Sun Downing Syndrome And Elderly Dementia - Myassignmenthelp.Com

Question: Discuss about the Sun Downing Syndrome And Elderly Dementia. Answer: Sun Downing Syndrome (SD) is a highly prevalent condition that is associated with individuals with dementia occurs during the middle stages of mixed dementia or Alzheimers disease (Ferrazzoli, Sica and Sancesario 2013). This is called late-day confusion creating agitation and confusion in the late afternoon and evening being less pronounced during the day. There is no exact reason for this behaviour although it is aggravated due to low lighting, fatigue, increased shadows, internal clocks disruption, infections or separating reality from dreams. It is syndrome associated with nocturnal delirium and form of Behavioural and Psychological Symptoms of Dementia (BPSD) affecting around 10% to 25% patients in nursing care residents and 66% dementia dwelling patients (Yevchak, Steis and Evans 2012). Structuring of environment, meeting psychological and physical needs, scheduled activities of daily living, enhanced social activities and preventing loneliness can reduce SD symptoms (Venturelli et al. 2016). It is hard to distinguish sundowning as it has an unclear diagnostic criteria and definition. Therefore, the following essay involves the discussion of sundowning syndrome as a nursing issue and critical appraisal of current evidence associated with it. During my clinical placement, I was working at dementia ward in nursing home where I was assigned to look after sun downing syndrome patients with dementia. I found it challenging to look after them during my shift and planned to research syndrome. A literature review was conducted to explore this condition, describing what it is, why it occurs and its prevalence with proper management and treatment in reducing agitation being a major nursing issue. Sundowning has entered the common parlance of aged care nursing and dementia caregivers questioning whether it is common syndrome as assumed associated with demented individuals or not (Ferrazzoli, Sica and Sancesario 2013). However, it is not a formal form of psychiatric diagnosis in the Diagnostic and Statistical Manual of Mental Disorders (DSM-MD). Moreover, the lack of consistent definition and diagnostic criteria are the man contributing factors to the conflicting and challenging interpretation of research findings particularly for nurses in terms of treatment outcomes (Nelson and DeVries 2017). The treatment guidelines are also not specific for SD in the major dementia treatment. Apart from lack of consensus, the hypothesis that symptoms (agitation) occur during late afternoon and evening is quite burdening for the nursing staffs and caregivers questioning the existence of SD (Ferrazzoli, Sica and Sancesario 2013). Therefore, it is important to have an insight into the current literature evidence related to SD and relevant to aged care nursing discussed in the subsequent section. Khachiyants et al. (2011) conducted a systematic review on epidemiology, etiology, differential diagnosis risk factors, prognosis and prevention of SD. The results depicted that SD is the second most common disruptive behavior form in institutionalized patients with dementia appearing endemic after wandering. 12.4% of elderly patients in nursing homes stated that cognition status disruption occurs during late afternoon. This data suggests that it becomes impossible for aged care nurses to carry out a validated comparative analysis about SD prevalence in different populations like non-institutionalized or institutionalized (Martins and Fernandes 2012). Moreover, the frequently observed abnormalities in behavior of demented patients with late afternoon exacerbation at late evening or night pose a significant burden to the nursing staffs and caregivers triggering challenges (Ferrazzoli, Sica and Sancesario 2013). However, the paper presented limited data in the prevention of SD as the c urrent literature lacked effective methods description. Canevelli et al. (2016) in their paper illustrated SD is a challenging manifestation and relevant to dementia in large number of affect individuals posing burden to aged care nursing and economic burden. There is lack of evidence regarding disentangling and clarifying the multifaceted and complex pathophysiological bases of SD phenomena. There is also lack of validated tool and screening for SD in the routine clinical practice especially outpatient settings. These factors pose future developments and research regarding SD in dementia for aged care nurses emerging as an issue in the nursing specialty. Cipriani et al. (2015) published a paper explaining that SD is a poorly defined entity that lacks accurate understanding of clinical characteristics, treatment and management. The study stated the role of suprachiasmatic nucleus (SCN) in hypothalamus for the generation and synchronization of behavioral and physiological rhythm. SCN is biological clock that control melatonin production suppressed by dark and light alterations. They stated that sundowning is based on cortical activation or arousal reaction depending on cortex cholinergic differentiation where sleep disruption is the prime contributor. They also established correlations between noise, amount of light, staff fatigue and shortages. According to Blais, Zolezzi and Sadowski (2014) non-pharmacological interventions like music therapy, bright light therapy and aromatherapy may be of some benefit, however, pharmacological therapy provide minimal benefit only associated with safety concerns. The use of antipsychotics and melatonin showed evidence, however benzodiazepines are not recommendable as there are adverse side effects in elderly patients. This shows there is poor management of SD and quality of evidence supporting treatment is weak. As non-pharmacological interventions are safe, they are first line of SD treatment and require further development of SD management strategies. According to Gnanasekaran (2016) the clinical phenomenon of sundowning syndrome is known as early evening disruptive behavior. The paper suggested that there is limited medical literature regarding definition criteria and consistent diagnosis. The current understanding about this syndrome is greatly incomplete with limited justification. The literature is scarce and there is lack of comprehensive understanding of SD with studies failing to realize the basic existence of this syndrome. However, this study is perceived during evening hours creating stress and fatigue among nursing staffs in long-term care facilities. According to Zhou, Jung and Richards (2012) the antipsychotic medications given for dementia causes sleep disturbances or irregular circadian rhythms in the patients that may be a reason for the sundowning syndrome associated with this condition. Night awakening due to SD in patients is distressing for both patients with dementia and caregivers especially clinical depression among nurses and caregivers. From the above discussion, it is evident that there is limited literature available suggesting that some demented patients display sundowning, although, it is a prevalent syndrome among elderly population. Due to this reason, nurses and caregivers are unable to provide accurate treatment and management of the condition. Moreover, the agitation that occurs during the late evening or night is also a matter of concern. At that time-frame, there is shift change or fatigue that occurs among nurses and caregivers also causes poor diagnosis and management of SD among dementia patients. Therefore, future studies are required to have a clear definition, understanding and differential diagnosis of SD in demented individuals. References Blais, J., Zolezzi, M. and Sadowski, C.A., 2014. Treatment options for sundowning in patients with dementia.Mental Health Clinician,4(4), pp.189-195. Canevelli, M., Valletta, M., Trebbastoni, A., Sarli, G., DAntonio, F., Tariciotti, L., de Lena, C. and Bruno, G., 2016. Sundowning in Dementia: Clinical Relevance, Pathophysiological Determinants, and Therapeutic Approaches.Frontiers in medicine,3. Cipriani, G., Lucetti, C., Carlesi, C., Danti, S. and Nuti, A., 2015. Sundown syndrome and dementia.European Geriatric Medicine,6(4), pp.375-380. Ferrazzoli, D., Sica, F. and Sancesario, G., 2013. Sundowning syndrome: A possible marker of frailty in Alzheimers disease?.CNS Neurological Disorders-Drug Targets (Formerly Current Drug Targets-CNS Neurological Disorders),12(4), pp.525-528. Gnanasekaran, G., 2016. Sundowning as a biological phenomenon: current understandings and future directions: an update.Aging clinical and experimental research,28(3), pp.383-392. Khachiyants, N., Trinkle, D., Son, S.J. and Kim, K.Y., 2011. Sundown syndrome in persons with dementia: an update.Psychiatry investigation,8(4), pp.275-287. Martins, S. and Fernandes, L., 2012. Delirium in elderly people: a review. Frontiers in neurology, 3. Nelson, R.J. and DeVries, A.C., 2017. Medical Hypothesis: Light at Night Is a Factor Worth Considering in Critical Care Units.Advances in Integrative Medicine. Venturelli, M., Sollima, A., C, E., Limonta, E., Bisconti, A.V., Brasioli, A., Muti, E. and Esposito, F., 2016. Effectiveness of exercise-and cognitive-based treatments on salivary cortisol levels and sundowning syndrome symptoms in patients with Alzheimers Disease.Journal of Alzheimer's Disease,53(4), pp.1631-1640. Yevchak, A.M., Steis, M.R. and Evans, L.K., 2012. Sundown syndrome: a systematic review of the literature. Research in gerontological nursing, 5(4), pp.294-308. Zhou, Q.P., Jung, L. and Richards, K.C., 2012. The management of sleep and circadian disturbance in patients with dementia.Current neurology and neuroscience reports,12(2), pp.193-204.