Dementia is marked by a gradual loss in cognitive function, this can take many forms. Whilst every person with dementia is different, and dementia affects people in different ways, there are some common difficulties that tend to occur as dementia develops.
A widespread symptom of dementia is confusion about time. “What time is it?” is a frequently repeated question. Coupled with the short-term memory difficulties that people with dementia – particularly those with Alzheimer’s – tend to experience, not understanding the concept of time, or being able to remember what time it is (having been told) can be very distressing.
Time is crucial to our everyday lives. We mark out our days with time, it underpins our lives with structure and predictability. Losing grip of time is a definite sign that a person with dementia is struggling to make sense of a bewildering world.
My father, in the early stages of vascular dementia, has an exaggerated interest in time. He has a watch with him always and my mother and I often notice him looking at it, and then at the clocks in the house (there are many): he tries to figure out what time it is, but often he can’t, and he is sometimes unsure whether it’s morning, afternoon or evening.
Repeatedly asking the question “What time is it” can be incredibly wearing for family members too.
In common with many people with dementia, my father gets confused about which day of the week it is; he will often start the day by asking this question, and then ask it many more times as the day progresses. Arguably, what day it is doesn’t matter to a lot of older people, but some of the cues that would indicate the day to my father, seem to be jumbled and disconnected in his mind.
An example is the bins. At one time my Dad would absolutely know what day the bins were put out, and which type of bin was collected during each particular week. The schedule of bin collections was an important part of a routine that kept a rhythm in his life ticking over. But that has now gone. My Mum takes responsibility for the bins now, my Dad seems to have lost interest, bin day passes him by.
A particular type of time disorientation is called ‘Sundowning’, which is increased confusion and stress in the late afternoon and evening. Sundowning happens because dementia interferes with a person’s ability to regulate their circadian rhythm – the internal “body clock” that tells us when it’s time to be awake and when we should sleep.
Dementia disrupts a person’s sense of time of day. Low levels of lighting can exacerbate sundowning, shadows can be frightening for people with dementia, especially when the sun is setting.
Sundowning can cause sleep patterns to be disturbed. It’s important to encourage the person with dementia to be active during the day, if possible, outdoors, breathing fresh air and exposed to natural sunlight. For good sleep, it’s important for the person to feel physically tired by the end of the day.
The impact of light on sleep is well researched and the science can be applied therapeutically for people with dementia who experience sundowning. Being outside in bright natural light help a person maintain circadian rhythm and encourages sleepiness when the sun goes down. If this isn’t possible for the person with dementia, shining light from a fluorescent lamp for two hours (ideally in the morning) has a similar effect.
Regular routines help to counterbalance the negative impact of sundowning. Keeping everyday activities familiar minimises stress and maintains a sense of security for the person with dementia.
Diet is important too. Caffeine and alcohol should be avoided later in the day and the main meal of the day is best eaten at lunchtime rather then in the evening.
Please get in touch to share your experiences of time disorientation and sundowning. If you have found certain interventions or lifestyle approaches have worked well for the person you are caring for, please let us know. We are keen to disseminate information through our articles and social media to help others learn from those with lived experiences.