Paper
Friday, 21 July 2006
This presentation is part of : Issues of the Hospitalized Elderly
Sundowning: A Descriptive Qualitative Analysis
LuAnn Nowak, MSN, APRN, BC, Doctoral Candidate, Wayne State University, Detroit, MI, USA
Learning Objective #1: identify symptoms commonly identified by caregivers as being associated with the phenomenon of sundowning.
Learning Objective #2: describe temporal patterns associated with the most common symptoms of sundowning.
Individuals with dementia commonly experience behavioral and sleep-wake pattern alterations as part of their disease trajectory. Among the most common and disconcerting of these is the loosely described symptom cluster of sundowning: sleep-wake and behavioral pattern disruptions that begin in the afternoon and continue into the night. Sundowning frequently advances to the level where care delivery in the home setting becomes prohibitive, resulting in institutionalization. This descriptive qualitative study explored the constituents and characteristics of sundowning by examining written accounts of sundowning episodes as documented by institutional care-giving staff. The purposes of the study were (1) to identify and classify themes that captured the essence of sundowning as described by institutional staff, and (2) to identify temporal patterns associated with sundowning behaviors. Cases of sundowning were identified and referred for study inclusion by facility staff. Three sites were utilized to maximize opportunities for comparative analysis. Sampling continued until theoretical saturation occurred. The sample consisted of 18 records of individuals with dementia residing in nursing homes, four males aged 77 to 83 years (M=80 years), and 14 females aged 79 to 96 years (M=87 years). Medical records were retrospectively reviewed. Six major themes emerged: physical aggression, resistiveness, disconcerted verbalizing, nighttime sleeplessness, daytime sleepiness, and wandering. The temporal pattern of behaviors had two peaks which occurred between 2pm and 9pm, and 12midnight and 6am. This study was unique in that it examined qualitatively the language utilized by staff to describe behaviors they associated with sundowning: studies to date have utilized structured observational measures to quantify sundowning. These findings offer a new description of what constitutes sundowning from the eyes of institutional caregivers, as well as additional evidence regarding temporal patterning of behaviors. This knowledge can assist in detection of sundowning, and provide empirical evidence from which appropriate nursing interventions can be developed.

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