Alzheimer’s/Dementia and Sundowning:

Sundowning, also called “sundown syndrome” or “late-day confusion,” involves abnormal behavior that cycles in a circadian rhythm – in other words, the behavior occurs at certain times of day on a 24-hour cycle. Sundowning typically occurs late in the afternoon, or in the evening or night – thus the name. Sundowning is common for people with some forms of psychosis or dementia, or Alzheimer’s disease.

Experts estimate that sundowning occurs in about 45 percent of people with Alzheimer’s. When a person is sundowning, they may experience mood swings or become unusually demanding. They may be disoriented or suspicious. Sometimes a sundowning person sees or hears things that aren’t there. The most common type of disruptive behavior in senior residential care dementia patients is wandering, and sundowning is the second most common.

The combination of sundowning and wandering often precipitates an emergency situation, and professional medical care can greatly reduce the risk of an emergency.

The cause of sundowning is not known, but it’s suspected that a disturbed circadian rhythm may be a factor. Other contributing factors can include sleep disorders or medications that cause side effects such as confusion or agitation.

According to the [20]Mayo Clinic, sundowning is not a disease – it’s merely a symptom. Certain factors can aggravate sundowning, including fatigue, increased shadows, and low lighting.

What can you do to help?
* Limit caffeine and sugar intake after noon.
* Plan daytime activities to encourage sleepiness at night.
* Serve an early supper with a light snack before bedtime.
* Use a night light to ease the stress of dark surroundings at the end of the day.

Though sundowning and other behavioral disturbances can be treated with antipsychotic medications, the significant side effects may not be worth the benefits gained.

UTI and seniors:  What you need to know

Urinary tract infections, also known as cystitis or UTI, are caused by bacteria, which gets into the urine and may travel into the bladder or even up to the kidney. According to the American Urological Association, about 40 percent of women and 12 percent of men experience at least one UTI during their lifetimes.

Symptoms of cystitis (inflammation of the bladder or urethra) often begin suddenly, and can be quite severe. The urge to urinate frequently is very common, along with a burning sensation during urination. A UTI may also cause pain or pressure in the lower abdomen or lower back. The urine may be cloudy or dark, or may contain blood. This is often a sign of pyuria, or a high white
blood cell count. A person with a UTI may also develop a fever.

Sometimes bacteria travel up the urethra past the bladder, along one or both ureters, and into a kidney. (The ureters are muscular tubes that move urine from the kidneys down to the bladder.)

Symptoms of pyelonephritis, or kidney infection, usually affect the entire body and are more severe than that of cystitis or a bladder infection. According to the [21]University of Maryland Medical Center, these symptoms may include a lower UTI that lasts more than a week.

Chills and fever, or an increased need to urinate at night, may be a symptom of kidney infection. Another common symptom is back pain at waist level, which may or may not be accompanied by nausea or vomiting.

Those with diabetes or impaired immune systems are more at risk for kidney infections.

How does a UTI develop?
The urinary tract produces and stores urine; it’s made in the kidneys and moves to the bladder, where it’s stored before urination. The urethra is a small “tube” that empties urine from the bladder. An infection occurs when bacteria (usually from the digestive tract) cling to the urethra and begin to multiply. These bacteria can then travel up the urethra to the bladder or even to the

The kidneys, in the back of the body, filter liquid waste from the blood and move it to the bladder. Kidneys balance chemicals in the body and regulate the acidity of the blood; kidneys also produce some hormones that regulate blood pressure, keep bones strong, and stimulate the production of red blood cells.

Normally there is no bacteria in urine – it’s sterile. Post-menopausal women don’t have the protective effect of estrogen that younger women do; estrogen reduces a woman’s chances of developing a urinary tract infection. Some women are genetically more likely to experience UTIs. A woman’s urethra is shorter than a man’s, and women are thus more likely to develop a UTI. People with diabetes are also more likely to experience a UTI because the body’s immune function is decreased.

How is a UTI treated?
A short course of oral antibiotics is often sufficient to clear up a urinary tract infection. A severe UTI may require antibiotics for several weeks. If a UTI is not fully cured, it may recur, and a person needs extra liquids while taking medication for a UTI. A very serious infection may require intravenous antibiotics in the hospital.

Symptoms in older adults:

The classic symptoms of pain, urgency, or frequency, along with chills and back pain, are sometimes absent in older adults with urinary tract infections. Seniors may experience confusion or mental changes associated with a UTI, along with vomiting or nausea and shortness of breath. A sudden and persistent cough can also be a symptom in older adults. Many of these symptoms, while common in older adults, are not typically noticed as UTI symptoms in younger persons.

Additional resources for more information:

[22]American Urological Association
[23]National Kidney & Urologic Diseases Clearinghouse

Approximately 1 in 738 persons (about 0.14%) of persons in the U.S. are diagnosed with some form of dementia.

In May 2010, Alzheimer’s disease became the sixth-leading leading cause of death, according to the Centers for Disease Control and Prevention (CDC) National Center for Health Statistics.

Alzheimer’s currently affects over 5 million Americans. [6]In California alone, there are almost a half million people aged 65 and older with Alzheimer’s and other dementias.

Urinary tract infections result in more than 7 million doctor visits each year in the U.S., and account for about 5 percent of all primary physician office visits.

The costs associated with Alzheimer’s in the U.S. total $172 billion per year.