What does sundowning look like?
Sundowning describes a pattern of increased distress or confusion later in the day. A person may pace, call out, become suspicious, want to leave, say they need to go home, follow a carer closely, or experience hallucinations or delusions.
Not every difficult evening is sundowning. A sudden or dramatic change can be caused by pain, infection, constipation, dehydration, medication or delirium and should be medically assessed.
Why can symptoms get worse in the evening?
There is rarely one simple cause. Tiredness after processing a full day, fading light and shadows, disruption to the body clock, too much or too little daytime activity, hunger, pain and an unfamiliar routine can all contribute.
Keep a brief record of the time, what happened beforehand, food and drink, sleep, medication and what helped. Patterns are often easier to see on paper than during a stressful evening.
How to make evenings calmer
Prepare before the usual difficult time where possible. Close curtains before reflections appear in dark windows, switch lights on gradually and reduce avoidable noise. Keep your voice and movements unhurried.
- Offer the toilet, a drink or a light snack
- Use familiar music or a simple hands-on activity
- Avoid arguing about where the person is or what time it is
- Acknowledge the feeling: ‘You seem worried. I am here with you’
- Keep essential routines predictable, but stay flexible on a difficult day
What to say when they want to go home
‘Home’ may mean safety, familiarity or a place from an earlier part of life rather than a specific building. Instead of insisting that they are already home, respond to the feeling: ‘Tell me what you miss about home’ or ‘Let’s have some tea, then we can think about what to do.’
Do not trick, lock in or physically stop someone unless an immediate safety emergency leaves no safer option. If leaving the house is a recurring risk, ask the dementia team or local authority for an individual safety plan.
When to ask for professional help
Contact a GP if the pattern is new, worsening, affecting sleep or becoming hard to manage. Seek urgent medical advice for sudden confusion, signs of infection, new severe pain, a fall, medication concerns or a rapid change from the person's usual behaviour. Call 999 when anyone is in immediate danger.
Sources and further reading
Reviewed against trusted UK health guidance. Personal circumstances vary; speak to a qualified professional for individual advice.