Sundowning: Calm Late-Afternoon Activities for People with Dementia

Many families notice the same pattern: mornings are fairly settled, but as the afternoon wears on, the person living with dementia becomes restless, anxious, confused or irritable. They may pace, ask to “go home” even when they are home, or become upset easily. This is often called sundowning.

There is no single fix, but changes to the day’s rhythm, the room and the kind of activities you offer may make late afternoons calmer. This page gathers practical, non-medical ideas from the National Institute on Aging and the Alzheimer’s Association. It is not medical advice. If symptoms are new, sudden or getting worse, talk with the person’s doctor.

What is sundowning?

Sundowning is restlessness, agitation, irritability or confusion that begins or gets worse as daylight fades, in the late afternoon or early evening. The National Institute on Aging (NIA) notes that being overly tired can increase late-day restlessness.

What can make late-day restlessness worse?

Several things may contribute, often together. The Alzheimer’s Association lists factors such as:

• exhaustion after a full day;
• new or confusing surroundings;
• an “internal body clock” that is out of step, leaving the person sleepy by day and awake at night;
• low light and shadows, which can be confusing;
• picking up on stress or frustration from people around them;
• needing less sleep, which is common in older adults.

The NIA adds causes of agitation more generally, including pain, depression or stress, too little rest, constipation, too much noise or too many people, and certain medicines or medicine interactions.

How can I plan the day to make evenings calmer?

Shift demanding things earlier and keep the late afternoon gentle and predictable. Both the NIA and the Alzheimer’s Association recommend a regular routine. A sample day, to adapt to your own:

A few specific points from the sources:

• Daylight. The NIA suggests arranging time outside or by a window for sunlight each day.
• Daily movement, but not too much. Aim to be physically active each day without planning too many activities, says the NIA.
• Late-day drinks. Avoid alcohol and drinks with caffeine, such as coffee or cola, late in the day (NIA). The Alzheimer’s Association also mentions nicotine.
• Naps. Discourage long naps and dozing late in the day (NIA). The Alzheimer’s Association suggests limiting daytime naps if nighttime sleep is a problem.

For more on building a steady day, see daily routine activities.

How can I make the home calmer in the late afternoon?

Reduce noise, add light and keep familiar things close.

• Bright, even lighting. The Alzheimer’s Association recommends keeping the home well lit in the evening. Light the space before shadows appear.
• Less noise. Turn off or lower the TV and radio, and limit visitors or busy household jobs at this time. The Alzheimer’s Association suggests reducing evening stimulation such as TV, chores and loud music.
• Familiar comforts. The NIA suggests soothing music and keeping well-loved objects and photos around the home.
• Comfort checks. The Alzheimer’s Association recommends checking for pain, hunger, thirst, constipation, a full bladder, tiredness, infections and skin irritation, and keeping the room at a comfortable temperature.
• Your own mood. People pick up on stress. The NIA suggests slowing down and trying to relax if your own worries may be adding to the tension.

What calm activities can we do in the late afternoon?

Choose activities that are familiar, unhurried and easy to stop. The Alzheimer’s Association suggests soothing activities such as calm music, photos or a favorite movie, and a walk together to ease restlessness. The NIA suggests a snack or drink, a favorite TV show, music, a walk, reading, or a simple household chore like folding laundry.

Ideas to try:

1. Fold laundry together. The NIA suggests this kind of simple household chore. Towels are easy to handle, and the task has a clear end.
2. Play favorite music. Familiar songs from their younger years, at a low volume. Humming along counts. More ideas in music activities.
3. Look at photos. A photo album, or a few family pictures in Photo Pairs with the pictures left visible, can lead to quiet conversation.
4. Take a short walk. Around the garden, the block or a hallway, before it gets dark.
5. Share a snack and a drink. Something simple, warm and caffeine-free, at the table together.
6. Gentle matching. Picture Pairs with four tiles and pictures visible is easy to start and easy to stop.
7. Coloring. Coloring on screen or on a printed page, with no goal of finishing.
8. Looking and talking. Conversation Cards offer a picture and an open prompt. Simply looking is enough.
9. A breathing pause. Calm Breathing is a slow, quiet pause you start and stop yourself.
10. Hand tasks. Sorting buttons or socks, smoothing a soft blanket, or holding a familiar object. See sensory activities.

Avoid new games, busy outings and anything that asks a lot of memory or concentration late in the day. Save those for the morning.

What should I do when restlessness starts?

Stay calm, reassure, and gently redirect. The NIA suggests speaking calmly, listening to the person’s concerns, avoiding arguments, reassuring them that they are safe, and using gentle touch if it helps. Then try a distraction: a snack, a drink, music or a walk.

The Alzheimer’s Association suggests phrases like “You’re safe here” and “I’m sorry that you are upset,” and advises adding light, slowing down and limiting stimulation. Do not corner, crowd or restrain the person, or argue with them.

If the person becomes aggressive, the NIA advises staying at a safe distance until the behavior stops. In an emergency, call 911 and explain that the person has dementia.

Our guides on communication and what to do when they say no have more on calming words.

How do I find the triggers?

Keep a short log for a week or two. The Alzheimer’s Association recommends tracking what happens before sundowning episodes to identify triggers. Note the time restlessness began, what happened in the hour before, naps, meals and drinks, visitors, noise and light. Bring the log to the doctor. The NIA notes that keeping track of behavior changes can help caregivers and health care providers recognize a pattern.

When should I call a doctor about sundowning?

Contact the person’s doctor if restlessness is new, suddenly worse, or comes with other changes. The NIA says sudden or rapidly fluctuating changes in behavior, especially after an infection or recent medication changes, should be brought to a doctor’s attention immediately.

Ask the doctor to check for things that can make evenings harder. The Alzheimer’s Association mentions physical problems such as urinary tract infections, incontinence, restless legs and sleep apnea, and suggests asking which times of day are best for each medicine. The NIA lists pain, constipation and medicine side effects or interactions among possible causes of agitation.

The Alzheimer’s Association says non-drug approaches are generally preferred for sleep problems linked to Alzheimer’s, and that medicine for late-day agitation should be considered only if those fail, after weighing risks and benefits. That decision belongs with the doctor. Do not start, stop or change any medicine, sleep aid or supplement without medical advice.

How do I get through the evenings myself?

Late afternoons can be the hardest part of a caregiver’s day. If you can, ask a family member, friend or paid helper to cover the late afternoon a few days a week, even for an hour. Our guide to caregiver self-care lists respite options and the free Alzheimer’s Association 24/7 Helpline.