by National Institute on Aging

Late afternoon and early evening can be difficult for some people with Alzheimer’s disease. They may experience sundowning—restlessness, agitation, irritability, or confusion that can begin or worsen as daylight begins to fade—often just when tired caregivers need a break.Woman with Alzheimer’s experiencing sundowning

Sundowning can continue into the night, making it hard for people with Alzheimer’s to fall asleep and stay in bed. As a result, they and their caregivers may have trouble getting enough sleep and functioning well during the day.

Possible causes

The causes of sundowning are not well understood. One possibility is that Alzheimer’s-related brain changes can affect a person’s “biological clock,” leading to confused sleep-wake cycles. This may result in agitation and other sundowning behaviors.

Other possible causes of sundowning include:

• Being overly tired
• Unmet needs such as hunger or thirst
• Depression
• Pain
• Boredom
• Coping with sundowning

Do’s and Dont’s: Communicating with a Person Who Has Alzheimer’s Disease infographic. Click to open page with infographic.

​Read and share this infographic about how to communicate with a person who has Alzheimer’s disease.

Look for signs of sundowning in the late afternoon and early evening. These signs may include increased confusion or anxiety and behaviors such as pacing, wandering, or yelling. If you can, try to find the cause of the person’s behavior.

If the person with Alzheimer’s becomes agitated, listen calmly to his or her concerns and frustrations. Try to reassure the person that everything is OK and distract him or her from stressful or upsetting events.

You can also try these tips:

• Reduce noise, clutter, or the number of people in the room.
• Try to distract the person with a favorite snack, object, or activity. For example, offer a drink, suggest a simple task like folding towels, or turn on a familiar TV show (but not the news or other shows that might be upsetting).
• Make early evening a quiet time of day. You might play soothing music, read, or go for a walk. You could also have a family member or friend call during this time.
• Adjust lighting, letting in natural light during the day, if possible, and try softer room lighting in the evening.

Preventing sundowning

Being too tired can increase late-afternoon and early-evening restlessness. Try to avoid this situation by helping the person:

• Go outside or at least sit by the window—exposure to bright light can help reset the person’s body clock
• Get physical activity or exercise each day
• Get daytime rest if needed, but keep naps short and not too late in the day
• Get enough rest at night
• Avoid things that seem to make sundowning worse:
• Do not serve coffee, cola, or other drinks with caffeine late in the day.
• Do not serve alcoholic drinks. They may add to confusion and anxiety.
• Do not plan too many activities during the day. A full schedule can be tiring.

If problems persist

If sundowning continues to be a problem, seek medical advice. A medical exam may identify the cause of sundowning, such as pain, a sleep disorder or other illness, or a medication side effect.

If medication is prescribed to help the person relax and sleep better at night, be sure to find out about possible side effects. Some medications can increase the chances of dizziness, falls, and confusion. Doctors recommend using them only for short periods of time.

by National Institute on Aging

During an emergency or at the end of life, you may face questions about their medical treatment and not be able answer them. You may assume your loved ones know what you would want, but that’s not always true. In one study, people guessed nearly one out of three end-of-life decisions for their loved one incorrectly.

Research shows that you are more likely to get the care you want if you have conversations about your future medical treatment and put a plan in place. It may also help your loved ones grieve more easily and feel less burden, guilt, and depression.

What is advance care planning?

Advance care planning involves discussing and preparing for future decisions about your medical care if you become seriously ill or unable to communicate your wishes. Having meaningful conversations with your loved ones is the most important part of advance care planning. Many people also choose to put their preferences in writing by completing legal documents called advance directives.

Cover of advanced care planning guide publication.

Advance Care Planning: A Conversation Guide

Want to learn more about advance care planning? NIA’s guide offers conversation tips, worksheets, and more.

What are advance directives?

Advance directives are legal documents that provide instructions for medical care and only go into effect if you cannot communicate your own wishes.

The two most common advance directives for health care are the living will and the durable power of attorney for health care.

Living will: A living will is a legal document that tells doctors how you want to be treated if you cannot make your own decisions about emergency treatment. In a living will, you can say which common medical treatments or care you would want, which ones you would want to avoid, and under which conditions each of your choices applies. Learn more about preparing a living will.

Durable power of attorney for health care: A durable power of attorney for health care is a legal document that names your health care proxy, a person who can make health care decisions for you if you are unable to communicate these yourself. Your proxy, also known as a representative, surrogate, or agent, should be familiar with your values and wishes. A proxy can be chosen in addition to or instead of a living will. Having a health care proxy helps you plan for situations that cannot be foreseen, such as a serious car accident or stroke. Learn more about choosing a health care proxy.

Think of your advance directives as living documents that you review at least once each year and update if a major life event occurs such as retirement, moving out of state, or a significant change in your health.

Who needs an advance care plan?

Advance care planning is not just for people who are very old or ill. At any age, a medical crisis could leave you unable to communicate your own health care decisions. Planning now for your future health care can help ensure you get the medical care you want and that someone you trust will be there to make decisions for you.

Clonal hematopoiesis of indeterminate potential (CHIP), a condition that changes the DNA of some blood cells and increases the risk for blood cancers and cardiovascular disease, may reduce a person’s risk of developing Alzheimer’s disease. This finding from an NIA-funded study published recently in Nature Medicine may provide new insights into the role that blood cells play in brain health.

Blood cells live short lives and must be continuously replaced. The process of producing new blood cells is called hematopoiesis and occurs in the bone marrow. As blood cells are depleted, a pool of cells in the bone marrow called hematopoietic stem cells (HSCs) multiply to replenish them. Normally, tens of thousands of HSCs grow up to be exact copies of the replaced blood cells. In CHIP, however, the genes of some hematopoietic stem cells change and produce slightly different blood cells.

People with CHIP can live for many years but have an increased risk for blood cancer and cardiovascular disease compared to people without CHIP. The condition is common in older adults, and researchers estimate that 10% to 30% of people over 70 years old have CHIP. While most research on this condition has focused on how it affects cardiovascular health, its effect on the brain is not yet well understood. To address this gap, a research team led by Stanford University scientists is exploring how CHIP influences Alzheimer’s risk in older adults.

In this study, the scientists analyzed blood samples from 1,362 people with Alzheimer’s and 4,368 people without the disease. Then they sequenced the DNA from the blood cells to determine who had CHIP. Remarkably, the researchers found that people with CHIP had a reduced risk of developing Alzheimer’s.

Next, the team sequenced the DNA from the microglia of the brains of eight people with CHIP. As the brain’s immune cells, microglia play a central role in brain function and health. In Alzheimer’s, microglia fail to perform their job, instead damaging neurons they are meant to protect. For seven of these individuals, the researchers found microglia in the brain that carried the same CHIP variant in the blood cells. While not conclusive, this suggests that some of these variant blood cells migrate to the brain and may support microglial function.

Overall, these findings suggest that CHIP may provide some protection from Alzheimer’s. Future studies will explore the differences between the brain’s immune cells that carry CHIP variants and those that do not. Understanding why CHIP is linked to reduced Alzheimer’s risk could uncover new insights into slowing the progression of the disease.

This research was supported in part by NIA grants AG053959, AG077443, AG066849, AG059727, and AG052409.

These activities relate to NIH’s AD+ADRD Research Implementation Milestone 1.A, “Enable precision medicine research by supporting deep and longitudinal molecular endophenotyping of existing and new at-risk cohorts as well cohorts and/or individuals who resist disease despite high genetic risk (e.g. Down Syndrome, ApoE 4 homozygous, FAD mutation carriers).”

Reference: Bouzid H, et al. Clonal hematopoiesis is associated with protection from Alzheimer’s disease. Nature Medicine. 2023. Epub June 15. doi: 10.1038/s41591-023-02397-2.

by Bob Warnagieris, Ed.D.

Longevity has become a rather lively topic these days. Most people are interested in how they can be healthy, deal with stress, offset genetic surprises and enjoy their “Golden Years”. Definitely a positive venture, taking the steps early in life to achieve longevity. It’s reported that many people remain cognitively sharp, have decent short-and-long term memories, and have sufficient energy to pursue a rather vigorous life into their 80’s and beyond.

Improving one’s longevity prospects can be benefit by pursuing 6 major factors to reach and advanced the age of 80 and beyond. The 6 factors include (1) Genetics, knowing your family medical history and your ethnic factors; (2) Nutrition, paying attention to diet, weight control, natural vs processed foods, and cultural habits; (3) Physical activity, the benefits of exercise including aerobics, flexibility, strength and balance; (4) Regular Medical Care, consisting of primary physician and specialists, drugs and supplements, and alternative medicine; (5) Psychological Factors, including stress, spiritual needs, relationships and social connection; (6) Avoidance of known high risks, examples include smoking, alcohol, substance abuse and dangerous activities.

In a recent article, the AARP Bulletin of November 2023 cites the 7 Secrets of the Super Agers, i.e., 90 to 100. The 7 secrets include (1) Controlling blood sugar and blood pressure, (2) Talking to their friends a lot, (3) Avoiding stress and prioritize mental health, (4) Prioritizing sleep, (5) Protecting their vision and hearing (we should add teeth to that), (6) Not exercising more, but pushing themselves physically, (7) Doing more puzzles and Sudoku games than normal seniors. There’s a lot more detail that could be added to these “Secrets”, but suffice to say they all generally represent something most of us can learn about and do if so motivated.

The question then becomes, “Who’s Motivated?” Often seniors say, “Oh, I wouldn’t want to live to be 100.” If one has a genetic defect, a chronic disease or life-threatening malady, it is certainly understandable that suffering into the 90’s and beyond may just not be worth the effort or the accompanying discomfort. These are all very personal factors and decisions. Yet, for those that chose to achieve longevity, the practices mentioned above can greatly improve the quality of life while they are here, however long that may be.

Here’s what one might expect upon reaching the 80th year. More medical issues to address than what you had in the previous 80 years. Plenty of surprises, deficiencies, reduction in mobility and energy, susceptibility to the latest virus, hearing and eyesight decline, teeth implants, aches and pains that just don’t go away, etc. will be in your future. The good news is that soon you will realize that your longevity and enjoyment of life can be improved with some effort. However, for most of us, the late-life years, will also be fraught with health issues, medical appointments, and more pharmaceuticals than you can imagine. Frankly, it takes a lot of work to stay alive after 80.

The City of Ventura invites the community to contribute gift donations for the Santa to a Senior program running until December 14, 2023. The initiative aims to bring holiday cheer to seniors aged 60 and above, affiliated with the Ventura Avenue Adult Center’s Senior Nutrition Program. This program caters to seniors through both in-person meals and homebound deliveries.

“This marks our fifth year running Santa to a Senior, and we’ve made updates to the program to better serve the more than 200 seniors who participate annually,” said Recreation Manager Emily Fox. “To ensure everyone feels the joy of receiving a gift this season, we kindly ask that the community choose items from our gift wish list. Your thoughtful contributions will make a meaningful difference in spreading holiday cheer to the seniors participating.”

The pre-approved Santa to a Senior gift wish includes:

• $25 Gift Card (major grocery/pharmacy/retail stores)
• Bath/Hand Towels
• Gloves/Scarf (unisex)
• Nail Trimmer/Manicure Tools
• Non-slip Socks (unisex)
• Soaps/Lotions/Scrubs
• Blanket (unisex)
• Toiletry Items (unisex)

To donate to the Santa to a Senior program, visit the holiday display tree to choose a gift. Trees are located at City Hall Room 226 and the Ventura Aquatic Center.

Participants can also purchase a gift from the pre-approved wish list and deliver it to one of the designated drop-off locations. New, unwrapped gifts can be dropped off at Ventura City Hall, Ventura Aquatics Center, Ventura Avenue Adult Center, and Barranca Vista Center.

Visit www.cityofventura.ca.gov/SantatoaSenior for complete program details or call the Parks and Recreation Department at (805) 658-4726.

Older people tend to go to sleep earlier and get up earlier than they did when they were younger.

There are many reasons why older people may not get enough sleep at night. Feeling sick or being in pain can make it hard to sleep. Some medicines can keep you awake. No matter the reason, if you don’t get a good night’s sleep, the next day you may:

Be irritable

Have memory problems or be forgetful

Feel depressed

Have more falls or accidents

Being older doesn’t mean you have to be tired all the time. You can do many things to help you get a good night’s sleep. Here are some ideas:

Follow a regular sleep schedule. Go to sleep and get up at the same time each day, even on weekends or when you are traveling.

Avoid napping in the late afternoon or evening, if you can. Naps may keep you awake at night.

Develop a bedtime routine. Take time to relax before bedtime each night. Some people read a book, listen to soothing music, or soak in a warm bath.

Try not to watch television or use your computer, cell phone, or tablet in the bedroom. The light from these devices may make it difficult for you to fall asleep. And alarming or unsettling shows or movies, like horror movies, may keep you awake.

Keep your bedroom at a comfortable temperature, not too hot or too cold, and as quiet as possible.

Use low lighting in the evenings and as you prepare for bed.

Exercise at regular times each day but not within 3 hours of your bedtime.

Avoid eating large meals close to bedtime—they can keep you awake.

Stay away from caffeine late in the day. Caffeine (found in coffee, tea, soda, and chocolate) can keep you awake.

Remember—alcohol won’t help you sleep. Even small amounts make it harder to stay asleep.

Insomnia Is Common in Older Adults is the most common sleep problem in adults age 60 and older. People with this condition have trouble falling asleep and staying asleep. Insomnia can last for days, months, and even years.

Often, being unable to sleep becomes a habit. Some people worry about not sleeping even before they get into bed. This may make it harder to fall asleep and stay asleep.

Some older adults who have trouble sleeping may use over-the-counter sleep aids. Others may use prescription medicines to help them sleep. These medicines may help when used for a short time. But remember, medicines aren’t a cure for insomnia.

Restless legs syndrome, periodic limb movement disorder, and rapid eye movement sleep behavior disorder are common in older adults. These movement disorders can rob you of needed sleep.

People with restless legs syndrome, or RLS, feel like there is tingling, crawling, or pins and needles in one or both legs. This feeling is worse at night.

Some people find that relaxing their bodies puts them to sleep. One way to do this is to imagine your toes are completely relaxed, then your feet, and then your ankles are completely relaxed. Work your way up the rest of your body, section by section. You may drift off to sleep before getting to the top of your head.

Use your bedroom only for sleeping. After turning off the light, give yourself about 20 minutes to fall asleep. If you’re still awake and not drowsy, get out of bed. When you feel sleepy, go back to bed.

If you feel tired and unable to do your activities for more than 2 or 3 weeks, you may have a sleep problem. Talk with your doctor about changes you can make to get a better night’s sleep.

Dementia Friendly Ventura County’s next one-stop workshop to help people living with a dementia-related disease and their caregivers is scheduled for Wednesday, December 6, at Oxnard Family Circle.

The public is encouraged to stop by anytime during the “Living Well, Caring Well” event and meet with many local providers who can assist with dementia-related issues, including adult day centers, adult protective services, the Alzheimer’s Association, caregiver resources, financial resources, in-home care, health insurance counseling and advocacy, legal and advanced planning, long-term care ombudsman, neurology, and public benefit programs.

The December 6 workshop will be held from 2 to 4 p.m. at Oxnard Family Circle, which is located at 2100 Outlet Center Drive #380.

For more information, email [email protected] or call (805) 477-7300.