Sundowning & Late Afternoon Confusion: Environmental Strategies
Sundowning -- the increase in confusion, agitation, and anxiety that many people with dementia experience in the late afternoon and evening -- is one of the most challenging aspects of care. Environmental design, including lighting and signage, offers practical strategies to reduce its impact.
Sundowning affects an estimated 20-45% of people living with dementia, typically manifesting as increased confusion, restlessness, agitation, or anxiety during the late afternoon and early evening hours. While the exact mechanisms are not fully understood, research from the Alzheimer's Society and the University of Stirling points to a combination of factors: disruption of circadian rhythms, fatigue accumulated during the day, reduced lighting as natural daylight fades, and the increased difficulty of navigating an environment that becomes visually more challenging as light levels drop. Environmental design cannot eliminate sundowning, but it can significantly reduce its triggers and severity.
How Lighting Influences Sundowning#
As natural daylight fades in the late afternoon, the care home environment changes in ways that can disorient residents. Shadows lengthen, contrast between objects diminishes, and familiar visual landmarks become less distinct. For a person with dementia whose contrast sensitivity is already impaired, this transition from daylight to artificial light can make the environment feel suddenly unfamiliar and threatening. The DSDC recommends maintaining light levels of at least 300 lux in corridors and communal areas during evening hours, with gradual transitions rather than abrupt changes from bright to dim lighting.
Environmental strategies for managing sundowning:
- Increase artificial lighting gradually before natural light begins to fade, preventing a sudden drop in visibility
- Use warm-toned lighting (2700-3000K) in communal areas during evening hours to create a calm atmosphere
- Ensure signage remains clearly visible under artificial lighting -- matt or satin finishes prevent glare from overhead lights
- Position illuminated or high-contrast signs at key navigation points including toilets, bedrooms, and lounges
- Reduce visual clutter in corridors during evening hours by closing unnecessary doors and minimising distracting stimuli
- Create a calm, well-lit activity area where residents can engage in soothing activities during the sundowning period
- Use consistent evening routines supported by environmental cues -- the dining room sign visible from the lounge signals that supper is approaching
Signage That Works After Dark#
Many care homes invest in excellent daytime signage only to find that it becomes ineffective in the evening when sundowning peaks. Signs positioned on walls that are brightly lit by windows during the day may be in shadow by 4pm in winter. Signs with colours that provide strong contrast under natural light may appear washed out under fluorescent tubes. A signage audit should always be conducted at different times of day, including the late afternoon period when sundowning is most likely. The most effective signs maintain high contrast under all lighting conditions -- this is one of the criteria assessed during DSDC accreditation.
Pro Tip
Conduct your signage audit at 4-5pm during winter months. Walk the building and note which signs are difficult to read under artificial lighting. Consider adding supplementary lighting, such as LED picture lights above signs, to maintain visibility during the critical sundowning period.
NICE guideline NG97 recommends that care environments should consider lighting as a therapeutic intervention, not merely a practical necessity. Appropriate lighting during the late afternoon and evening can reduce agitation, support orientation, and improve sleep quality -- all of which are affected by sundowning.
Recommended Products
Our DSDC 1A-accredited signs are manufactured with matt-finish surfaces that eliminate glare under artificial lighting. The high-contrast colour schemes maintain visibility in reduced light conditions, making them effective during the critical sundowning hours when navigation becomes most challenging.
"We noticed that most of our sundowning incidents involved residents becoming disoriented on their way back from the lounge. Adding projecting signs and improving corridor lighting in the late afternoon reduced these episodes significantly." -- Deputy Manager, Dementia Care Home, Norfolk
Sundowning cannot be designed away entirely, but its impact can be substantially reduced through thoughtful environmental design. Lighting, signage visibility, reduced visual clutter, and consistent evening routines all contribute to an environment that supports residents through the most challenging hours of the day. For care home managers, addressing sundowning through design is both a compassionate response and a practical strategy for reducing incidents and improving quality of life.
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