Ask Kurt, Home Care 101: How to cope with Sundowning

Ask Kurt: Is a new column by Professional Home care expert Kurt Leggard, a registered Nurse and the Director for one of the largest Licensed Home Care Services Agency in NYS. Each week Kurt will be answering your questions regarding Home Care.

Home care, is supportive care provided in the home. Care may be provided by licensed healthcare professionals who provide medical care needs or by professional caregivers who provide daily care to help to ensure the activities of daily living(ADL’s) are met. In-home medical care is often and more accurately referred to as “home health care” or formal care.

This weeks question is from Stephanie in Sag Harbor, NY

Question: My question is this: What do you recommend to cope with “sundowning” , a condition of extreme irritability of older people between 5pm and 7pm…hard time for caregivers to handle.


Kurt: Thank you for the question Stephanie. As defined, ‘Sundowning’ is characterized as a spectrum of behaviors of individuals with a diagnosis of Alzheimer’s Disease or other dementias with the individual presenting as agitated, extremely confused and sometimes combative beginning toward the end of the afternoon to early evening sometimes extending through the entire night. Basically, when the sun goes down.

I tend to begin any recommendations with addressing ‘Sundowning’ as a condition that is very stressful for the caregiver as well as a potential safety risk for the sufferer. It is imperative that the caregiver takes care of their own health care and emotional needs and gets appropriate rest and respite to handle the rigors of caring for the individual suffering with ‘Sundowning.’ Please get support if you can.

The immediate things you can do for the sufferer is to ensure that a recent medical examination has been conducted to determine if there are any medical conditions that may be the underlying cause for the ‘Sundowning.’ If an individual is in pain, this may cause ‘Sundowning’ to start or become more pronounced as will severe constipation, Urinary Track Infections, poor nutrition, dehydration and many other conditions.

If the sufferer tends to wander (a possible secondary affect), it is very important to conduct a complete environmental review of the client’s home. Remove safety hazards (loose carpets or rugs, telephone or lamp wires, use night lights, etc) to prevent falls. If the client is at risk for wandering out of the home, safety door locks should be installed out of the reach of the client but easily accessible to the caregiver. Visible signs inside and outside of the door to identify where the lock is located can be helpful if there is a need for an emergency evacuation, as in the case of fire.

There is nothing more frightening than a love-one wandering outside and lost. Safety locks can prevent this. Do not lock a sufferer indoors without appropriate supervision. If a lock is needed, then there is a great chance that ongoing supervision is indicated (consider the many Homecare options available but be cautious to consider caregiver compatibility and costs).

The following are my recommended interventions: Maintain a routine for the sufferer. Stress will exacerbate ‘Sundowning’ and routines reduce stress. Maintain or increase the activity status of the sufferer during the day and avoid naps if possible. Naps can tend to disrupt the clients nighttime sleeping pattern. As the sun light in the sufferer’s home decreases through the afternoon to the evening, increase the amount of lighting used in the home. The use of lights will reduce one of the triggers of ‘Sundowning.’ Reduce foods that have caffeine and sugar during dinner and snacks. Keep snacks light prior to going to sleep. Ensure that the sufferer has had adequate hydration during the day (the elderly are prone toward dehydration) but reduce fluids at night to minimize nighttime urination (nocturia). Minimize disturbances during the night This seems pretty reasonable but is sometimes difficult to manage, depending on outside traffic, neighbors, etc.

I read in ( ) that each sufferer has triggers that lead to ‘Sundowning’ and they recommend keeping a journal, recording all triggers to be avoided. Great recommendation!

A final or perhaps initial intervention may be to medicate the sufferer based upon their symptoms and behaviors. Interestingly, some medications may themselves be the cause (trigger) for what appears to be ‘Sundowning’ but may actually be causing medically induced insomnia and confusion. Review all medications the sufferer is taking with their physician or nurse practitioner to determine if medication may be the cause of the problem.

Ultimately, this is a very difficult and challenging circumstance for caregivers to handle. It can be very exhausting and frustrating for everyone involved. A combination of the recommendations offered will hopefully provide some answers and work for you. Get plenty of rest and support if possible. (please review Web MD ( and the Alzheimer’s Association ( ) for excellent information.

Each week I will be answering your Home Care Questions: Email your questions to

Go Red for February..National Heart Awareness Month

February is National Heart Awareness month and the color is RED…What does that mean GO RED? Although Red is the color of Valentine’s Day it is the celebration on women who have battled Heart disease, it is the color for bringing awareness to Heart Disease the #1 Killer among Women in the Nation. It is a very important cause for me because my mother has heart disease and it was very scary and continue to be scary. Heart disease is the leading cause of death and a major cause of disability in the United States. Nearly 600,000 Americans die of heart disease annually. This represents almost 25% of all deaths in the United States. To raise awareness of this disease, February has been recognized as “American Heart Month” since 1963.

go redThe U.S. Preventive Services Task Force (USPSTF) strongly recommends cholesterol screening for men aged 35 and older. For people who have a family history of early heart disease the USPSTF recommends cholesterol screening beginning at age 20 for both women and men. Health care providers can help patients evaluate their family histories to determine a screening approach that is best for them.

  • Heart Disease is the #1 Killer for women in the Nation.
  • 42 million women in the US have Heart disease
  • #1 Killer among African-American women
  • #1 killer among all Americans both men & women
  • 1 in 26 women die from Breast Cancer
  • 1 in 3 will die from heart disease

My mother’s life was saved twice once in 2005 and again in 2013 because she recognized the signs and went to see her doctor…What are some of the signs to recognize:

  1. Extreme Fatigue
  2. Shortness of Breath
  3. Light-headed
  4. Nausea
  5. Intense heart palpitations

If you are administering these symptoms seeks medical attention, better to be safe than sorry…This my friends is not just a disease that hits older white men. It can attack anyone at anytime at any age. There are some preventative actions you can do as well:

  1. Loose Weight
  2. Develop a Healthy Plan
  3. Exercise
  4. Snack through-out the day with healthy snacks
  5. drink plenty of Water
  6. Decrease sugar and Salt intake (Star Jones recommends Stevia, a natural sugar substitute)
  7. organize a 30 minute walk a day…Make it fun walk with friends

Take Control of your life Hamptons MouthPiece Readers….YOU CAN DO IT! 

Go Red for February..National Heart Awareness Month..for more information visit American Heart Association,

Easy ways to help fight heart disease…join National Wear Red Day! It’s easy. On Friday, February 7th, wear red and collect $5 donations from your friends/colleagues! They get a red dress pin and you can all feel good about supporting the fight against heart disease & stroke! I can sign you up to be your organization’s coordinator. Just email my friend

795,000 Americans face stroke each year, and the number of Americans living with stroke is expected to grow to 3.4 million by 2030. Despite many medical advances, there is still so much work to be done. That’s why we need Congress to make stroke research funding a priority this year. Our lives truly depend on it.

American Heart Association Quick & Easy Cookbook, 2nd Edition: More Than 200 Healthy Recipes You Can Make in Minutes

Hamptons Wellness: Are You Getting Restful Sleep
We all need sleep. It is an essential function of life, but sleep nowadays can be significantly disrupted. You may have been in bed for eight hours, but then you wake up feeling groggy. You now live in a world that requires you to go, go, and go. Many nights, you may be unable to shut your mind off, which reduces your ability to get enough restful sleep. In turn, you have trouble staying alert throughout the day. Moreover, it can have a profound effect on your daily life. Here are some ways to make sure you are getting enough quality sleep:

  1. Stick to a sleep schedule. Go to bed at the same time, and wake up at the same time, even on weekends.
  2. Avoid taking naps. If you have insomnia, this could be why. However, if you need a cat nap, 30 minutes should be the limit.
  3. Don’t be a victim of after-dinner dozing. Get up and do some activity after your meal. Moreover, big meals right before bed can cause stomach issues and heartburn.
  4. Avoid that nightly drink after work. Alcohol interferes with the quality of sleep.
  5. Caffeinated drinks can also be a culprit. It can cause sleep problems many hours after you finish drinking it.
  6. Make sure you get enough exercise. 20-30 minutes of daily activity, like a walk or a bike ride can help you sleep more soundly.
  7. Turn off the television. Many people use them to fall asleep. However, TVs stimulate the brain. That goes for your computer too. Read a book instead.
  8. Keep your bedroom cool. A bedroom that is too hot or too cold can reduce the sleep quality. The temperature should be around 65 degrees.
  9. Manage your stress. A simple thing as getting organized can help. Moreover, taking a break when you need one goes a long way.
  10. You may use smoking as a coping mechanism. However, you should stop. Nicotine is a stimulant.
  11. Make sure your mattress is comfortable.
  12. Increase your exposure to natural light during the day. This will help with the production of melatonin.
  13. Take a bath before bed. It will help you wind down.
  14. Stop worrying about the day. If it can be put off until tomorrow, deal with it then.
  15. Write down any bothering thoughts in a journal. This way you can “unload.”
  16. Don’t watch the clock while trying to fall asleep. It can increase your stress.

If you follow these tips and are still having trouble with getting a restful night’s sleep, you should see your doctor. It could be a sign of something more, such as:

  1. Diabetes: frequent urination, symptoms of low blood sugar, nighttime limb pain, and night sweats.
  2. Fibromyalgia: a condition characterized by painful ligaments and tendons. Researchers have found that about 50% of fibromyalgia sufferers have abnormal deep sleep, in which slow brain waves are mixed with waves usually associated with relaxed wakefulness.
  3. An overactive thyroid stimulates the nervous system, making it hard to fall asleep. It also causes night sweats.
  4. Heart failure: the heart’s inability to circulate blood properly. It can cause fluid to build up in the lungs and tissues. Patients with heart failure may awaken during the night feeling short of breath.
  5. Kidney disease: these damaged organs can no longer filter fluids and keep electrolytes in balance. Waste products build up in the blood and can result in insomnia or restless legs syndrome.
  6. Enlarged prostate: a person can have the urge to urinate constantly, getting up five or six times a night.
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The writer, Trisha Vassello, is a student of medicine at University of Florida’s College of Medicine who uses writing on medical topics as a means to provide supplemental income. Many of her friends work in the trucking industry, and so she also intends to get certified for DOT physical examinations, and to better facilitate this she plans to register her future practice online through

Hamptons Wellness:EBOLA FEAR, What you need to know

<a href=""><strong>Ebola</strong></a> is a rare and deadly infectious disease that is characterized by the following signs and symptoms: fever, severe headache, muscle pain, weakness, diarrhea, vomiting, abdominal pain and unexplained hemorrhage (bleeding or bruising). Symptoms may appear anywhere between 2-21 days after an exposure to the virus. People <strong>DO </strong>recover from Ebola but it is dependent on early identification and good supportive clinical care. The mortality rate is anywhere from 40-80%.

<strong>Ebola </strong>was first identified in the Democratic Republic of the Congo in 1976 near the Ebola river. Although it is unknown what the natural hosts of the virus is, it is believed to be animal borne. It is believed that when humans ate bat or bush meat (a delicacy in some parts of the Congo and Liberia), the Ebola virus was acquired in humans.

<strong>Ebola</strong> is spread through direct contact. It is highly contagious! Ebola enters the body through what is called a 'Portal of Entry,' broken skin, mucous membranes in the eyes, ears nose or mouth with contaminated blood or body fluids including but not limited to urine, saliva, sweat, feces, vomit, breast milk and semen. The human body remains contaminated even after death. This is why it is imperative to dispose of the dead host properly, sometimes by cremation or burial in a specially sealed coffin.

The persons most at risk for getting infected are the family members caring for the sick, healthcare workers and people preparing and disposing the dead. Improper disposal or sterilization of contaminated material increases the risk for transmission of the virus. It is very important to note that even after recovery from Ebola where an individual is no longer infectious, Ebola virus has been found in semen for up to 3 months. Abstinence or the use of condoms will help prevent the spread of the disease. Pets may harbor the virus and they must be tested to insure they are virus free. Animals that are infected will unfortunately have to be euthanized.

The individuals most at risk for exposure are persons who have recently traveled to the western part of Africa. Healthcare workers involved in the recent cases inTexas are obviously at risk. But a word of caution. This disease is a now a world traveler. Ebola has appeared in Africa, Spain and the United States in this most recent outbreak. From a public health position, people everywhere in the United States should expect the possibility of outbreak in their community some tie in the future. It is important that our population not panic! Past outbreaks in Africa have been contained although the components of this current situation is much more problematic and dangerous. The disease spread from a rural area in Africa to the urban city. Dense populations, myths and denial has contributed to the spread in Africa. The use of 'home remedies and refusal to self-identify has made this outbreak much more difficult to contain. Ebola has always been a death sentence and the stigma attached to families with infected relatives is a powerful deterrent to seeking care. Suspicion of the government has made the task of identification and treatment very difficult (if this sounds familiar just think of the Swine Flu during the Nixon administration).

<strong>What do we do here and now?</strong> This would be a very good time to reinforce the techniques for preventing the spread of illnesses in our own backdoor. Hand-washing is the single most important aspect of reducing the spread of disease and illness. Parents should be teaching their children, schools should be teaching their students and employers should mandate in-service training for all employees about using good hand-washing techniques. ALL public buildings with bathrooms should have  signs illustrating hand-washing techniques. Local governments should have public service announcements about hand-washing. These interventions are that important. The next step is more difficult. We must begin to become disciplined about keeping our hands away from our faces, especially our eyes, nose, mouth and ears. This is an unnatural act and must be made into a habit. Again, practice will make perfect. This is less about preventing Ebola as it is about preventing the Flu (influenza season is beginning soon!), reducing the risk of the common cold. Parents must insist that their children wash their hands upon coming home and before each meal. Schools must have ample supplies of hand sanitizers and liquid soap in appropriate dispensers in bathrooms and around their schools (bar soap is a great source of spreading infection). I am not a great proponent of antibacterial soaps because I feel regular soap and friction from hand washing with good technique will remove most germs. The removal of door knobs (an great source of infection) and the use of swinging doors should be proposed.<iframe width="420" height="315" src="//" frameborder="0" allowfullscreen></iframe>
If children are sick, keep them at home. If an employee is sick, do not pressure them to come to work. This only exposes more people to their germs. <strong>Ebola </strong>can be contained but it will take a more coordinated response to the epidemic in Africa than has been presented. I am astute enough to know that because this epidemic occurred in Africa as opposed to Europe, the world's response was muted and slow. In this global, interconnected community that we are all a part, it is more important than ever to know that we are all neighbors now. What happens in my backyard is sure to affect you. I hope that we don't get to the point that we have to close borders and restrict passage. People who are restricted in their travel <strong>WILL</strong> find a way to get out. By keeping borders open and travel regulated, the path of least restriction allows us to identify travelers who are at risk and by extension, a risk to others. 

We must remember that everyone in the 1980's did not know anyone who had AIDS except if they were a part of the Gay and Lesbian community, inner city Blacks or IV drug abusers. AIDS was not a problem for the greater unaffected population. <strong>In the 21st century, we have ALL been touched by the AIDS catastrophe.</strong> We as a society fell asleep at the switch because it was the 'OTHERS' who were affected. Well, this is about all of us now! If we fail again through the lack of moral imperative and political will to act aggressively to combat this disease now, I shudder to think what the results will be this time. We must not make this mistake again.

Hamptons Wellness:Fix the Foot and Fix the Rest of the Body
The IET team attended a course back in May that would expand our knowledge and ability to help our clients more then we would have imagined all through natural 3D movement techniques. That course was level 1 and 2 Anatomy in Motion (AiM). The 2 weekends each consisted of hands on training and knowledge that included a greater understating in human movement anatomically, 3D stretching, gait phasing and how to get the body to find its center with a return of full mobility. What your feet do or more specifically don’t do affects your movement all the way up to your head!

All 4 of us walked away after the first night blown away with amazement! Hands down this is one of the best courses I have taken and learned from. Gary Ward, the founder of AiM was an awesome instructor along with Chris Sritharan, David Mc Gettigan, Karen Lacey and Robert Kavanagh who were all are very knowledgeable and were there for us to learn but really grasp and understand the information presented.

I look at the body in a totally different way…starting with the foot! That’s right- look down and take a good look at your feet…think of all the work they do for you each and every day. Think of all the injuries you have ever had and how your body has been able to adjust to keep you out of pain…good chance it all leads back to your feet! And if they didn’t start the problem, they can fix the problem!IMG_5914-e1410215067764

Most of us are living with some kind of body ache or pain, of course all on different scales. Our bodies are natural compensators, so when we have an injury to the body it will naturally find a different route to still allow you to be functional and move…the body is amazing!!! BUT over time when your body keeps acting in a compensatory state real pain and injuries are going to occur. That’s where we start looking at the body and asking the question; “What is your body not able to do? Or why is it not moving properly?”

AiM taught us to look at the body as a whole but starting with the foot. If your foot is locked up and isn’t able to do what its suppose to, through all our gait phases, then the rest of our joints up the body aren’t going to be able to do what they are suppose to do…chain reaction…thus in turn a compensation pattern and over time pain.

We have been seeing instant results with our clients when using the AiM techniques. By giving support to the foot and showing the foot that it can do what its been avoiding (that could be supinating, pronating, inverting, everting, just to name a few examples) the brain will perceive it can do the movement its been shifting you away from. By using foam wedges and putting your foot into the position its avoiding, the brain perceives its touching the floor and doing what its been not able to do, while moving thru a 3D stretch… that way when you go and walk the brain has the perception that the foot can do what we just “showed it”.

AiM has been a great addition we have added to our toolbox here at IET. Its helping our clients get out of pain, move better and get stronger! Like I said, the past 3 months we have seen instant results with our clients, from the youngest 9yrs old to our oldest 84yrs old. The body can heal itself! Looking at it as a whole from the foot up to the head, we understand what it needs thus show it that it can do it!!!

Move Better ~ Feel Better ~ Perform Better