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He just had his pacemaker battery replaced.
Dad has lots of confusion almost every day. What other steps can I take to manage his mental confusion and Sundowning?
We have a care aid that bathes and walks him.

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You can't manage his confusion. You can learn more about how to interact with him when he is not making sense.
I do know a bit about Sundowning. I found that closing the drapes before it gets dark and keeping lights on, not overly bright, but just a well-lit space, including the surrounding rooms, so there are no dark spaces he can see, will help a bit.
Part of sundowning is just mental exhaustion. He may need to nap earlier in the day. Also, keep his routine as close to the same every day as you can. I found consistency in routine is KEY! Any change can over-tax his brain and cause a meltdown. His brain is struggling to process his reality, and every bit of stimulation is a lot for him to process, and can be tiring. So, also limit over- stimulation. Limit loud noise, bright light, too many people around.

If he shows a lot of emotional stress, talk with his doctor about medication to ease anxiety, or something to calm and relax him, such as Xanax, Hydroxyzine, Trazodone, or something more natural if you wish. Just be careful with addictive drugs, such as Xanax, which can cause anxiety and agitation if a dose is missed.
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You might try keeping his daily routine consistent, especially his sleep and meal times, which can help reduce confusion.
Also, make sure his room is well-lit and calm as the evening approaches.
You can ask his doctors if the meds that are prescribed to him can contribute to confusion
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