Sunbathing and walking morning exercise for patient with sundown syndrome

Abstract

One of the typical symptoms exhibited by patients with cognitive impairment is restlessness in the afternoon or evening, disorientation, and hallucinations. These symptoms are commonly referred to as sundown syndrome or sundowning. Sundown syndrome describes a series of neuropsychiatric symptoms that occur in the elderly, with or without dementia, typically in the early or late afternoon or at night. From a neurobiological perspective, the causes of sundown syndrome are often linked to primary alterations in normal circadian rhythms. One key component in the regulation of circadian rhythms is melatonin. Research has shown that melatonin levels decrease with age and decline even further in conditions such as Alzheimer's disease and other neurodegenerative disorders. Complementary therapies, such as sunbathing and morning walks, can help reduce the symptoms of sundown syndrome. These therapies are based on the understanding that exposure to sunlight influences the production of melatonin and serotonin, the precursors of melatonin. Serotonin has a calming effect, preparing the brain and body for sleep, while melatonin helps reduce sleep alertness. Sunbathing therapy aims to optimize melatonin production in the afternoon and evening. Meanwhile, morning walking exercises stimulate the pineal gland to secrete serotonin. Both sunbathing and walking are accessible activities that can be performed by elderly individuals who do not have significant mobility issues. In this case study, the complementary therapy provided to the client included sunbathing for 15 minutes each morning between 7:30 and 8:00 AM for five days, along with morning walking exercises for 15 to 20 minutes, depending on the client's tolerance. After the intervention, the score for sundowning symptoms decreased from 12 to 8, indicating a positive response to the complementary therapies.

Keywords: Sundowning syndrome; psychogeriatric; mental health nurses; walking exercise; prevention