PURPOSE: This study aimed to increase knowledge about the roles of two professional disciplines in the use of nonpharmacological interventions with residents exhibiting sundowning behaviors and about the potential impact of caregiver burden. Two research questions were posed: What nonpharmacological interventions are used by staff in a skilled nursing facility to reduce agitation levels in those who exhibit sundowning behaviors? and how do sundowning behaviors affect caregiver burden for direct caregivers in a skilled nursing facility?

RATIONALE: The phenomenon of sundowning is one that is not fully understood, and it is important to highlight the various interventions that have been attempted with this population and assess how an occupation-based frame of reference can be applied to enhance intervention approaches.

METHOD: A qualitative case study was conducted utilizing semistructured interviews with a convenience sample of 7 nursing personnel and 2 activities staff members. Each interview ranged in time from 30 to 60 min and was audio recorded and transcribed verbatim. Three layers of structural coding and analysis within and between transcripts were completed.

PARTICIPANTS: Inclusion criteria for participants included any nursing and/or activities department staff member who provided direct contact with residents on the locked dementia unit, worked between 3:00 p.m. and 11:00 p.m., and was able to provide consent. Participants included 1 man and 6 women with job titles including registered nurse, licensed practical nurse, certified nursing assistant, and activities leader. Ages ranged from 27 to 59 yr, and years of experience ranged from 1.5 to 43 yr.

ANALYSIS: Analysis of the qualitative data included thematic categorization and application of the results to the Model of Human Occupation (MOHO) frame of reference (Kielhofner et al., 2002). The results of the study highlighted the following four aspects of care: Understanding sundowning through definitions and descriptors, individual intervention approaches, contextual and environmental approaches, and the overview of caregiver burden. Results of this study were then applied to the MOHO to assess how the frame can be applied to improving resident care for those who exhibit sundowning behaviors.

RESULTS: The researchers concluded that the participants in this study described a wide range of individualized intervention approaches in relation to the phenomenon of sundowning, but further research and literature should address this topic to determine the most appropriate and beneficial means of providing care for these patients.

DISCUSSION: After applying the results to the MOHO frame of reference, it was recommended to incorporate effective communication techniques among team members, encourage participation in meaningful activities to promote personal causation, provide activities comparable to a person’s cognitive function, use external learning tools to facilitate reality and facility orientation, and utilize sensory-based environmental interventions.

IMPACT STATEMENT: This research study is important to the field of occupational therapy because our knowledge about the MOHO frame of reference as well as about other professionals’ roles provides an important function for occupational therapists to increase quality of life and engagement in meaningful occupations for those experiencing sundowning.

Kielhofner, G., Ankersjo, M. M., Oakley, F., Scheinholtz, M. K., Anderson, S., & Vercruysee, L. (2002). Applying MOHO to clients who are cognitively impaired. In G. Kielhofner (Ed.), A Model of Human Occupation (3rd ed., pp. 381–390). Philadelphia: Lippincott Williams & Wilkins.