Issue 4

Sundown SyndromeSun Sets, Confusion Rises

Sundowning is the term that refers to increased confusion and disorientation in the late afternoon and early evening. As many as 20% of people with dementia experience sundown syndrome.

This behavior usually is at its most severe during the middle stages of Alzheimer’s, becoming less as the disease progresses. Some studies show that sundowning is associated with faster decline in the ability to think and with faster disease progression.

People who have sundown syndrome may have mood swings and may be suspicious, agitated, yelling, lashing out at caregivers, pacing more, and have tremors. They may have difficulty sleeping, and wander more and “want to go home” as light

Pathways

Residential CareJournal

Benefits of DogsHealthier Living

Most people know that people who own dogs live longer, have lower blood pressure, less anxiety and better immune systems. They also have more social interactions, Alzheimer’s patients with dogs in the home have fewer outbursts and men with dogs have lower triglycerides and cholesterol. These are the scientific conclusions of research about family pets that can be easily found.

But there are even more benefits and some of them are pretty astounding. Dogs are being trained to assist in the medical field. For instance, dogs can be trained to sniff out low blood sugar in diabetics, picking up odors beyond human capacity. Dogs can also be taught to prod the diabetic with a cold nose, fetch a blood glucose testing equipment or press a phone button that calls 911.

continued on page 3 Sundown Syndrome

continued on back page Benefits of Dogs

Pathways Residential Care Journal

Old Person SmellIs there really such a thing as “old people smell,” or is it in your imagination when you visit seniors who look right at home among their antiques? A recent study says young people really can identify such a smell, and old men smell the best.

ResearchJust how do you go about proving this? Johan Lundström and his colleagues at the Monell Chemical Sense Center in Philadelphia collected the underarm scents of people in three age groups: 20-30 years old, 45-55 years old and people 75-95 years old. Then they had other young people (ages 20-30) sniff the armpit pads.

Collecting ScentsThe researchers had the participants wear the same T-shirt to bed for five nights. The shirts and sheets had been washed with scent-free detergent and the participants washed with scent-free soap every night. They also agreed not to smoke, drink alcohol or eat foods that are known to cause body odors. Special pads were sewn into the underarms of the T-shirts to collect their body’s scent.

RatingsThe people doing the sniffing rated the pads on pleasantness and intensity and had to guess which of two odors came from older participants. Then they were instructed to label all of the armpit pads by age category.

Although they had trouble distinguishing between the young and middle aged people’s pads, they were able to correctly determine which came from old people more often than would be randomly expected. Evaluators used words such as “earthy” and “mild, like stale water” to describe the odors of older people.

“These elderly odors were very distinct and easy to group together,” says Lundström. The study found that the armpit pads from old men were rated the most pleasant, especially compared with middle-aged

Managing StressSet Worries DownThe instructor of a stress management class walked into the room holding out a half glass of water. Everyone in the class thought they knew what was coming: “Is the glass half full or half empty?”

But the instructor surprised the students by asking with a smile, “How heavy do you think this glass of water is?” People called out answers ranging from 6 ounces to 20 ounces.

The teacher replied, “It changes. It depends on how long I hold it—the absolute weight doesn’t matter. If I hold it a minute, it is light. If I hold it an hour, it is heavy and I will have an ache in my arm. If I hold it for a day, it will be too heavy to lift and I will drop it.

“It seems the longer I hold it, the heavier it becomes. If, however, I set it down when it feels heavy and rest a while, I have the strength to hold it again.

“It is the same way with stress,” she said. “If we carry our burdens all the time, sooner or later, the burden becomes too heavy and we won’t be able to carry on.

“Just like with the glass of water, you have to put down your burdens for a while and rest before shouldering them again. When you are refreshed, you will be able to take up the burden, stronger again.”

So, put aside your burdens whenever you can; they will still be there after you have rested and you will be able to carry on as strong as ever. continued on next column

men, although the odors from old women were rated behind those of middle-aged women.

Lundström and his colleagues concluded that if you associate the scent of old people with something negative, it is likely to have more to do with context than the actual odor.

The study was reported online May 30, 2012 in PLoS ONE.

Helping Neighbors on Life’s Journey

fades and shadows appear. They may also be aware of their own confusion which can frustrate them more.

CausesAlthough the causes of sundown syndrome are not proven, many experts believe that in Alzheimer’s the changes to the brain affect the part that regulates our bodies’ rhythms of sleep and wakefulness—the cluster of nerve cells that keeps the body on a 24-hour clock. Other possible causes include:

• Mental and physical fatigue, making the resident less able to cope with stress

• Low lighting, increased shadows• Discomfort due to pain, urinary tract infection,

fecal impaction, etc.• Medications• Hunger• Noisy sleeping environment• Lack of organized evening activities• Too much sleep during the day• Change of shift activity with many people coming

and going

ManagementThis is especially the time to apply basic techniques for dealing with people who have dementia:

• Reassure the resident in a calm way; tell them they will be all right and that they are in a safe place.

• Don’t argue with the resident or ask why they are confused.

• Try to find out if they have a need; are they cold, hungry, wet, in pain?

• Remove the resident to a calmer place, such as outside or his room—somewhere with fewer people and noises.

• Change caregivers if there is a chance that this is upsetting the resident.

• Reminisce with the resident about bedtime

activities they followed with their children when they were young parents.

Consider alternative techniques such as: aromatherapy, a pet, calming sounds (bubbling brook, birds, wind in the trees), soothing food or warm milk, singing a favorite song or hymn, reading a familiar poem or children’s book, gently brushing hair, putting on a favorite movie, or massaging shoulders (only with the resident’s permission and in a common area).

PreventionPreventing problems is the best form of managing them. These suggestions won’t work for every person, but persistence pays off if you keep trying:

• Maintain a consistent sleep schedule and daily routines; limit daytime sleep to short naps.

• Increase activity during the day including some physical activity such as walking or dancing.

• Monitor diet; avoid caffeine, or serve only in the morning. Offer a light, bedtime snack.

• Let residents choose where they are most comfortable sleeping.

• Consider the use of melatonin to promote sleep.• Keep a dim light on at night and the room

uncluttered.• Have the resident occupied during shift change if

this seems related to the sundowning.• If sundowning occurs at a certain time every

evening, plan for it. Have the resident involved in an activity during this time.

Seek medical advice if other measures don’t work. There may be medical conditions contributing to the sundowning. The physician can also review the resident’s medications to check for drugs that can be eliminated.

Always keep in mind that this behavior is not done on purpose—the resident may be as baffled by it as you are. But good planning can help prevent and manage sundown syndrome.

References: Mayo Clinic online; Web MD; Alzheimer’s Association, Care & Compliance Group.

continued from page 1 Sundown Syndrome

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continued from page 1 Benefits of Dogs

It could be scent or it could be a subtle change in behavior, but some dogs are able to sense a seizure coming on as much as 30 minutes before it occurs. This means the dog may be able to alert the person, go for help, move objects out of the way and lay down next the person during the seizure.

More and more people with post traumatic stress disorders, such as soldiers returning from war zones, are benefiting from dogs as companions because they can they can ease anxiety in a number of ways.

Dogs also have the remarkable ability to detect certain kinds of cancers. One example is being able to reveal the presence of bladder or prostate cancer cells in urine. Some researchers have shown that dogs can recognize lung and breast cancers by smelling the patient’s breath, and they can spot melanoma by licking a person’s skin.

A dog’s brain may be only one tenth the size of a human’s, but his nose more than makes up for it: dogs have 40 times as many scent receptors as humans. It is truer than ever that dogs really are man’s best friend.

References: My Health News Daily; Web MD.

Join Pathways for a morning with Jon Katz

This year’s featured speaker, Jon Katz, will share the humor and ‘dog sense’ he gained as he and his rescued border collie Izzy, specially trained

as hospice volunteers, brought comfort and joy to hospice patients.

Tables and individual seats available Visit www.pathwayshealth.org or call 408.730.1200

Pathways Home Health & Hospice is a not-for-profit 501(c)(3) organization.

One from the Heart Awards BreakfastFriday, October 5, 2012, 7:30 to 9:30 a.m.

Crowne Plaza Cabana Hotel, Palo Alto