Sundowning in Dementia: Calming Activities That Actually Help

The clock hits late afternoon, and the change begins. Your usually calm loved one becomes agitated, confused, or anxious. They may pace, become argumentative, see things that aren't there, or try to leave the house.

This is sundowning—one of the most challenging aspects of dementia care.

If you're dealing with sundowning, you're not alone. It affects up to 66% of people with Alzheimer's and other dementias. And while there's no magic cure, the right activities and strategies can significantly reduce its intensity and help both of you through those difficult evening hours.

What Is Sundowning?

Sundowning (also called "late-day confusion") refers to a pattern of increased confusion, agitation, anxiety, or behavioral changes that typically occur in the late afternoon or evening.

Common sundowning behaviors include:

1. Increased confusion or disorientation
2. Anxiety, agitation, or restlessness
3. Pacing or wandering
4. Mood swings, irritability, or anger
5. Yelling or aggressive behavior
6. Seeing or hearing things (hallucinations)
7. Suspiciousness or paranoia
8. Attempting to leave ("I need to go home")
9. Difficulty following directions
10. Shadowing (following caregiver constantly)

Why Does Sundowning Happen?

The exact cause isn't fully understood, but several factors likely contribute:

Circadian rhythm disruption: Dementia can damage the brain's internal clock, disrupting sleep-wake cycles.

Fatigue: Mental and physical exhaustion accumulates throughout the day.

Low lighting: Dim light can increase confusion and shadows can trigger visual misperceptions.

Hunger or thirst: Blood sugar drops and dehydration affect cognition and mood.

Unmet needs: Pain, need for the bathroom, or discomfort they can't express.

Overstimulation: Too much activity during the day can lead to evening overwhelm.

Understimulation: Boredom and lack of activity can also contribute to restlessness.

Setting the Stage: Environmental Strategies

Before we discuss activities, optimize the environment:

Increase lighting. Turn on lights before dusk. Bright, even lighting reduces shadows and confusion.

Reduce noise. Turn off news programs or loud TV. Keep background noise minimal.

Create calm. A peaceful environment helps prevent agitation from escalating.

Maintain routine. Predictability is soothing. Keep evening routines consistent.

Limit caffeine and sugar. Especially in the afternoon, these can worsen agitation.

Ensure comfort. Check for pain, hunger, thirst, or need for the bathroom.

Calming Activities for Sundowning Hours

The right activities during sundowning aren't about stimulation—they're about calm engagement. The goal is to redirect anxious energy into something soothing and purposeful.

1. Gentle Coloring

Coloring is one of the most effective sundowning activities. It's calming, requires minimal cognitive load, and provides gentle focus.

Why it works: The repetitive motion is soothing, similar to meditation. It redirects attention from internal distress to a simple, pleasant task.

Tips for sundowning:

1. Use very simple designs with large areas
2. Offer only 2-3 color choices
3. Soft colored pencils (not overstimulating bright markers)
4. Sit beside them and color together
5. Don't worry about staying in lines—the process matters

CarePrints offers: Over 1,700 coloring pages including simple, calming designs perfect for evening hours. Our large-format pages with clear outlines work well for seniors experiencing confusion.

2. Sorting Activities

Sorting provides purposeful, repetitive activity that occupies hands and mind without requiring memory or complex thinking.

Sorting ideas:

1. Buttons by color or size
2. Playing cards by suit
3. Coins into piles
4. Socks by pairs
5. Silverware into compartments

Why it works: Sorting is calming, provides a sense of accomplishment, and taps into procedural memory that often remains intact.

CarePrints offers: Montessori-inspired sorting and categorizing activities in our Premium Activities collection, designed using evidence-based calming approaches.

3. Music and Singing

Music can reach through agitation when nothing else works. It activates different brain pathways and can shift mood quickly.

Tips for sundowning:

1. Choose slow, familiar songs from their youth
2. Keep volume low and soothing
3. Sing along softly—they may join
4. Avoid music that's too energetic or unfamiliar
5. Try hymns, lullabies, or big band ballads

Why it works: Music triggers emotional memory, provides comfort, and can redirect focus from anxiety to pleasant associations.

4. Gentle Hand Massage

Touch can be profoundly calming when words fail. A simple hand massage provides comfort and connection.

How to do it:

1. Use unscented or lightly lavender-scented lotion
2. Hold their hand gently first
3. Use slow, gentle strokes
4. Massage palms, backs of hands, and fingers
5. Watch their face for signs of comfort or discomfort

Why it works: Gentle touch releases oxytocin, reduces cortisol, and communicates care without requiring verbal comprehension.

5. Looking at Photo Albums

Familiar images can ground someone experiencing confusion. The past often feels more real than the present during sundowning.

Tips:

1. Use albums with large, clear photos
2. Don't quiz or ask "who is this?"
3. Make simple observations: "What a lovely dress"
4. Let them lead the conversation
5. Accept whatever they say about the photos

CarePrints offers: Reminiscence prompt cards that can guide gentle conversation while looking at photos together.

6. Folding Activities

Simple folding tasks are calming and provide a sense of contribution.

What to fold:

1. Washcloths or hand towels
2. Napkins
3. Small blankets
4. Clothing items

Why it works: Folding is familiar, repetitive, and purposeful. It occupies hands and provides mild cognitive engagement without stress.

7. Simple Word Searches

For those who can still engage with word puzzles, very simple word searches provide gentle cognitive focus.

Tips for sundowning:

1. Large print, high contrast
2. Very simple themes (colors, animals)
3. Work on it together
4. No pressure to complete
5. Stop if frustration appears

CarePrints offers: Hundreds of word searches including simple, calming options with large print suitable for evening hours.

8. Rocking or Gentle Movement

Repetitive, gentle movement can be deeply soothing.

Options:

1. Rocking chair (if available and safe)
2. Gentle chair dancing while seated
3. Slow arm movements to music
4. Soft ball rolling back and forth

Why it works: Rhythmic movement is naturally calming and can reduce agitation.

9. Sensory Activities

Engaging the senses can redirect attention from internal distress.

Ideas:

1. Feeling soft fabrics (fleece, velvet, silk)
2. Handling smooth stones or stress balls
3. Smelling familiar, comforting scents (vanilla, lavender, coffee)
4. Watching fish in an aquarium (or video of one)
5. Looking at lava lamps or slow-moving visual displays

10. Snack Preparation

Simple food preparation provides purpose and results in a reward.

Simple tasks:

1. Stirring ingredients
2. Spreading butter or soft cheese
3. Arranging crackers on a plate
4. Washing vegetables
5. Sorting candies

Why it works: Food preparation is familiar, purposeful, and results in eating—which addresses possible hunger contributing to sundowning.

11. Watching Calming Videos

When active participation isn't possible, calming visual content can help.

Good options:

1. Nature documentaries (without predator scenes)
2. Aquarium videos
3. Fireplace videos
4. Gentle travel footage
5. Old musicals or familiar classic movies

12. Reading Aloud

Even if they can't follow a story, the rhythm of being read to can be soothing.

Tips:

1. Choose familiar content (poetry, prayers, children's books)
2. Read slowly with a calm voice
3. It doesn't matter if they comprehend—the rhythm soothes
4. Stop if they seem agitated by it

CarePrints offers: E-Tales—short, calming stories written specifically for seniors that can be read aloud during difficult hours.

13. Simple Puzzles

Very simple puzzles can provide calming focus for those who can still engage with them.

Tips:

1. 6-12 large pieces maximum
2. Familiar, pleasant images
3. Work on it together
4. No pressure to complete

14. Prayer or Spiritual Practices

For those with religious backgrounds, familiar prayers or spiritual rituals can be profoundly grounding.

Options:

1. Reciting familiar prayers together
2. Reading from sacred texts
3. Listening to hymns
4. Holding prayer beads
5. Quiet reflection time

15. Simply Being Present

Sometimes the best activity is no activity at all—just calm, loving presence.

How to do it:

1. Sit beside them quietly
2. Hold their hand if welcome
3. Speak in soft, reassuring tones
4. Don't try to reason or argue
5. Simply be there

Activities to Avoid During Sundowning

Not all activities are appropriate during evening hours:

Avoid:

1. Stimulating TV (news, action shows)
2. Challenging activities that cause frustration
3. New or unfamiliar activities
4. Activities requiring memory or learning
5. Large groups or social situations
6. Arguing or reasoning about delusions
7. Physical restraint (unless safety requires it)

When Sundowning Gets Severe

If sundowning is severe or getting worse, talk to their doctor. Medical issues (infections, pain, medication side effects) can worsen sundowning and should be ruled out.

Medications can sometimes help, but should be considered carefully due to side effects in older adults.

Environmental and activity-based approaches should be tried first and continued even if medications are added.

Caring for Yourself During Sundowning

Sundowning is exhausting for caregivers. It often hits when you're already tired from a full day.

Strategies:

1. Accept that some days will be harder than others
2. Tag-team with other family members if possible
3. Have activities ready so you're not scrambling
4. Stay calm—your agitation can increase theirs
5. Take breaks when you can
6. Join a support group for understanding

CarePrints can help: Having a library of calming activities ready means you're prepared for sundowning hours without having to think about what to do. Our thousands of printable activities can be organized by type and difficulty so you always have options available.

Be Prepared for Evening Hours

CarePrints provides thousands of printable activities designed for seniors at every cognitive level—including calming options perfect for sundowning hours.

Our library includes:

1. 1,700+ coloring pages (including simple, calming designs)
2. Hundreds of word searches at various difficulty levels
3. Montessori-inspired sorting activities (Premium)
4. Reminiscence prompts for gentle conversation
5. E-Tales calming stories
6. Evidence-based Premium Activities

[Browse Calming Activities →] https://www.geriatriccaresolution.com/care-prints

Questions? Contact us at 1.888.896.8275 or careprints@gcaresolution.com