When the Sun Goes Down

August 15, 2004

At ten o’clock in the morning, he seems like any other elderly Southern gentleman, circling words in his puzzle book as he sips the last of the coffee. He tells everyone who asks how he is doing, “Well, 50 years ago I was doing better.” To the casual observer, he is managing nicely, living alone and coping with day to day problems. But by late afternoon, the scene changes dramatically.

At first, we did not understand the strange and extraordinary transformation. Eventually, I stumbled upon the explanation—sundowning, a rare phenomenon occurring in the afternoon and evening among the elderly. It is characterized by distinct physical and mental changes. What may have been easy to accomplish in the morning is impossible by evening.

Family members are often unaware that their elderly parent is experiencing sundowning, especially if the parent is living alone. Typically, older people are in for the night by late afternoon. By the time the family catches on, the parent may have lived in an unsafe environment for a long time.

Our family has known for more than six months that Daddy should no longer live alone. The difficulty lies in explaining this to him. Because he functions reasonably well during the day, he resents the fuss over his continuing to live by himself. Conversations about driving are met with stony silence.

Why am I telling you all this? Recently I wrote two essays, one about taking my dad to Tampa, and the other for Father’s Day about how our family was coping with his decline. Many people told me that they were just beginning to experience the same things with their parents. Few knew about sundowning.

What does sundowning look like? Take an eraser to a picture of your 84 year old father.

When we take Daddy out for lunch, he orders from the menu and enjoys the meal and the company. At dinner, he struggles to read the menu. If given several options, he gets increasingly confused. “What are you going to have?” he often asks. I now order for him. He does not recognize the food, even if it is something that he eats regularly. He will often say, “I like this. I have never had it before.”

Table manners are forgotten at night. He may feed himself with his fingers, have food on his face and clothes, and help himself to food on the plates of others at the table. He tends to eat an inordinate amount of soup, because it is easy—no cutting. He devours his food as though he is starved.

Any time during the day, he repeats himself, telling the same stories over and over. Late in the day the stories begin missing parts and the names of the characters change. The long dead are resurrected.

Although Daddy has lived in Huntsville all his life, thanks to sundowning he often recognizes few places other than his own home at night. During the day, he drives to familiar places. At night, that is dangerous. On at least two occasions, he has gotten lost at night. We are looking at GPS devices.

Rational decision making becomes irrational. A couple was in the store late one afternoon. The man, dressed in a native, African costume complete with a walking stick, and a woman, also dressed in costume, talked Daddy into taking them to the bus station. While I was distracted at the back of the store, he left with these strangers. Nancy, one of our employees, yelled, “Come quick!” and ran to stop him. As I approached his car, I heard Nancy begging him to wait for me. He saw me and backed out of his parking space, the car door open and nearly running over Nancy’s foot.

A few months ago, the phone rang at 8:30 pm. He was asleep in the recliner and fell trying to answer the phone. He bled all night. The next morning, he called my brother and asked him to bring him a couple of band-aids. My sister-in-law found a bloody scene when she arrived at the house. He had slept in a long-sleeved shirt thinking that would stop the bleeding. Had he fallen in the morning, he would have made better decisions.

Most mornings he knows which day it is and takes the correct medicine. But by nighttime he is likely to take two days’ worth, forgetting both what day it is and that he has already taken the evening pills.

Physical difficulties become more pronounced. While Daddy is unsteady on his feet during the morning, he can hardly walk by evening. Normally quite talkative (hence nicknamed “Chat” by his grandfather) during the day, at night he is mostly silent.

Our family is neither unique nor courageous. My brother and I remember what it was like to live in an extended family—two grandparents and an old maid family friend lived with us. Today, more options are available for independent living. However, the day ultimately arrives when the family must make those painful decisions that satisfy no one.

One morning I tried to explain to Daddy that he could no longer live alone because of sundowning. I carefully and, as gently as possible, described his demeanor late in the day. I told him that he needed to be near other people for his own well being. I was proud of myself for the way I handled the situation. Later, he told my brother that I had accused him of having Downs Syndrome. Back to square one.