Anger, Anxiety, Paranoia, and Sundowning

It is heartbreaking and frightening to see someone you love and respect become sullen, ill-tempered, and accusatory.  I first witnessed this change with my father-in-law, who was a favorite dentist, scoutmaster, and local community and church leader.  He was remarkably well-liked and was always positive, and involved in family and community projects.

It was only a couple years after he was diagnosed with early-onset Alzheimer's and had to sell his dental practice that we jointly purchased an old historic home with my in-laws, and they moved 600 miles to live with us.  No doubt the move to a totally new environment as his memory and coping abilities were failing only increased his confusion and paranoia.  It was a Dr. Jekyll and Mr. Hyde transformation.

The old historic house where we took care of my father-in-law for his final 3 years.

It really would have been more appropriate to call our home the old "hysteric" house because of all the trauma and anxiety we experienced in that multi-generational setting.  My father-in-law was often on, or over, the edge - especially in the late afternoon as the daylight began to decrease.  We weren't familiar with the term "sundowning", but we were well aware of the behavior and no one had to define the term when we heard it.

The change was radical and tragic.  In only a few years my father-in-law went from being the favorite, fun-loving grandpa, to someone our children had to fear when he became anxious and angry.  There were a few times where he became threatening with a knife or other tool, and our daughters knew they were to go up to their rooms when this occurred.  My wife even felt her life was threatened once when he came after her with a hammer.  Fortunately, I was able to overpower him when he became too threatening, but it was awful to experience.  This was 35 years ago and something for which a calming medication would now be prescribed.

I may be wrong, but it seems strong-willed men who were very independent are the most prone to reacting with suspicion and paranoia in the middle stage of Alzheimer's as they lose their bearings and coping ability; which is aggravated when they are tired and as daylight decreases.  

I was very fortunate that my wife became more trusting of me instead of paranoid as her dementia progressed, and which I tired to describe in "Doing the Best They Can".  I highly recommend considering medication and becoming familiar with the recommendations below to deal with anger, anxiety, paranoia, and sun-downing.

Your comments and willingness to share experiences related to anger, anxiety, paranoia, and sun-downing in the comments section below would be appreciated.

Resource Links

• Alzheimer's Association - Dealing with anxiety and agitation.
• Alzheimer's Association - Dealing with suspicion and delusions.
• WebMD.com - Alzheimer's disease and anxiety - triggers and care at home.
• Alzheimer's Society - Causes and possible ways to treat anxiety for someone living with dementia.
• National Institute on Aging - Coping with agitation and aggression in Alzheimer's disease.
• National Institute on Aging - Tips for coping with Sundowning.
• Harvard Medical School - What works best for treating depression and anxiety in dementia.
• nnLearn.org - Sundowing, a guide to difficult behavior at the end of the day.
• Home Care Assistance - Strategies for dealing with sundowners syndrome.
• Healthline - 7 tips for reducing sundowning.

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