Dear Aimee - Happy Witching Hour
Dear Aimee: I have been caring for my wife who has Alzheimer’s disease for three years. For the past several months I have noticed she often becomes anxious later in the afternoon. Without warning she seems to almost change personalities around 4:00 p.m. appearing to be agitated and even angry with me without cause. She has even fallen a few times (thankfully without injury!) which is very upsetting to the both of us. What used to be the beginning of our Happy Hour has now become the “Witching Hour.” I really love my wife and just want to enjoy our time together. Is there something I could be doing differently or some other explanation for these episodes? Frustrated in Folcroft Dear Frustrated in Folcroft: First let me start by stating what a loving, compassionate caregiver you are for your wife. It is obvious that your relationship is based on a deep mutual respect as evidenced by the way in which you write about her. That being said, the late afternoon behavioral changes you are seeing in your wife may be explained by the phenomenon known as “sundowning” or “Sundowners Syndrome”. Sundowning can manifest as mental or behavioral changes towards the end of the day. It can be more prevalent especially during this time of year as the days grow shorter especially with daylight savings time just around the corner.
There are several strategies for managing the agitation, confusion or anxiety you may see displayed in your loved one. First, take a step back and recognize that no one is at fault or purposefully acting out. Mostly likely, your wife is not upset with you or anything you did or did not do. Second, seek advice from a healthcare provider who is familiar with your wife’s condition. They may offer counsel over the phone or recommend an office visit to further explore what may be behind her change in condition.
Additionally, you may want to consider some practical interventions that compliment your healthcare provider’s direction. One strategy which can be very effective is to keep your wife’s routine simple and predictable at the day’s end. Offer her a snack or something to drink to keep up her energy. Remind her to use the restroom so as to rule out a factor that can increase agitation. Perhaps there is a favorite television show that she enjoys watching giving her a gentle cue that even though the day is over that life will still be consistent. If heading out to dinner you may want to consider taking advantage of an early bird special and leave your house while it is still light out.
Conversely, it may not be a good time for your wife to receive visitors or take phone calls. She may respond better to sitting in a quiet room and in the company of others. Experiment with what works for your schedule and keeps life peaceful for your both. There is no right answer, but rather work on finding a solution that supports you both. Surround yourself with people who empower whatever system you develop. Should you encounter any social resistance from friends or loved ones know that people will eventually adjust to whatever you decide is best for you and your wife.
Lastly, consider talking with your healthcare provide about the use of a mild sedative or anti-anxiety medication. Routinely administering a small dose mid-afternoon can be another effective measure to ward off late day anxiety and agitation. However, note that these medications should never be mixed with alcohol or other sedatives. Best wishes to you and your wife as you reclaim your Happy Hour time together!
About Aimee
For the past 10 years, Aimee J. Gustitis, BSN, RN, JD, has worked in longterm care, home, hospice and hospital settings empowering patients and their caregivers to navigate the complex world of senior healthcare. Additionally, she collaborates with pediatric special needs clients and their families to provide school-based nursing care. Her practice also includes providing legal nurse consulting services to law firms. She is well-versed in elder care case management, electronic health records documentation and interdisciplinary team participation. She has extensive experience determining hospice eligibility and with end of life comfort kit symptom management.
Aimee embraces the hospice philosophy that death need not be fearful and painful, but rather can be a beautiful, dignified experience for both the patient and their loved ones. As a Nourish For Caregivers facilitator she combines these areas of clinical expertise into serving those caring for aging, chronically ill and disabled loved ones.
She can be reached at 501 Lawrence Road, Suite C3, Broomall, PA 19008; or at 610-724-8950 or aimeegustitis@outlook.com.