Autumn 2026·7 min read·Bruce Tollefson, Abloom Senior Living

When the late afternoon is the hardest part of the day

Sundowning, what tends to help, and how the hours between four and eight get covered.

What it looks like

The Alzheimer's Association calls this sundowning, and describes it as increased confusion that people living with Alzheimer's and dementia may experience from dusk through night. The association counts sundowning as a group of symptoms, not a disease of its own: trouble sleeping, anxiety, agitation, pacing, hallucinations, disorientation. Mayo Clinic describes the same thing as a state of confusion that begins in the late afternoon and lasts into the night.

In a house it usually arrives as a stretch of two or three hours. Four o'clock is fine, five is worse, and by six she is following you from room to room, or she has her coat on and her car keys in her hand, or she is angry with you in a way she has never been in forty years. Some families get two difficult hours. Some get the whole evening and a broken night after it.

Most families assume at first that something they are doing at dinnertime is causing it. You are not behind for having thought that; it is where nearly everyone starts.

We are a care provider in Washington County, and this article is general information, not legal, financial, or medical advice. Ask her clinician about anything that turns on your parent's health, her medications, or her diagnosis.

What causes it

Both sources say nobody knows, which is a frustrating thing to hear when you have come looking for a reason. The Alzheimer's Association states that the exact cause is unknown, and that sundowning may occur due to disease progression and changes in the brain. Mayo Clinic puts it the same way: the exact cause of sundowning is not known.

What the sources do offer is a list of things that appear to make it worse. The Alzheimer's Association names mental and physical exhaustion from a full day of activity, low lighting and the shadows it throws, a mixed-up internal body clock, disorientation after dreaming, and picking up stress or frustration from the people nearby. Mayo Clinic's list overlaps and adds hunger and thirst, pain, boredom, depression, unfamiliar surroundings, and infections such as urinary tract infections.

Neither source can say which of those is at work in a particular house. You can usually find that out yourself in about a week.

Start with a week of notes

Before you change anything, write down when it starts and what came before it. The Alzheimer's Association suggests keeping a log of what happens before an episode so that patterns and triggers become visible.

Keep it rough. The time it started, what happened in the hour before, what she ate and when, whether she napped and for how long, who was in the house, what the light was doing. A week of notes on the back of an envelope is plenty.

Patterns turn up that nobody would have guessed. It is worse on the days after the grandchildren visit, or when the afternoon pill is two hours late, or at the moment the kitchen light goes on and the window is already black.

You do not have to fix anything during the week you spend writing it down.

Rule out the ordinary physical causes

Most families assume this is the dementia, which is a fair place to start. Check the ordinary physical causes first anyway: an infection, pain, constipation, hunger, thirst, short sleep. Several of them can be treated in a week. A urinary tract infection can leave an older adult confused and agitated without a fever and without ever complaining of pain, and Mayo Clinic lists infections such as urinary tract infections among the things that worsen late-day confusion. Pain, constipation, hunger, thirst, and short sleep are on the same list, and every one of them can be treated.

Medication timing is worth raising at the same appointment. Mayo Clinic suggests asking a clinician about the best times of day for medications, and the Alzheimer's Association says the same. If the afternoon doses are landing late because nobody is there at two o'clock, that is worth saying out loud at the appointment; sometimes the doses can be moved to a time when somebody is in the house. Our article on who can give your parent medications at home covers who is allowed to do what with a pill box in Minnesota.

What tends to help between four and eight

Neither source presents any of this as a cure. These are the measures they recommend.

Move the hard work to the morning. The Alzheimer's Association and Mayo Clinic both suggest scheduling appointments, outings, and bathing in the morning or early afternoon, while she has the most left.
Keep the late afternoon quiet. The Alzheimer's Association suggests limiting television, chores, and loud music in the evening, and Mayo Clinic suggests reducing background noise and stimulating activity. Familiar gentle music or nature sounds are on Mayo Clinic's list of things to try instead.
Feed her earlier, so the biggest meal is behind her before late afternoon. The Alzheimer's Association suggests a larger lunch and a lighter supper, and cutting back on caffeine, alcohol, and nicotine.
Turn the lights on before you need them. Low light and shadows appear on both lists. Here in December the lamps have to go on in the middle of the afternoon. Closing the curtains before the window goes black costs nothing to try, and neither does putting a second lamp in the room so the light is even. Mayo Clinic also suggests a night light.
Watch the naps, because a long one at three can cost you the night. Both sources suggest limiting daytime sleep when the nights are poor, and both suggest daylight and some movement during the day.
Keep the clock the same every day. A steady schedule for waking, meals, and bedtime is on both lists, and it is the measure that takes the longest to show results.
Raise melatonin with her clinician. Mayo Clinic notes that some research suggests a low dose of melatonin may ease sundowning. That is a question for her clinician.

The Alzheimer's Association notes that approaches other than medication are generally preferred, and that where medication is considered, the risks and benefits should be weighed with a doctor first. If the measures above do not help, that conversation is the next one to have.

Covering the hours nobody is there for

The hard stretch lands at the hour when the family has the least left to give it. Five in the afternoon is when you are driving home, or getting your own children fed, or catching up on work from the day.

Paid hours do more when they sit on the difficult stretch. A caregiver who arrives at three thirty, gets supper going, keeps the evening quiet, and stays until she is settled covers more than the same number of hours spread across a calm weekday morning. Our page on how many hours a week it really takes walks through counting that honestly.

If she is up at two, the nights work differently. Abloom Senior Living does not place a caregiver who sleeps in the house. An overnight shift is staffed by someone who stays awake for all of it, which costs more per hour than a sleeping arrangement would. Our page on overnight and around-the-clock hours explains how those shifts are built.

What the care plan should say

Nobody in Minnesota can sign your mother up over the phone, and that rule exists for your benefit. Under Minn. Stat. 144A.4791, subdivision 8, a comprehensive home care provider must have a registered nurse conduct an individualized initial assessment in person, completed within five days after services are first provided. Subdivision 9 requires the written service plan to be finalized no later than fourteen days after services begin. You can bring your questions to that visit half-formed, since working them out is part of what the nurse does while she is there.

Use that visit. Ask that the plan give a start and end time for each shift, say what the caregiver does during those hours, and say what happens when she wants to leave the house at six. Bring your week of notes to it. Ask any provider you talk to, ours included. Dementia care at home is part of what Abloom Senior Living does. Our page on what a visit looks like describes how a first one tends to go, if it helps to know before somebody is standing in the kitchen.

Free help with the rest of it

Minnesota Aging Pathways, formerly the Senior LinkAge Line, is a free statewide service of the Minnesota Board on Aging run in partnership with the state's area agencies on aging. The Board on Aging lists the number as 800-333-2433. They do not sell anything, and they will talk through housing options, insurance, and community services with you for as long as it takes. Our article on the free help available to East Metro families covers what they can and cannot do.

If you want help with the evening hours

You do not have to decide anything about the next five years to get through this week. A few covered afternoons can be stopped whenever you want, and they are often enough to tell you whether the evenings are manageable at home.

Abloom Senior Living provides in-home care in clients' own homes in Woodbury and the East Metro under a comprehensive home care license from the Minnesota Department of Health, paid privately or through long-term care insurance. If your situation needs something we do not do, or funding we do not take, we will say so on the first call and point you toward who does. You are welcome to ask for a visit at your parent's home. We also run a separate five-resident home in Woodbury, and you are welcome to come see it and ask questions in person, whether or not care at home is where you land.

Frequently asked questions

How long does sundowning last?

It varies, and no source gives a reliable timeline. In a given day it usually runs from late afternoon into the night, which is where both the Alzheimer's Association and Mayo Clinic place it. Over the course of the illness, families often find it changes as the dementia changes. Her clinician is better placed than any article to say what to expect in her case.

Is sundowning a sign that the dementia is getting worse?

Most families ask this one first. The Alzheimer's Association says sundowning may occur due to disease progression and changes in the brain, so it can accompany a change. It can also be driven by something ordinary and fixable, such as an infection, pain, hunger, or a late medication dose. Both sources list those, which is why a medical check comes before any conclusion about progression.

Should I argue with her when she says she wants to go home?

The instinct to tell her the truth is a kind one, since she is home and you want her to know it, but it tends to make her more agitated. Both sources point toward calming the environment instead: lower the noise, raise the light, put on familiar music, go for a short walk if she is steady enough. If she is leaving the house, that is a safety question of its own, and our article on wandering below covers it.

Does Medicare pay for a caregiver in the evening?

Generally no, and most families find that out later than they would like. Almost nobody is told this in advance. Medicare covers skilled home health care for a limited period under specific conditions, and ongoing personal care at home is not part of that benefit. Families pay for evening hours privately or through a long-term care insurance policy. Minnesota Aging Pathways at 800-333-2433 can walk through what a particular policy or situation allows.

Would a move to a care home fix the evenings?

Sometimes it does and sometimes it does not, because the pattern travels with the person. What a smaller setting changes is who is awake and nearby when it starts. Ask that about any specific home you are considering, and ask it early.

Sources

Sleep Issues and Sundowning, Alzheimer's Association
Sundowning: Late-day confusion, Mayo Clinic
Minn. Stat. 144A.4791, Home Care Bill of Rights; Requirements for Home Care Providers, Minnesota Office of the Revisor of Statutes
Minnesota Aging Pathways, Minnesota Board on Aging

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