Caregiver Experiences and Perceptions of Managing Sundowning Behaviour in Dementia: A Protocol for a Qualitative Evidence Synthesis

Background Sundowning syndrome, characterized by increased confusion, agitation, and behavioral disturbances during late afternoon and evening hours, affects up to 66% of individuals with dementia. This phenomenon significantly impacts caregivers who must manage these challenging behaviors while experiencing physical and emotional exhaustion. Despite its prevalence, caregiver perspectives on managing sundowning remain poorly synthesized in the literature. Objective To systematically identify, appraise, and synthesize qualitative evidence on caregiver experiences and perceptions of managing sundowning behavior in individuals with dementia across diverse care settings. Methods This qualitative evidence synthesis will follow the Enhancing Transparency in Reporting the Synthesis of Qualitative Research (ENTREQ) guidelines and Joanna Briggs Institute methodology for qualitative systematic reviews. Comprehensive searches will be conducted in MEDLINE, CINAHL, PsycINFO, EMBASE, Scopus, and Web of Science from inception to December 2025. Two reviewers will independently screen studies using Covidence software, extract data, and assess quality using the Critical Appraisal Skills Programme (CASP) qualitative checklist. Data synthesis will employ meta-aggregation and thematic synthesis approaches. Data Synthesis The synthesis will use Noblit and Hare’s meta-ethnographic approach combined with Thomas and Harden’s thematic synthesis. Line-by-line coding will identify descriptive themes, which will be developed into analytical themes. The Confidence in the Evidence from Reviews of Qualitative research (GRADE-CERQual) approach will assess confidence in review findings.