Where is Joe? VITAL tools for Coping with Sundowning
by Dr. Amanda Mullen,
PAC Mentor, Trainer, Coach, and Consultant
It’s 5:00 pm, and Joe is sitting down for a rest while the dinner he has prepared finishes up in the oven. Joe’s wife, Martha, is puttering around the kitchen, as she has started to do lately. She stopped cooking months ago, but she seems restless around this time of day; and Joe has found that staying busy seems to help her, so he has taken his usual seat in the living room to watch a little TV. Martha wanders into the room, wringing her hands, and with a worried expression. She looks directly at her husband and asks, “Where’s Joe?”
It's happening again. The doctors have told Joe that Martha’s confusion is increasing in the evenings due to sundowning, a common exacerbation of the disorientation and agitation caused by her dementia. She is not recognizing him, even though they have been married for 50 years. Joe takes a breath. Even though he knows this is part of her disease, it never fails to catch him off guard. Joe can get through this with Martha, but having the right skills as her care partner is VITAL.
Validate: Martha needs to know that she has been heard and is being taken seriously before any attempt to redirect or calm her will work effectively. Even though Joe’s first instinct is to say, “What do you mean? I am Joe!,” this will not help Martha. Instead, her husband will have to join her in her world, and matching her tone, emotion, and facial expression, simply say: “You are looking for Joe?”
Investigate: It is time for Joe to become a detective and try to determine what need is prompting Martha’s distress. Why is she looking for him? Joe can start with an either/or question such as, “Are you looking for Joe because you want to tell him something or you just want to be with him?” This type of question will help to identify if Martha is more task-driven (wants to DO something that somehow involves Joe) or comfort driven (wants to FEEL something, perhaps comfort and stability from being with her husband).
Try: Depending on the results of his investigation, Joe can decide on a course of action. If Martha is more task driven, he might respond by saying, “You are wanting to tell Joe something. Let’s write it down so that we will remember when he gets back.” If she is comfort driven, Joe might respond by saying, “You are wanting to be with him. I understand. You love him very much. Good news! I think he will be back soon!”
Adapt: Sometimes, confusion hangs on for longer than we expect. This can often be due to environmental triggers…something that Martha is seeing, smelling, or hearing in the house may be prompting her to look for her husband. This is, after all, the time of day that he used to return from work, and they would enjoy dinner together. If Martha remains distressed, Joe might want to try to prompt a change in environment by saying, “Let’s sit outside on the porch while we wait. Smell that lovely summer air (taking in a deep breath through his nose and out of his mouth).” If Joe can prompt Martha to take a deep breath, this will not only bring oxygen to her brain; but it also may serve to decrease stress and improve her ability to organize her thinking. And, let’s be honest, Joe could use a few deep breaths at this point as well! While on the porch, Joe might share a funny story about the two of them from the distant past. Martha will have easier access to long-term, emotional memories, and the positive feelings that are elicited could begin to decrease her distress.
Let it Go: Sundowning, and the confusion and anxiety that emerge when it occurs, can be so unsettling. Eventually, Martha will likely return to recognizing Joe as her husband. Joe’s biggest task at this point will be to let it go. Reminding Martha of the episode or asking questions such as “Why didn’t you recognize me?” will only return her to a place of anxiety. Just as in the beginning of this sundowning experience, Joe’s task is to meet Martha where she is and maintain their connection. “I love you sweetheart. Dinner smells great. Let’s sit down and eat!”
Dr. Mullen is a Clinical Psychologist who has focused her career on supporting, teaching, and counseling people living with dementia as well as their families and care partners. She was awarded a Doctor of Psychology degree from Nova Southeastern University in Florida in 2001 and has since returned to live in Massachusetts where she was born and raised. In her private practice, Changing Minds, Dr. Mullen focuses on helping elders and their families navigate brain change. Through this work, she has had the opportunity to learn and fully embrace the PAC philosophy. Along with her business partner, a friendly Labradoodle named Eva, she plans to continue to develop dementia resources in her area that are based on the principals of PAC.