An Ignored Subject in Dementia Patients: Sundowning Syndrome and Nursing Approaches

Year 2021, Volume: 37 Issue: 1, 79 - 86, 27.04.2021

Öznur Erbay , Ayfer Karadakovan

Abstract

Neuropsychiatric symptoms are exacerbated in the early hours of the evening or in the afternoon, especially in people with dementia, which is defined as “Sundowning Syndrome”. Although this syndrome has been described in the literature a long time ago, it has been ignored. However, the lack of evidence-based studies on the subject is insufficient to determine the clinical features and prevention strategies. This affects both the patient and the caregiver and in particular contributes negatively to the caregiver burden. Sundowning syndrome, in which behavior such as disorientation, confusion, agitation, restlessness and wandering occurs, is mostly confused with delirium. Unlike delirium, however, it is seen that the sundowning continues for a longer period of time and the same behavior occurs especially in the early hours of the evening.
Early detection of Sundowning syndrome symptoms will help reduce the burden of both the demented individual and the caregiver. Therefore, it is necessary to adopt a multidisciplinary team approach. Nurses in this team have important duties. When nurses meet a patient with dementia, they should include observations that give a clue to Sundowning syndrome to the classic nursing assessment. This will help in the early recognition of many neuropsychiatric symptoms, including Sundowning.
In this review, it is aimed to present clinical features, pathophysiology, treatment management and nursing approaches of Sundowning syndrome and to guide nurses and other health professionals related to the subject considering the deficiency in the literature.

Demans Hastalarında Gözardı Edilen Bir Konu: Gün Batımı Sendromu ve Hemşirelik Yaklaşımları

Abstract

Akşamın erken saatleri veya öğleden sonra, özellikle demanslı bireylerde nöropsikiyatrik semptomlar şiddetlenmekte ve bu durum “Gün Batımı Sendromu” olarak tanımlanmaktadır. Bu
sendrom literatürde uzun zaman önce tanımlamasına rağmen gözardı edilen bir alan olmuştur. Bununla birlikte konuyla ilgili kanıta dayalı çalışmaların eksikliği, klinik özelliklerini ve önleme stratejilerini belirlemede yetersiz kalmaktadır. Bu durum hem hastayı hem de bakım vericisini etkilemekte ve özellikle bakım veren yüküne olumsuz yönde katkı sağlamaktadır. Oryantasyon bozukluğu, konfüzyon, ajitasyon, huzursuzluk, anlamsız gezinme gibi davranışların ortaya çıktığı gün batımı sendromu daha çok deliryumla karıştırılmaktadır. Ancak deliryumun aksine, gün batımının daha uzun bir süre devam ettiği ve özellikle akşamın erken saatlerinde aynı davranışların ortaya çıktığı görülmektedir. Gün batımı sendromu belirtilerini erkenden tespit etmek, hem demanslı bireyin hem de bakım vericisinin yükünü azaltmaya yardımcı olacaktır. Bu nedenle multidisipliner bir ekip anlayışı benimsenmesi gereklidir. Bu ekipte yer alan hemşirelere önemli görevler düşmektedir. Hemşireler demanslı hasta ile karşılaştığında, klasik hemşirelik değerlendirmesine gün batımı sendromuna yönelik ipucu veren gözlemleri de eklemelidir. Böylece gün batımı sendromu da dahil birçok nöropsikiyatrik semptomun erken tanınmasına yardımcı olacaktır. Bu derlemede literatürdeki eksiklik göz önünde bulundurularak, gün batımı sendromunun klinik özellikleri, patofizyolojisi, tedavi yönetimi ve hemşirelik yaklaşımlarını sunmak, konu ile ilgili hemşirelere ve diğer sağlık profesyonellerine rehber olmak amaçlanmıştır.

Keywords

Gün batımı sendromu, demans, hemşirelik

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