Is "sundowners" a real term?

CoffeeRTC, BSN, RN · Mar 28, 2011

Do you work LTC? I find it hard to believe that if you do...no one has heard of this?? Heck, this really should have been covered in school in the geriatric classes.

Normally, behaviors start around dinner time and can get worse right after dinner and at bed time. Then sun doesn't have to be down, just named after that time of the day.

Oh...it really is a night an day type of thing. Pleasant, cooperative residents in the morning and then a switch is flipped...confused, scared, agittated in the pms. That is another reason you might see psych meds at the dinner time (some have minor sedative effects)

purse · Mar 28, 2011

Yeah LTC. Im not a nurse though, but I have noticed that the psych meds are ALL in the AM?!! and then there are some that are PRN, but the meds like ativan, risperdole, xanex are all straight order in the AM, maybe that could be a reason why the are freaking out at night. Im not a strong believer in prn meds to calm someone down i normally try to talk it out and redirect first, ive only used a PRN once. Most of the time the pt is so aggitated they wouldnt even take the pills if you tried to give it to them.

CoffeeRTC, BSN, RN · Mar 28, 2011

If you are not a nurse how do you give meds? Med aid?

Yeah, a lot of pts might need psych meds in the am just to function, but maybe they need to look into something at night? Aricept and Namenda are two big alz meds given in the pm. We don't like to use alot of meds and often times redirection, calm approach, letting them work thru what ever (we had one person that needed to walk around and check the doors..this meant opening them and making sure they were closed) getting activites involved or getting them involved in an activity helps with the redirection (one resident folds clothes and gets the clothes ready for her kids school in the morning...yeah..she is 80yrs old)

Meds aren't always the answer and shouldn't be given unless needed and trying to give a prn when they are already worked up isn't happening either.

Do they give inservices to the CNAs etc on this? This is very common in most if not all LTCs.

purse · Mar 28, 2011

If you are not a nurse how do you give meds? Med aid?
Yeah, a lot of pts might need psych meds in the am just to function, but maybe they need to look into something at night? Aricept and Namenda are two big alz meds given in the pm. We don't like to use alot of meds and often times redirection, calm approach, letting them work thru what ever (we had one person that needed to walk around and check the doors..this meant opening them and making sure they were closed) getting activites involved or getting them involved in an activity helps with the redirection (one resident folds clothes and gets the clothes ready for her kids school in the morning...yeah..she is 80yrs old)
Meds aren't always the answer and shouldn't be given unless needed and trying to give a prn when they are already worked up isn't happening either.
Do they give inservices to the CNAs etc on this? This is very common in most if not all LTCs.

Im a PCA, and i do give meds, i have noticed that aricept and namenda are usually given around dinner time.. and no no inservices on this! At least not for the PCAs, not sure about the CNAs(we dont work together)

Horseshoe, BSN, RN · Mar 28, 2011

I saw this early in my nursing career. I had the same patient three days running. She was the sweetest thing during the day, then around 5 or 6 pm, this transformation would come over her face and she would start accusing me of trying to poison her when I would hang her IV meds or try to give her anything IVP. It happened so quickly...sweet expression one minute, disgusted and distrustful the next.

tahoe77 · Mar 28, 2011

I typically work the 3 to 11 shift and have more than a handful of patients, that act weird at night.. such as they get out of bed and wander down the hallway trying to leave to go to a dance or go to the bus station or something. they are usually easily redirected, but i have told my 7 to 3 coworkers about this and they look at me like i am completely crazy. I actually had one pt who came out of his room and was slamming his walker into me trying to leave and push me out of the way..!! Apparently, this never happens in the day time shift, and I dont even think my coworkers believe me when i tell them..?! Then someone told me about sundowners, and how they act crazy only at night..? Is this a real thing or am I just completely nuts!! It really is boogling my mind as to why these pts just act like this and not anyone else.

If they don't believe you than they are the ones who are crazy.

Sundowners is very real. Don't even think twice about this. You are right.

Forever Sunshine, ASN, RN · Mar 28, 2011

If you are not a nurse how do you give meds? Med aid?
Yeah, a lot of pts might need psych meds in the am just to function, but maybe they need to look into something at night? Aricept and Namenda are two big alz meds given in the pm. We don't like to use alot of meds and often times redirection, calm approach, letting them work thru what ever (we had one person that needed to walk around and check the doors..this meant opening them and making sure they were closed) getting activites involved or getting them involved in an activity helps with the redirection (one resident folds clothes and gets the clothes ready for her kids school in the morning...yeah..she is 80yrs old)
Meds aren't always the answer and shouldn't be given unless needed and trying to give a prn when they are already worked up isn't happening either.
Do they give inservices to the CNAs etc on this? This is very common in most if not all LTCs.

We have a resident who packs her stuff up. In bags. Every night between 9pm and 11pm. Keeps her busy, we just have to watch to make sure she doesn't start taking off down the hallway with the stuff(has happened). Then she gets tired from packing and goes to sleep.

CoffeeRTC, BSN, RN · Mar 28, 2011

We have a resident who packs her stuff up. In bags. Every night between 9pm and 11pm. Keeps her busy, we just have to watch to make sure she doesn't start taking off down the hallway with the stuff(has happened). Then she gets tired from packing and goes to sleep.

I had one just like that. Sometimes family would be there and take her bags and walk to the door then walk around the outside of the building with them and then come back in. This person lived in a small town and everything was walking distance. She thought she was going to her daughters house for a visit.

FranEMTnurse, CNA, LPN, EMT-I · Mar 28, 2011

I also believe the sundowners syndrome exists. It happens especially in the mentally disturbed or the elderly people.

libragirl924 · Mar 28, 2011

I'm also a medical transcriptionist at the moment while in school and I hear the providers using this term a lot before I started school; I had to look it up, of course, because I was totally clueless. Also, I live with and take care of my 83 y/o Gramps who has Alzheimer's and does this on occasion, but he's usually pretty easy to redirect.