What if the best way to address sundowning begins at breakfast?
Most discussions about sundowning focus on what happens in the late afternoon or evening. We talk about pacing, repetitive questions, increased confusion, agitation, and emotional distress.
But what if some of those behaviors aren’t simply symptoms?
What if they are signs that an important preserved ability has gone unsupported throughout the day?
Over the years, I’ve observed that many individuals living with dementia become increasingly restless when they haven’t had opportunities to use their strongest remaining abilities.
A person with strong bodily-kinesthetic abilities may spend the day sitting and become increasingly restless by evening.
Someone with strong interpersonal abilities may have very little meaningful social interaction and begin seeking connection as the day progresses.
A person with strong verbal-linguistic abilities may spend much of the day with limited opportunities for conversation and become more repetitive later in the evening.
In other words, what we call sundowning may sometimes be the result of unmet needs accumulating throughout the day.
Looking Beyond the Behavior
One of the challenges in dementia care is that we often focus on managing behaviors after they occur.
We try to reduce pacing.
We redirect repetitive questions.
We calm agitation.
We search for ways to make the evening easier.
While these approaches can be helpful, they may overlook an important question:
What need is this behavior trying to express?
The Preserved Abilities Method™ encourages us to look beyond the behavior itself and consider the preserved ability that may be driving it.
When we do, the behavior often begins to make more sense.
The Person Who Paces
Pacing is frequently viewed as a sign of agitation or restlessness.
Sometimes it is.
But sometimes it may also reflect preserved bodily-kinesthetic abilities.
For individuals who have always been active, movement may remain an important part of how they interact with the world.
If opportunities for movement are limited throughout the day, the need for movement doesn’t necessarily disappear.
It may simply emerge later in the form of pacing, wandering, or increased restlessness.
Providing opportunities for walking, exercise, household tasks, gardening, or purposeful movement earlier in the day may help support this preserved ability before evening arrives.
The Person Who Repeats Questions
Repetitive questioning is often attributed entirely to memory loss.
While memory impairment certainly plays a role, some individuals also retain strong verbal-linguistic abilities.
Communication may remain one of their strongest ways of engaging with the world.
If opportunities for meaningful conversation are limited, the individual may continue seeking interaction through repeated questions or comments.
For these individuals, storytelling, conversation, reading, word games, or reminiscing throughout the day may help satisfy that need for communication.
The Person Who Follows Caregivers or Family Members
Many caregivers describe loved ones who begin following them from room to room as the day progresses.
This behavior is often viewed as anxiety or dependence.
Sometimes it may be.
But it may also reflect strong preserved interpersonal abilities.
Individuals with interpersonal strengths often thrive on human connection and social engagement.
When meaningful interaction is lacking, they may naturally seek it out in whatever way they can.
Supporting interpersonal abilities through conversation, group activities, shared experiences, or regular social engagement throughout the day may help reduce the need to seek reassurance later in the evening.
The Person Who Becomes Withdrawn
Not everyone experiences sundowning through increased activity.
Some individuals become quieter, overwhelmed, emotional, or withdrawn.
Those with preserved intrapersonal abilities often benefit from calm environments, personal reflection, and opportunities to process their surroundings.
For these individuals, excessive stimulation throughout the day may contribute to evening distress.
Supporting their need for quiet time, familiar routines, and peaceful environments may help reduce feelings of overwhelm.
What If Sundowning Starts Earlier Than We Think?
One of the central ideas behind the Preserved Abilities Method™ is that the best way to address a difficult evening may begin much earlier in the day.
When a person’s preserved abilities are not recognized or supported, frustration, boredom, isolation, and unmet needs can gradually build over time.
By evening, those unmet needs may begin to appear as behaviors we associate with sundowning.
In other words, the behavior may not simply be appearing.
It may be accumulating.
An Important Note
Sundowning is complex, and there is no single explanation for every situation.
Factors such as fatigue, changes in lighting, disrupted sleep patterns, medications, medical conditions, pain, and disease progression can all contribute to evening confusion and distress.
The purpose of this article is not to suggest that all sundowning is caused by unmet preserved abilities or that every case can be prevented.
Rather, it is to encourage caregivers and professionals to consider whether supporting a person’s strongest remaining abilities throughout the day may help reduce some of the factors that contribute to difficult evenings.
A Different Way to Think About Sundowning
Instead of asking only:
“How do we manage sundowning?”
We might also ask:
“How are we supporting this person’s preserved abilities throughout the day?”
The answer may provide valuable clues.
Too often, dementia care focuses on what has been lost.
The Preserved Abilities Method™ focuses on what remains.
When we identify and support a person’s preserved abilities, we may improve engagement, reduce frustration, strengthen communication, and perhaps even lessen some of the factors that contribute to sundowning.
Sometimes the best way to address a difficult evening is to start much earlier in the day.
Learn more about the Preserved Abilities Method™ at:
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Supporting a person’s strongest remaining abilities throughout the day may help reduce frustration and improve engagement before evening arrives.