The Importance of Rhythms for Dementia Patients in Eliminating “Sundowners” and Other “Behaviors”
By Dr. Allen Power, Eden Mentor, St. John’s Home, Rochester, N.Y., Associate Professor of Medicine, University of Rochester
I recently had the pleasure of visiting with an elder who experiences frequent distress in the late afternoon. I was immediately struck by the connection of her anxiety and desire to leave with a lot of change-of-shift activity. This leads me to suggest a larger discussion about the whole concept of what we call “sundowning”.
More and more, I have come to see the term “sundowning” as a classic example of what Dr. Tom Kitwood called positioning, meaning that we blame the distress on the disease, rather than looking for other factors. Consider this scenario:
Whenever I teach a 3-day Eden course, I can guarantee that around 2-3 PM, some of the people in the class will get up, walk around a bit or stand in the back for a while. They are usually nurses and CNAs. Are they sundowning? Agitated? Of course not.
Most day shift nurses and CNAs work from 6 or 7 AM till 2:30 or 3:30, and they are on their feet a lot. But I take them and shift their workday to an 8-5 schedule and make them sit most of the day. I force people into a rhythm that is different from their usual pattern, and by mid-afternoon, their bodies start to rebel.
I suppose I could shift the class to 6a – 3p and create more opportunities for walking around, but instead I schedule it around my own work needs and I usually get so caught up in the process that I don’t think to get people moving around more. Does any of this sound familiar? Welcome to long-term care.
I am going to suggest an alternate idea, which many of you may find a bit challenging to accept at first: Dementia does not cause “sundowning”. We do! Dementia simply “fans the flames” by making people (1) more sensitive to their environment, (2) more easily fatigued, and (3) less able to cope with having their biorhythms shifted into artificial schedules that better suit our nursing home operations.
This is a small distinction, but a very important one. Here’s why: We cannot cure dementia, but we can cure almost all cases of “sundowning” without medication, by shifting operational patterns and staff behavior.
Still not convinced? By happy coincidence, my friend Ann Wyatt of the NYC Alzheimer’s Association just sent me an email of their latest newsletter. This issue tells the story of how Beatitudes, a care home in Phoenix, shifted operations and staff behavior, and created a “rest as needed” policy on their dementia-specific living areas. They have been virtually “sundown-free” for 14 years and have eliminated almost all of their psychotropic medications as well!
I would encourage you to share this information with your teams and begin to look at how we might be able to create a more natural experience that honors the individual rhythms of our elders. This is powerful stuff, and a great example of how culture change improves not only quality of life, but clinical care as well.
Life can be awful. Now it has gotten worse! (Paraphrase of Woody Allen’s words and view of life)
By Richard Taylor, Ph.D., Former psychologist, author, “Alzheimer’s From the Inside Out”
Editor’s Note: This blog was written on January 16, 2012
On Watching and Hearing the Wisdom of the new Federal Committee to write a plan to plan to write a plan (now to write a draft of a plan to plan to write a plan) of how the Federal Government should lead/fund/create the efforts of a few to “create a world without Alzheimer’s on or just before or after January 1, 2025”…
I spent the last few days watching the self-anointed leaders of the Alzheimer’s crisis take a step backwards from their own promise (a plan to write a plan) and produce a framework of a plan to write a plan). And then spend a day telling each other the framework is not enough.
Finally I had to turn it off. Enough was/is enough. I commit to spend the remainder of my public life pointing out the fallacies, half-truths, myths and stigmas these folks are creating and reinforcing out of one side of their mouths, while out of the other side comes their promise to undo what they persist in creating. Of course they can still suck through a straw in the middle of their mouths your support, donations and prayers. And they can occasionally burp out a false hope or two every so often. We cannot let these foxes be the spokespersons for us. We cannot let them spend all our money on bench/cure research and relatively little on psychosocial research. We cannot let them decide for us who should the focus of their efforts and who can be ignored. It’s time for the chickens to stand up and crow, to walk around a pick/peck, to be seen and heard.
Myths, half-truths, lies and hoaxes are what we use as stand-ins to avoid thinking about specific individuals. True, we demonize some while we lionize others. We take pity on some and worship others. Yet everyone is someone, distinctly different and fundamentally alike as you and I. But it is easier, safer to think of classes of human beings – by sex, race, ethnicity, disease groups, etc.
If we continue to buy the lie that Alzheimer’s Disease is the sole cause of a public health crisis we are dooming more than another generation to feel “left out” of the dementia discussion, of the dementia research, of the dementia support (such as it is) provided by organizations and governments.
This is wrong, wrong, wrong.
If we continue to believe the hoaxes, half-truths and myths promoted by organizations and researchers that all that is needed is 13 more years, lots and lots more money and a committee or two to watch over the assured progress, we are dooming the rest of the dementia community to a life much emptier of quality, meaning and joy while we wait for the clouds to part and the cure pill to come tumbling down by January 1, 2025.
This is wrong, wrong, wrong.
What are we goanna do for/about the increasingly bad state of life for the 10 million Americans now living with some form of dementia and the 20 plus million more of those who struggle to care for them? What are the research priorities? Finding answers to today’s human problems, or making up a date when there will no longer be tomorrow’s problems?
Let us stop watching this happen. There is no plan, there is no science, and there is no growing consensus outside of a relatively small group of researchers, to find a cure on or near January 1, 2025.
Let us stand up and speak out. These emperors of Alzheimer’s are not the leaders who will address the dementia public health crisis. These emperors stand naked from their own inability to solve this 30-year-old crisis. They stand naked together and lacking little to no support from their scientific colleagues most of whom admit we are not even close to understanding Alzheimer’s/Dementia. Remember the findings of the NIH just last year? http://www.nih.gov/news/health/apr2011/nia-19.htm
Now comes a committee of the one eye (bench research) to proclaim “war on Alzheimer’s.” They even tell us the date the war will be over, if only we sacrifice the quality of life of those currently with it, so we can concentrate our energy, donations, money and prayers for finding a cure so no one else will ever get it.
This is wrong, wrong, wrong.
They are declaring war, to the neglect of those whose name they want us to fight/donate for. This war, as most wars, comes down to power, influence, fame and money. Though pure of motive in most of their minds and hearts, they have simply come to believe their own hoaxes, lies, half-truths and stigmas. These in their twisted minds justify the war. They justify neglecting those in whose name the war is fought and write them off as collateral and relatively inexpensive casualties. This war is about opening up nursing home beds, saving Medicare, reducing the federal deficit. For these are the reasons/evidence they advance to justify the war. And, yes, there are occasional warnings of “this could happen to you if you don’t do and support what we ask/need. And who is the enemy? What is the enemy? Dementia? Alzheimer’s Disease? Stigmas and hoaxes? The symptoms of the poor, suffering, soulless, dying twice, barely human beings who are living with the symptoms? Those who care for or watch their loved ones slip away and are over-burdened in not knowing how to bring quality of life to those with the disease?
Be careful not to wound them while you shoot at their symptoms. Be careful not to demonize them with your neglect of their humanity, your weapons of war which may or may not slow down, reverse, eliminate and/or destroy the symptoms – but then again the last 15 weapons (pills) we have developed have all failed, leaving broken hearts, broken half promises, crushed hopes in the minds and hearts of care partners and their loved ones.
Please, please – for your own sake, the sake of your family, and the rest of the world – stand up and speak out. We are quickly falling further and further behind in the race they created to capture the hearts, minds and money of politicians and citizens. They first redefine the dementia crises with the words “The Alzheimer’s Crises.” And then they convinced others with power that they are suddenly smart enough to this time for sure truly claim the cure is just 13 years away with absolute certainty.
We all whispered to each other about how wrong this was. Wrote blogs, created petitions, made presentations to each other, fired off an occasional broad side via emails, and then we all went to bed. They have stayed up all night, running focus groups, reinforcing fears and stigmas, lobbying for 20 years for something that was “soon to come, light at the end of the tunnel, supported by breakthroughs. Claiming, now they know what to do, how to do it, they just lack a few pennies to support their efforts.
Now they spread false hopes, reinforce stigmas, state wishes as facts – all while under the all-knowing eyes of the Executive and Legislative branches of our government.
What is each of us going to do about out this? What are some of us going to do about this? What should all of us do about this?
You decide. I have.
Richard
richardtaylorphd@gmail.com
ANNOUNCING THE LAUNCH OF…”I Can and I Will!”
www.alz.co.uk/icaniwill
Another way for you to stand up and speak out.
A way to benefit from the collective life experiences of kindred spirits living around our world with Alzheimer’s and other forms of dementia.
And a way to say “I CAN! I WILL!” to raising awareness about dementia, addressing the myths and stigmas that accompany a diagnosis of dementia, and enabling people living with dementia to be more open with others about their disability.
With support both financially and organizationally from Alzheimer’s Disease International (ADI), the I CAN! I WILL! Stand Up and Speak About Dementia project and website has moved from dream to reality to become a unique information resource about dementia and the people who live with it, a place where people from all walks of life and from all countries can share their experiences with dementia and find hope and inspiration.
The goal of the I CAN! I WILL! website is to become an “idea library” of hundreds of ideas. By reading the ideas posted on the website — AND by contributing their own thoughts — people with dementia, care partners, medical professionals, Alzheimer’s society/association members and others can say “I CAN!” and “I WILL!” to ideas that can impact their own lives, families and communities, and potentially, the world.
