Abstract
BackgroundSundown syndrome (ie, agitation later in the day) is common in older adults with dementia. The underlying etiology for these behaviors is unclear. Possibilities include increased caregiver fatigue at the end of the day and disruption of circadian rhythms by both age and neurodegenerative illness.ObjectiveThis study sought to examine circumseptan (weekly) patterns in search volumes related to sundown syndrome, in order to determine if such searches peaked at the end of the weekend, a time when caregiver supports are least available. We also sought to examine both seasonal differences and associations of state-by-state search activity with both state latitude and yearly sun exposure.MethodsDaily Internet search query data was obtained from Google Trends (2005-2017 inclusive). Circumseptan patterns were determined by wavelet analysis, and seasonality was determined by the difference in search volumes between winter (December, January, and February) and summer (June, July, and August) months. Geographic associations between percent sunny days and latitude were done on a state-by-state basis.Results“Sundowning” searches showed a significant increase at the end of the weekend with activity being 10.9% (SD 4.0) higher on Sunday as compared to the rest of the week. Search activity showed a seasonal pattern with search activity significantly highest in the winter months (36.6 [SD 0.6] vs 13.7 [SD 0.2], P<.001). State-by-state variations in “sundowning” searches showed a significant negative association with increasing mean daily sunlight (R2=.16, β=-.429 [SD .149], P=.006) and showed a positive association with increasing latitude (R2=.38, β=.648 [SD .122], P<.001).ConclusionsInterest in “sundowning” is highest after a weekend, which is a time when external caregiver support is reduced. Searches related to sundown syndrome also were highest in winter, in states with less sun, and in states at more northerly latitudes, supporting disrupted circadian rhythms as another contributing factor to these behaviors.
Highlights
Agitation and aggression in older adults with dementia are accompanied by significant emotional costs for caregivers and accounts for approximately 30% of the total annual cost of caring for a person with Alzheimer’s disease in the community [1]
Since overall search activity often varies on different days of the week, search is normalized for the overall number of searches and is reported as a score between 0 and 100 [26]
Sunday was the only significant factor variable, indicating that this was the only day of the week that showed a significant difference in search activity as compared to Monday
Summary
Agitation and aggression in older adults with dementia are accompanied by significant emotional costs for caregivers and accounts for approximately 30% of the total annual cost of caring for a person with Alzheimer’s disease in the community [1]. One of the most troublesome and common behavioral issues is the “sundown syndrome,” which is characterized by increasing http://aging.jmir.org/2019/1/e13302/ XSLFO RenderX. Sundown syndrome has shown to be present in 66% of community-dwelling older adults with dementia and greatly increases the risk of institutionalization [3]. Exum et al looked at the use of “as needed” (prn) medications in institutionalized older adults and found that medication use to control difficult behaviors occurred at institutionally defined times such as shift change (reflecting caregiver fatigue) as opposed to changes in ambient light [6]. Sundown syndrome (ie, agitation later in the day) is common in older adults with dementia. Possibilities include increased caregiver fatigue at the end of the day and disruption of circadian rhythms by both age and neurodegenerative illness
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