A nurse is caring for a client with dementia who becomes agitated and combative in the late afternoon and evening. This pattern is known as:

SUNDOWNING: A pattern of increased confusion, agitation, anxiety, and behavioral disturbances that occurs in the LATE AFTERNOON AND EVENING in some clients with dementia. CONTRIBUTING FACTORS: Fatigue, reduced lighting/increased shadows, disrupted circadian rhythm, overstimulation or understimulation, unmet needs; MANAGEMENT (non-pharmacological first): Maintain a consistent daily routine; increase lighting in late afternoon/evening (reduce shadows); reduce noise and overstimulation in the evening; encourage daytime activity and limit daytime napping; calm, reassuring approach; address unmet needs (toileting, hunger, pain, comfort); avoid caffeine late in the day; familiar objects and people; PHARMACOLOGICAL: Used cautiously and as a last resort (antipsychotics carry risks in dementia — increased mortality, used only when necessary for safety); DISTINGUISH from DELIRIUM (acute, fluctuating, often reversible cause — infection, medication; requires medical workup) — sundowning is a pattern within chronic dementia; nursing role: implement environmental/routine modifications, ensure safety, calm approach, address underlying needs, minimize pharmacological intervention.