My stepmom, 93 gets very agitated in the early evening and gets upset about her money, how can we handle her stress with this?

Here is a section of my book "Dementia Care Companion" related to your question. I hope it helps.

Sundowning and Nighttime Issues
Many of the symptoms of dementia tend to get worse late in the day and toward the evening. During the day the patient might be able to go about their life without too much difficulty, while in late afternoon or evening they may experience increased confusion, restlessness, and anxiety. This is known as sundowning because the confusion tends to intensify during the dusk hours.
Sundowning occurs mostly in the middle and late stages of dementia. The compounding loss of brain cells over time makes it harder for the brain to process complex visual stimuli, such as the dimming ambient light and the lengthening shadows at dusk. Destruction of neurons in the brain also disrupts the body’s internal clock, which regulates night and day cycles (circadian rhythms) and related physiological processes. The result is a variety of sleep disorders that reach well past dusk and into the night.
Most elderly people do not enjoy a continuous eight hours of sleep and may wake up several times during the night. For those suffering from dementia, these sleep breaks can be accompanied with confusion of time and place, restlessness, and other behavior disorders. For example, the patient may wake up in the middle of the night, get dressed, and leave home, believing that it is time to go to work.
Improve the Living EnvironmentEmpty heading
·      Provide adequate lighting in the patient’s living environment. Dim light makes it harder to see things, leading to confusion and anxiety.
·      At the end of the day before it gets dark outside, draw the curtains and turn on the lights to make it easier for the patient to transition from day to night.
·      Ensure a safe sleeping environment. Equip the patient’s room for comfort and safety, including comfortable temperature, nightlight, and closed and locked windows.
·      Install safety features to alert you if the patient leaves their room. You can use motion detectors, baby monitors, or similar devices.
·      Pay attention to nighttime dangers. The patient may leave home in the middle of the night and not be able to find their way back. Or they may go into the kitchen, turn on the stove, and leave.
Refine Daily Routines
·      Organize daily routines with a natural progression from morning to noon, through the dusk hours, and into the night. By the time you help the patient to bed, they should be primed and ready for a good night’s sleep.
·      Schedule adequate physical activity during the day and prevent long naps. Long naps during the day translate to difficulty sleeping at night.
·      Keep dinners light, while lunches can be more filling.
·      Avoid coffee, tea, soda, sweets, and alcohol in the evening.
·      Limit sensory stimuli during nighttime. Watch out for loud TV, noisy children, and lengthy visits from friends and relatives.
Reduce Physical and Mental DistressEmpty heading
·      Watch for signs of physical and mental distress. Hunger or thirst, uncomfortable ambient temperature, fever, constipation, itching, and infection can disrupt the patient’s sleep.
·      Do not resort to force to put the patient to bed. Restraining the patient in any way and using force will make the situation worse and lead to more anxiety and even aggression.
·      Speak gently and make the patient feel safe. Say things like: “Everything is fine,” or “Don’t worry, I will stay with you.”
·      If the patient suffers from sleep apnea (a sleep disorder in which breathing stops repeatedly during sleep), consult with your doctor.

Smorrison: Most likely this behavior is sundowners. Speak to her physician.

Discuss behavior with her MD.
Medication might help her and you want a medical diagnosis.

Perhaps offer her an early evening (before this starts) a soothing massage - shoulder rub ? foot massage ? Or a warm sponge bath / shower?

It is possible to separate them in the early evening for a while - take her for a walk - or take your dad for a walk?

What is the home dynamics? Are you / are they living with you?
Are they in a care facility and/or live at home?

Never argue with stepmom. Depending on her diagnosis, reasoning or logic generally doesn't help. If she understands a bit, tell her "I'm working on it," or anything that might appease her. If sun downers, I'd try non-verbal behaviors / distractions.

Gena / Touch Matters

So during my dad's last year, he became very focused on his money and buying a car. He was bedridden and needed 24/7 care... the nurses explained that it's a common theme among the elderly as those 2 things are a last grasp at the independence they once had. He told me that "a man needs money in his pocket". Any actual money I gave him would disappear by the next visit, so I solved the problem by purchasing movie prop money on Amazon! I took a bag full of this fake money with me and the instant he asked for his money,. I pulled it out and said I am protecting your money, but if you want I will leave this here for you. Bag was stuffed with fake $100 bills but let me tell you, thIs stuff looks REAL.
He was so happy but then told me keep it so nobody could steal it from him. I gave him $400 for his pocket money and put it back in my purse. He would still ask but when i'd pull it out he was satisfied. I shared with the nurses for their other elderly patients too.
As for the car..I told him I would take $50k pf his "money" and give get a car because prices had gone up. He immediately decided he didn't need a car so that was that. This man never paid more than $18k for a car in his life.. moral of the story is for you not to get upset or stressed..but get creative in dealing with a dementia patient..

This is something that doesn't have a one-size-fits-all solution, and there are times it has no solution at all. I had an uncle who focused on money a lot throughout his life, and in the dementia he eventually had it was a nightmare of worrying about money; it is a common obsession.

Some fixations can be dealt with or lessened in trial and error medications through an MD. This often requires a specialist in neuro-psyc following his or her complete evaluation.

Just know you aren't alone. This paranoia about finances is common. And seek help through the medical team. At the point that there is no solution to this compulsive behavior placement can become a necessity for the mental health of all. I am so sorry.

Talk to her about her money. Why is she upset up about it? Does she not have access to it? Show her bank account, brokerage, retirement accounts, social security checks to put her at ease. Give her some cash, put it in her purse, let her count it, so she feels like she is not dependent, even though she might be.

The only thing that helps with my dad, who had similar concerns about finances, is Seroquel.

He still talks about work, but hasn't gotten anxious about money in a long time.

Seroquel helps him sleep and lessens his agitation and worry. Seroquel has made a world of difference.

Is she on meds for depression, anxiety or agitation? My Mom (96) benefitted a lot from the minimum dose of Lexapro, prescribed by her primary care doc.

If this is a "suddenly" new behavior, it may be a UTI, so she should get checked for this.

Does your Mom have a formal diagnosis of cognitive and/or memory impairment?

Does your Mom have a PoA?

https://www.agingcare.com/topics/19/sundowners-syndrome

The best defense is a good (and early) offense... your Dad needs to be intentional about heading off the behaviors.

- replace lightbulbs with daylight spectrum brightness and turn them on before dusk in the areas where you Mom is present (tv room, hallways, bathroom, bedroom, etc).

- he starts to distract her before The Witching Hour with a walk outside, a board or card game (rules don't matter), an activity (food prep, folding laundry, etc.)

- he doesn't try to reason against her paranoia, he instead tries to calm her by telling therapeutic fibs: "I''m concerned, too... I'll look into this first thing tomorrow." Then he keeps changing the subject no matter how many times she tries to return to it. It won't be easy but it will be necessary.

More information would be helpful.