Healthcare News & Insights

Avoid ‘sundowning’ in elderly hospital patients

It’s a serious concern at many hospitals: the “sundowning” phenomenon. In the evening hours, elderly patients, disoriented by their surroundings, start behaving erratically – yelling, rambling, wandering away from their hospital beds. This behavior can take a serious toll on their recovery. 

ThinkstockPhotos-122552779An article from Boston’s NPR outlet, WBUR, discusses sundowning in detail. According to the article, many experts agree that older patients are more prone to this behavior during the nighttime and early-morning hours. But few explanations exist as to why.

There’s also debate about whether this behavior is another form of delirium. Some say it’s related, while others consider sundowning its own separate condition.

Whatever the cause, it’s tough for facilities to get a handle on it.

The condition’s most prevalent in elderly patients with memory problems or dementia, but it can strike any older person. It’s likely the biggest trigger is being in unfamiliar surroundings.

And per Dr. Sharon Inouye, an expert on aging quoted in the article, biological factors that play a role in sundowning include “disruptions in circadian rhythms, nadirs in cortisol, stress hormones, sympathometic neurotransmitters, melatonin or fluctuating cytokines.”

In other words: Changes in sleep patterns and hormone fluctuations may lead to big problems for hospitalized older patients.

HELPing hand

The best strategy for hospitals to decrease the likelihood of sundowning in older patients (or to identify problems more quickly) is to take a preventive approach.

Some hospitals have specific protocols in place to keep elderly patients from developing signs of sundowning or delirium. For example, Dr. Inouye developed the Hospital Elder Life Program (HELP), which is currently being used in over 200 hospitals worldwide.

Under HELP, clinical staff members are specifically trained on caring for older patients. HELP mainly focuses on making sure the elderly are aware of their surroundings. Staffers are told to regularly remind patients that they’re in the hospital, along with what day it is, the specific date and the time of day.

Other tactics used to keep patients oriented with their surroundings include:

  • making sure glasses and hearing aids are within their reach
  • getting them out of bed and walking regularly
  • ensuring they’re hydrated and well fed
  • avoiding the use of medications known to cause confusion
  • managing their pain, and
  • reducing hospital noise to improve their sleep.

HELP’s been beneficial for hospitals where it’s been implemented, according to another WBUR piece.

In fact, a study of the program showed that patients were 50% less likely to develop delirium or symptoms of sundowning than patients who weren’t treated using the program. Patients also had a 62% lower chance of falling while in the hospital.

Need for elder-care standards

Your nurses may be using similar tactics with elderly patients. Regardless, it’s beneficial to have a formal program in place at your hospital for elder care.

Creating a standardized protocol ensures your clinicians are on the same page regarding elder care. And chances are, having a formal process in place will improve patient outcomes – an important component of the value-based care initiatives affecting hospital reimbursement.

Plus, it’s easier to get families involved in the process if it’s standardized. They can play a critical role in keeping sundowning at bay by reinforcing the efforts of staff. In addition, they can let clinicians know about the patient’s normal behavior, which can help doctors and nurses spot any sudden changes.

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