Mom is experiencing "sundowning" more often now, usually 3x a week. Any advice?

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The nursing home calls me to talk to her when she is crying hysterically. I cannot always calm her and they usually end up giving her an extra dose of her meds (at my request). Why can't they just give her the meds and calm her; what can I do from home. I cannot run up there every time they cannot calm her down. She thinks someone is hurting my grandchildren, or she says they are taking her away, or sometimes just cannot stop crying. Has anyone else experienced this? She is already on medication for anxiety and they administer a gel (ABH ?) to help calm her when all else fails. What other options are there at this point in dementia? She also is being treated for past seizures and a prior "mini" stroke. She is immobile due to a broken kneecap for which she refused surgery and/or PT. She is 92 and hardly eats any food, but drinks her nectar and always eats a chocolate or two each day. I keep her calm when I visit by bringing photo albums, which she loves to look at. Otherwise, her days are "empty"; no other family members will visit her and I am an only child. It is so sad to hear her when she gets like this.

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Since the med angle has been very nicely covered, I offer this. I'm an only child too, and nobody but me ever visits my mom (even when she lived 5 miles from her sisters!)

I would look to see if the facility is really the right one. It made all the difference to shift my mom into a psychiatric memory care unit vs. the generic nursing home unit she had been. The memory care staff were trained to prevent & handle these behaviors, unlike the people on the generic care unit. When mom moved, I stopped getting those phone calls. Frankly, I am the last person on the earth who can calm her down, so that angle was never going to work!

The area she is in now is very well lit until bedtime, when everybody is in bed. Lighting helps a lot. They have a daily schedule with Sundowners in mind, since everybody there has it. It's pretty quiet in general, less commotion, less noise, all intended to keep the calm.

Calling you to come fix it is lame in my opinion. The facility should have a plan already, and staff who know what it is and how to use it. Her doctor needs to be apprised of these incidents, their frequency, severity, & duration simply to rule out anything else.
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I agree with you about why the staff can't handle the situation on their own. My loved one was formerly at an Assisted Living facility who chose to call me to handle the matter instead of doing it themselves. It's very disturbing and difficult to do when you have a job. Often calming words or redirecting can make a big difference.

Some things that helped my loved one were antidepressants. She went on Cymbalta and it made a huge difference. They did try Valium for her anxiety, but it did not work very well at all and I was told that it is not advisable for Alzheimers, but I have no independent knowledge of that. Once that was removed, she improved with the Cymbalta.

The biggest change was due to me moving my loved one to a new facility that was better equipped to handle her. For some reason they are more compassionate and know how to address her if she gets anxious or resistant, without calling me every day. She's much happier and I can sleep at night and not jump every time the phone rings. I know it's not easy to move someone in a NH though. Another thing I would suggest is to see who is working when your mom gets anxious. I noticed that it seemed to be certain ones that triggered my cousin. Maybe it was a coincidence, but I think some staff members who are on duty aren't as equipped as others.

What if you spoke with someone about going to sit or read to your mom at a time before the sun downing starts. I know that there are volunteers from several churches who would go to visit anyone who needed a visitor. They went to see my cousin, because I thought it would help her. The ones in my area don't charge any fees for this. It might be worth a try. Good luck. I know this is so stressful. Hopefully, it will improve.
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Anxiety meds like Ativan work quickly but don't last more than 4 hours. Dementia often requires an SSRI as well, but it takes about a month to be fully effective. ABH PLO Topical Gel has mixed reviews. Ingredients and/or Strength: Lorazepam 1 mg/mL Diphenhydramine 12.5 mg/mL Haloperidol 2 mg/mL. Obviously this approach is not working for her, so I would ask the MD if an extended release product like Klonopin twice a day would be better.
The idea is to PREVENT the sundowning, because once the patient is hysterical, the stress hormones are pumping around and control is lost.
Also be mindful of her chocolate consumption, chocolate is very stimulating and can launch a mood similar to caffeine rage and precipitate seizure activity.
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