Has anyone ever heard of Sundowners Syndrome?

[Dave44]

My wife's grandmother was admitted to the hospital where they decided she had pneumonia. Next thing you know she is acting like she has alzheimers when it gets later in the day.. and really wild late at night! The next day she seems to be kind of lucid, but does not remember the night before? One of the nurses said that it is this sundowner thing.

Are our hospitals destabilizing old people? She never had any indications of this till 5 days ago. Here is one website.
She is all of a sudden having more than flashbacks, she has full blown memories that have never happened! She said she was at boarding school this AM and never went to one.


http://sundownerfacts.com/sundowners-syndrome

 

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[bigscoop]

I deal with these conditions, and others, daily, since 2007 (parents). One thing you really need to check are any recent med changes as some meds can cause the condition you're describing. Ran into this exact same issue with my father a couple of years ago. They put him on Amenda and all heck broke loose, he was seeing marching armies on the walls at night, taking walks with children at night, stuff like that. I took him off the Amenda and he was fine. Like your wife's mother, "sundowners" was the problem, but it was actually the meds they put him on. Many meds, even some heart meds, can effect the brain function of some patients.

TAKE WARNING! YOU and YOUR wife MUST stay on top of what doctors are doing and what meds they are prescribing. If you don't it will leave your wife's mother a victim to trial to error medicine practices. I can't tell you the number of times I've had to step in, and the things I had to learn along the way. Last year they were preparing to to heart procedure on my father for a condition he had since he was a child. Only by having this information on hand to show them did they finally, at the very last minute during prepping, decide against the procedure. Dad is doing fine now with just a minor adjustment to his meds. This is sometimes the real world of medicine, not trying to scare you, just trying to inform you that you really need to stay on top of "Everything". Good luck.

 

[Dave44]

Thank you scoop! I told my wife it had to be medication or a stroke. They tested her and said she did not have a stroke. We will check this out!

 

[bigscoop]

Thank you scoop! I told my wife it had to be medication or a stroke. They tested her and said she did not have a stroke. We will check this out!

If she has gone through "all" the appropriate testing and no signs of a stroke have been found (keep in mind that TIA's may not show up with standard testing) then I would be willing to bet that it is a medication issue. Keep an eye on her walking, if you see changes in her walking like dragging feet/foot, weaving or even slight balance problems - even if they quickly pass - then take her to get checked out. I noticed a very slight sag in my father's left cheek one day, vital signs were good and he appeared to be doing ok until I handed him a fork a few minutes later and noticed that he couldn't handle it very well. I called 911 and it ended up being a mild stroke. I can't tell you how slight these syptoms were but I can tell you that they were so slight I almost didn't make the call because his vitals were good and he seemed to be ok otherwise. It was just something in his face that made me believe something wasn't right. I got lucky on that one. But to be honest, most of the sudden issues or changes have been because of med changes so keep a close watch on them and learn the possible side effects of each. Hope your wife's mother comes out of this ok.

 

[Felinepeachy]

I agree 100% with Scoop. My father in law was diagnosed and treated for Alzheimers for three years before they finally said it was his medications and didnt have Alzheimers after all. He is MUCH better now and his mind is as good as ever. These damned doctors just want to over medicate the elderly. I rust doctors about as far as I can spit.

 

[Dave44]

I agree 100% with Scoop. My father in law was diagnosed and treated for Alzheimers for three years before they finally said it was his medications and didnt have Alzheimers after all. He is MUCH better now and his mind is as good as ever. These damned doctors just want to over medicate the elderly. I rust doctors about as far as I can spit.

I have been hearing more and more about this lately, It is hard to imagine that these things could happen that fast. It seems to be a new occurence according to the article. Thank you Peachy. Keep in touch!

 

[mrs.oroblanco]

I agree with everything everyone has said.

Check meds, (and not just meds, but certain meds interact with certain foods causing all sorts of weird things).

All that said, after several years of doing the nursing home thing, and 7 years of hospice - Sundowner, aside from any interaction of meds, or foods, or even Alzheimers - is, indeed a real phenomenon. And, I call it a phenomenon, because, caretakers have seen it for years, and NOT just in Alzheimers cases. (of course, if you are a nurse, doctor's and scientists say whatever they will say, and figure that you are not educated enough to see what you see).

Some patients - aside from the Alzheimers diagnosis, especially older folks who have had several other medical problems, can become irrational,
hallucinate, and can even become dangerous (violent) by the end of the day - (why its called Sundowner's). Nurses have long realized that it helps a lot to get patients to sleep earlier, or to get them to nap during the day - and that with those person's who do not have Alzheimers (or other dementia), can quite often relieve some of the symptoms. A common thread is getting patients up so darned early. Even though it is well documented that a "regiment" can help considerably, sometimes the structure is way TOO structured to a population rather than an individual. Some people's biological clocks are different than others, and when you take some people who have always been "night owls", put them on a strict regiment that gets them out of bed at 6-7 am, makes them eat by 8 am, makes them eat again at 12:30 pm, dinner at 5 pm, and bed by 9, does NOT reset their biological clock, but rather makes the situation worse. Some of the newer (and better) nursing homes are now putting tv's and radios in individual rooms (more like a bedroom or a hospital room), where a patient can continue what feels natural and familiar, helps soften symptoms of Sundowners.

As does natural light. More places are going with the lighting that has the components of sunlight, and, amazingly, in those instances, depression and Sundowners have improved dramatically. You can buy one yourself. It is the nursing home's version of "cabin fever" (the real reason for cabin fever is lack of sunlight-its a real condition).

My father-in-law's father was having such an issue, and he did not have any disease in the Alzheimers or dementia areas, but, by evening, you could not even talk to him. The nursing home had no problem with us changing his light bulbs, to see if it would help. It did. Now, things didn't become "rosy" of course, he had other issues, but, it sure made everyone a little better - within a year, the nursing home started using them in several places at the facility.

Also, it is never, never, never, easy to take care of someone else. It just isn't. And, it is not easy for a person who has taken care of themselves for years, to be at the mercy of a bunch of other people - even if its their own children. So, after you take care of all the obvious (meds, food, combinations of the meds or meds and food) - you should start looking at the other issues. Oh, and if there is a respiratory disease faction in a person, you might also want them to make sure that their O2 levels are up there, and their CO2 levels are low - that also creates what LOOKS like Alzheimers or Sundowners.

Beth

 

[mrs.oroblanco]

Texastee,

I know you meant to say they may turn blue when CO2 is high, and O2 is low (instead of the other way around), but, you are right.

However, if clubbing happens, it can be from many, many causes. (including none of the following), everything from emphysema, to infection, to hormone imbalances, to cardiac problems of all types.

Unfortunately, it does not always happen for a clue, but, if you do have clubbing - definitely check it out. (assuming that the person's fingers are not genetically clubbed).

Turning blue - or purple is definitely a no-no - but, again, sometimes that doesn't happen until it is already in the acute stage. Also, for high CO2, it can happen in many disease processes - or in certain long term medications, if it changes respiration. It can also happen if the acid-based balance in the body gets messed up by some (and could be simple) endocrine issue. Even a low grade fever can cause CO2 levels to rise, minor infections - anything - its amazing, especially the older you get, how a little thing can cause a ruckus. I had a patient once who kept telling her doctor that she had a fever, and he kept telling her, no, your temp is only 99, that's not a fever. Well, 98.6 is an AVERAGE temp, this lady's normal temp ran about 97.6 - so - she did have a low grade fever. Luckily, with her insistence that he check her records, they found out she did have a slightly elevated temperature - so they did a cbc, etc., and found out she had appendicitis. So, it is imperative that each person knows their norms. My blood pressure makes many who take it act like they think I'm dying. My bp runs low, low. 100/62 - give or take. So, when something is wrong, if my bp goes up to 120/80 - a doctor who didn't know my "norm" would think my bp is fine. So, if you have people you look out for, make sure you know their "norms", too, because it could save their lives. And, if you KNOW something is not right, don't let anyone say different. Follow it up. Nobody knows your body, and your family's like the people closest to them - be an advocate - pushy is ok when it comes to your health. The days of being patted on the head and being told "don't worry about it" are over.

Anything - anything, unusual needs to be checked, however, a doctor can check co2 levels quite easily, and 02 levels should be as close to 100 as possible.

Beth

 

[mrs.oroblanco]

Texastee,

Gosh, I never seem to be able to catch Dr. Oz's program very often. (when I can, I do).

But, it can be a bad sign, and needs to be checked out, for sure.(clubbing) I'm actually really happy that there are folks now who are educating the public on medical (real medical) issues, like Dr. Oz, and The Doctors.

Back during my parents days, the doctor was king - and certainly, they have the knowledge and the training - but it is always good for the public to know things too. It helps catch things much earlier, so that the percentage of cures can go up.

Beth

 

[Dave44]

WOW, I am learning alot Thank You all! Mrs Oro that is so close! She does not breathe well, she doesn't like to move around a whole lot, and she sleeps late and stays up late! Like you hit it on the head!


I have to say,, she is about 83 or so. I am on the side that says let her do her thing, whatever it is. She has earned her freedom to live healthy or not. But that may seem callous? I just think when people reach that age if they are lucid their choices trump what we think!

I do not , however feel that their mind should be taken from them artificially! She seemed fine last night, we are watching her.

 

[mrs.oroblanco]

Texastee and Dave44,

I empathize with both of you. On SOOOOO many levels.

I was doing "home" care before I got into hospice, and there were many times - too many times, that I stayed in the hospital with patients because their families had similar instances, and just could not be there 24/7, so - I became part of their family for awhile. (believe it or not, I still keep in contact with some families).

The ADM's are notoriously horrendous (the automatic med dispensing machines), crooking an arm will set it off, 1 drip off in a second, will set them off, and staff starts to become............I hate to say "hardened", but, when you are at the nurses station, and the same machine has gone off 30 times for no reason, you start to get used to it - not a good thing - but, its a fact. People think night shift is the worst, but, actually, it is the day shift that is the worst time. Meds, doctors, nurses, meals, cleaning, bed changing, therapists, visitors, priests and pastors, salesmen, testing, surgeries - they all take place most of the time during the day - and it wreaks havoc. On both patients and staff. And, almost every single place I have ever gone has been understaffed. (and interestly enough, its also the hours when most billing mistakes take place-patients are often shared during the day, and, for everything that a patient needs, there is a little sticker on each item. When you pick it out of the cart for a patient, you take off the little sticker and put it on the patient's chart that is by the desk. How ripe is THAT system to have 3 nurses grabbing the same thing for the same person, or putting it on the wrong chart?- Very.) Also - and this is not bad or good, but it just is - when a family member stays with a patient, especially if they have some knowledge and can spot problems - or even fix an issue or two - some staff tend to let them - and go on to the "other" patient who does not have someone taking care of them. Now, understand, I am NOT defending, just saying what happens. And, frankly, doctors don't often impress me during rounds. You have no idea how many times nurses have chased down doctors saying "are you SURE that's what you wanted? Or - hey, you forgot to sign off on the meds (the two biggies, in my experience).

Dave44,

You have my full agreement - you know what they want - even when and IF, they lose their faculties, if you know what they wanted before that happened, I am an advocate for doing what I know they wanted. Neither one of my parents wanted to die in a hospital or nursing home. I brought them both home, my mom with cancer, and eventually, my dad - who eventually had Sundowners, and did not have Alzheimers.

Taking care of my mom is how the hospice invited me to join their staff - and it was the most.....wonderful, and the most stressful, job, I have ever done. And it is a MUCH harder job when it is one of your family, because you get to see every minute of their decline.

Beth

 

[bigscoop]

One of the very best things I do with my father (he's 84, & Alzheimers) is to not let him sit in front of the TV all day, not let him sleep past 9am or stay up past 10pm, and we take short walks and do mild exercises every day. I can't tell you how important this is, has made a hude difference in his health. The saying, "if you don't use it, you lose it" has never been more true then during aging. At first, he wasn't always happy about it (the same with bathing) but now he enjoys the walks and he's just more active on his own. You can really see the difference. Also gets his meds like clockwork each day, within the same hour every morning and night. Also get "good meals", especially breakfast and dinner. There is no doubt in my mind that these important areas of daily living have really added to his health & happiness, but getting him to this point was a real bear!

 

[ivan salis]

"sundowner syndrom "--as in when the "sun goes down"-- the VISITORS , go home and the night shift folks whip out the "nighty night" knock em out / shut em up / do not bother us all night meds * -- old folks are highly touchy to drugs =-- so giving them strong "shut up and go to sleep already" meds -- might cause them to seem out of their minds --some might even have a drug "hangover" effect the next day --which often makes it seem their semi nuts. --its a dirty nursing home / hospital secert that they often dope up the inmates on the "night shift" to make their shift goe easier.

 

[mrs.oroblanco]

bigscoop,

You're spot on - and each individual has their own tolerances and abilities.


Ivan,

While their are bad nursing homes - no doubt about it - that has nothing to do with Sundowners, and no, does not have anything to do with giving meds to patients.


Beth

 

[bigscoop]

And my last words of advice/experience to those who are finding themselves entering the situation........Know your own limits because the stress can be extremely hard on you. Get/seek help when you reach those personal limits. If you are family, get use to being the kicking stump when things go badly.....accept it....because it's just human nature to blame those on the inside when we're simply looking in. Take care of yourself and stay as active as you can in your own life and interest. Daily care giving, as I have had to suddenly learn from the inside, is going to be "extremely stressful" and "life altering"........but you can & should know when to draw the line. If you get sick or ill from it all, then you won't be much help to anyone. Try to keep a balance. Not going to always happen, but that's simply a part of daily care giving.

 

[mrs.oroblanco]

bigscoop,

AMEN to that! And, just remember that there are folks like me (look up "respite services" or "hospice" or Home Health), who, without getting involved with the government - who will give you a break, or just a few hours off. And, medicare pays for some services, depending on the case.
There are also folks who will shop for you, pick up meds - all that sort of stuff.

As bigscoop said - it's a stressful thing, and sometimes, you don't realize how stressful until it is all said and done, so, try to have someone to talk to, because, at some point, you might get frustrated, or angry, and then feel guilty for feeling angry - its all normal, and it helps to have someone to vent to.

Beth

 

[Real de Tayopa Tropical Tramp]

Daved Bigscoop: what's this nonsense about being in their 80's and so going bonkers? Heck Oro is still reasonable. but of course he has Beth to keep him in line.

As for me, my excuse is that I am aTreasure hunter. Society expects that of me.

Don Jose de La Mancha

p.s. some serious, excellent advice has been given in here, and from Treasure hunters?

When I was in premed, one of the professors that liked me said, "Joe, doctors are mostly normally intelligent people, most are just more highly trained than the average person, but as a group, not more intelligent. Never let your ego cause you to underestimate a good nurse, she is closer to the patient than you and probably just as well informed. Finally, remember out of every 1000 doctors, probably only one will every make a good Diagnostician".