An adult daughter is sitting, holding her senior farther's hand

Anyone who has had the responsibility for caring for someone living with dementia knows that there are numerous challenges associated with this. We’ve included some of the most common along with ways to manage these challenges.


Sundowning, also called Sundowning Syndrome, can occur in patients with Alzheimer’s or other dementia related diseases and usually present in the form of changes in behavior and/or mood swings. The individual may get increasingly upset or agitated, demanding, become suspicious or paranoid. Visual or auditory hallucinations may also be present. The individual who is sundowning typically exhibits these behaviors during the late afternoon, evening, or at night. Sundowning is probably one of the greatest factors contributing to caregiver burnout.  Often, the individual will wander, causing safety concerns for living at home. Treating these symptoms with medications is a common practice. Unfortunately, these medications have significant side effects. Alternate treatments such as music, painting and other forms of creative expression have shown to be successful as have aromatherapy, soothing sounds and touch.

Other ways to manage sundowning include:

  • Notice and pay attention to patterns – See if there is something specific that seems to trigger sundowning behaviors and do work do avoid or limit those triggers.
  • Stick to a regular routine – Many people living with dementia do best when they aren’t surprised by something new, which may confuse them. By keeping a regular routine and following it every day, you minimize the chance for upset.
  • Help them get a good night’s sleep – Limit caffeine and sweets to morning hours and keep the evening meal small and simple.
  • Keep things calm in the evening – Put on some relaxing music, play cards, or go for a walk to wind down. Tell other family members to not make too much noise.


The best way to communicate with someone living with dementia is to enter their world as much as possible. For instance, if they say, “Eisenhower is doing a great job as president,” rather than correcting them and bringing them into your world, you could simply respond, “Yes, I like Ike too.” This provides a foundation for you to have a conversation.  By validating their experience, you put them at ease, making it easier to redirect them into a new activity or thought process. Here are some other tips to help you and your loved one have a meaningful conversation:

  • Make sure you have their full attention. If there’s a TV or radio on, turn it off. Make eye contact and identify yourself before you attempt to touch them.
  • Because long-term memories may remain intact, reminiscing about the past is a good way to have a conversation that is enjoyable for the both of you. You might bring out an old photo album to help jumpstart a conversation.
  • Validate their emotions. If they are upset about something, telling them that everything is going to be fine won’t make the situation any better and may cause more distress. Instead, validate their feelings by telling them you understand and would feel the same way if such a thing were happening to you. Then offer to help them solve the issue.
  • Use words of encouragement and support. If a loved one feels like someone is in their corner and looking out for them, this may allow them to trust you more.

Other issues

Caregivers may be in denial about the disease and its effect on the individual living with it as well as its effect on them. Educating and bringing an understanding about the stages of the disease and positive care tips can help caregivers to be more successful in their interactions. Those caring for a loved one may become angry at the person they care for and others around them for a multitude of reasons including, frustration, patience worn thin by constant repetition, the lack of a cure or lack of empathy or assistance from others. There are many specific techniques available which can help to curb behavioral issues related to Alzheimer’s and dementia.

  • Knowing when to back down or choose your battles.
  • Letting go of ego and being okay with saying you are wrong or sorry, even if you are not.
  • Being able to redirect unwanted behavior into something more positive
  • Understanding that their reality is different from yours.
  • Using multiple forms of communication – validation, music, painting, dance touch – for maximum understanding.
  • Seeking professional assistance in learning to cope and handle difficult situations.

Finally, keep an open heart. Understand that your loved one is facing one of the greatest challenges imaginable and that your compassion will provide comfort as they continue their journey.