be directly improving the future treatment options for Alzheimer's patients suffering from sundowning symptoms. If you could, please please take 10 minutes to fill out this anonymous survey. It would mean the world to me.

The survey is HERE. (Hoping links are allowed on this forum?)

And for those interested in making this a public discussion... how do you personally differentiate between disruptive behaviors that occur in the evening/night and sundown-specific behaviors?

Also, PRN administration is largely an autonomous nursing role. Do you see any ethical dilemmas in this when the PRNs are given to alter behavior (non-pain)? Some argue that there may not be enough training available to nurses, that non-pharmacological measures (re-directions) are less likely to be used when PRNs are prescribed for behaviors, and the potential for over-use is higher.

Thanks so much for any insights you share!

[ktwlpn, LPN]

#4 and #10 did not work for me...I do not differentiate between sundowners and disruptive behaviors at night.Not sure I understand what you are asking.To me they are one and the same.I believe the prns are only indicated if the resident is in distress or irritating and escalating the rest of the unit endangering her safety.Our facility has two secure units,all staff receive additional training,nurses are encouraged to pursue dementia certification as well.

[Turquoises]

Thanks for the feedback - I've changed the settings so it works correctly. :)

Very interesting. Do you not differentiate because it makes no difference in treatment options, or because you don't give credence to the term "sundowning"? I've found a lot of people say that healthcare puts too many labels on behaviors, so I could understand someone who fell in the latter category.

[ktwlpn, LPN]

I will go back in and complete the survey.I don't differentiate between the two terms because I believe they are the same."Disruptive behaviors" occur around the clock but when they increase in frequency and severity in the evening I consider it "sundowning" The incident reports on our secure units dramatically increase in the evening hours in part due to "sundowning".We also have less staff in the evening,that does not help

[Red Kryptonite]

"Disruptive behaviors" occur around the clock but when they increase in frequency and severity in the evening I consider it "sundowning" The incident reports on our secure units dramatically increase in the evening hours in part due to "sundowning".We also have less staff in the evening,that does not help

More brilliant staffing choices from higher ups. Reducing staff in a dementia unit during prime sundowning hours....SMH.

I believe sundowning is real. It's also extremely variable. I've seen some individuals who start in the late afternoon as soon as the sun starts just thinking about going down, to some who don't start until long after dark.

I'd differentiate "disruptive behavior" from "sundowning" by the time, frequency, and severity of the acting out.

There will always be ethical concerns about meds being used as chemical restraints, and those will remain as long as staffing decisions force nurses not to have much choice in doing so. Who has time to implement non-pharm interventions when there are not enough staff? But also, the safety of the patient has to be paramount. If meds are the only way to keep him from injuring himself and others, it would be unethical not to use them.

I'll take the survey.

[Turquoises]

Thanks for the responses so far, I've gotten a good amount of participants and appreciate it!

I will go back in and complete the survey.I don't differentiate between the two terms because I believe they are the same."Disruptive behaviors" occur around the clock but when they increase in frequency and severity in the evening I consider it "sundowning" The incident reports on our secure units dramatically increase in the evening hours in part due to "sundowning".We also have less staff in the evening,that does not help

That is a really good point - where I work the 3-11 shift is notorious for increased falls, yet there is less staff allocated for the shift! 3pm is also when sundowning begins for some of my patients... I've wondered if shift change has anything to do with it?

More brilliant staffing choices from higher ups. Reducing staff in a dementia unit during prime sundowning hours....SMH.

I believe sundowning is real. It's also extremely variable. I've seen some individuals who start in the late afternoon as soon as the sun starts just thinking about going down, to some who don't start until long after dark.

I'd differentiate "disruptive behavior" from "sundowning" by the time, frequency, and severity of the acting out.

There will always be ethical concerns about meds being used as chemical restraints, and those will remain as long as staffing decisions force nurses not to have much choice in doing so. Who has time to implement non-pharm interventions when there are not enough staff? But also, the safety of the patient has to be paramount. If meds are the only way to keep him from injuring himself and others, it would be unethical not to use them.

I'll take the survey.

It really is that we're in a catch-22 situation. We all want what is best for our patients, but many facilities do not make this choice possible. We're sometimes stuck keeping the patient safe as opposed to doing what would be the most therapeutic for them, because really - we have a whole unit of patients and only so much time and staff.