"Sundowning" in demented individuals, as distinct clinical phenomena, is still open to debate in terms of clear definition, etiology, operationalized parameters, validity of clinical construct, and interventions. In general, sundown syndrome is characterized by the emergence or increment of neuropsychiatric symptoms such as agitation, confusion, anxiety, and aggressiveness in late afternoon, in the evening, or at night. Sundowning is highly prevalent among individuals with dementia. It is thought to be associated with impaired circadian rhythmicity, environmental and social factors, and impaired cognition. Neurophysiologically, it appears to be mediated by degeneration of the suprachiasmatic nucleus of the hypothalamus and decreased production of melatonin. A variety of treatment options have been found to be helpful to ameliorate the neuropsychiatric symptoms associated with this phenomenon: bright light therapy, melatonin, acetylcholinesterase inhibitors, N-methyl-d-aspartate receptor antagonists, antipsychotics, and behavioral modifications. To decrease the morbidity from this specific condition, improve patient's well being, lessen caregiver burden, and delay institutionalization, further attention needs to be given to development of clinically operational definition of sundown syndrome and investigations on etiology, risk factors, and effective treatment options.
Alzheimer Disease ; Antipsychotic Agents ; Anxiety ; Caregivers ; Cholinesterase Inhibitors ; Circadian Rhythm ; Cognition ; Dementia ; Dihydroergotamine ; Humans ; Hypothalamus ; Institutionalization ; Melatonin ; N-Methylaspartate ; Phototherapy ; Risk Factors ; Suprachiasmatic Nucleus

Dementia caregivers suffer a considerable care burden. They are confronted with a high rate of economic burden, psychological morbidity, social isolation, physical ill-health and financial hardship. Although many researchers have tried to determine the influence of the stressors in dementia caregiving on caregivers, the results remain inconclusive. However, many kinds of psychosocial interventions have been demonstrated to reduce caregivers'psychological symptoms and delay nursing home admission. Caregiver characteristics rather than objective care needs tend to be responsible for a caregiver's psychological symptoms. Future research should focus on individualizing treatment approach and developing partnerships with health professionals as well as disseminating general information about dementia caregiving.
Aged ; Caregivers ; Dementia ; Health Occupations ; Humans ; Nursing Homes ; Social Isolation

Horticulture therapy employs plants and gardening activities in therapeutic and rehabilitation activities and could be utilized to improve the quality of life of the worldwide aging population, possibly reducing costs for long-term, assisted living and dementia unit residents. Preliminary studies have reported the benefits of horticultural therapy and garden settings in reduction of pain, improvement in attention, lessening of stress, modulation of agitation, lowering of as needed medications, antipsychotics and reduction of falls. This is especially relevant for both the United States and the Republic of Korea since aging is occurring at an unprecedented rate, with Korea experiencing some of the world's greatest increases in elderly populations. In support of the role of nature as a therapeutic modality in geriatrics, most of the existing studies of garden settings have utilized views of nature or indoor plants with sparse studies employing therapeutic gardens and rehabilitation greenhouses. With few controlled clinical trials demonstrating the positive or negative effects of the use of garden settings for the rehabilitation of the aging populations, a more vigorous quantitative analysis of the benefits is long overdue. This literature review presents the data supporting future studies of the effects of natural settings for the long term care and rehabilitation of the elderly having the medical and mental health problems frequently occurring with aging.
Aged ; Aging ; Antipsychotic Agents ; Dementia ; Dihydroergotamine ; Gardening ; Geriatrics ; Horticultural Therapy ; Humans ; Korea ; Long-Term Care ; Mental Health ; Quality of Life ; Republic of Korea ; United States