Eight ways to accommodate sensory changes with dementia
- Limit background noise during conversations
- Approach the person from the front and not the side or behind
- Go along with hallucinations or distract the person with a game or puzzle
- Increase lighting around seating areas or in areas with busy patterns
- Incorporate contrasting colors, (e.g., painting the white wall behind the toilet green to help make the commode stand out)
- Use hand gestures along with verbal directions or questions
- Stick to a mealtime routine
- Place sugar and salt out of sight
After the age of 60, changes in our five senses naturally occur.
Vision diminishes, making it more difficult to read that fine print, drive after dark and even distinguish between blue and green. Food might taste bland and require intense seasoning. Noxious smells like gas or spoiled food may not register. A person might even experience an increase or decrease in sensitivity to touch. And beyond 65, about one-third of older adults experience some hearing loss as well.
Dementia only intensifies these changes. Providing loved ones with the best quality of life requires caregivers to understand how dementia affects a person’s sense of sight, taste, smell, touch and hearing—and accommodate those changes. Janice Downing, BSHD, education specialist with the nonprofit Alzheimer’s Resource of Alaska explained how to do it during a recent webinar.
Sensory issues tend to be mistaken for other problems
“Dementia causes a breakdown in an individual’s sensory processes,” Downing explained. “They may have difficulty seeing, reading signs or understanding what somebody is saying. These problems can be mistaken for vision and hearing loss when in fact they are related to changes in the brain caused by dementia.”
“Living with dementia and sensory loss presents challenges in day-to-day living,” she added. “People with dementia may experience disorientation, lack of spatial awareness, difficulties with depth perception and trouble recognizing familiar objects. There’s a lot of wiring between the eyes and the brain. If neurons or brain cells have died or synapses have been interrupted, we can see why a person is experiencing confusion or disorientation or an inability to recognize familiar people, places and things.”
Sensory changes caused by dementia
A loss of peripheral vision causes a person with dementia to be unable to tell when someone is seated next to them. By mid-stage, Downing likens the decrease to looking through binoculars.
“People coming up from the side or behind can really surprise or startle you,” she said. “Come up from the front.”
Difficulty distinguishing contrasts in colors also becomes a problem. If everything in a bathroom is white, cream and gray, a person with dementia will not be able to differentiate the toilet from the sink or bathtub. It’s important to incorporate contrasting colors in design, Downing said. Painting the wall behind the toilet green can make the commode stand out.
Depth perception suffers as well, which often makes 3D objects appear flat.
“It’s hard to tell how far or close something is,” she said. “You might see more spills; stairs can look like they’re blended together; a person might try to sit down in a chair and miscalculate how far it is and fall to the floor.”
Prevent falls by helping your loved one to a chair when possible, and put safety measures in place such as increased lighting.
Hallucinations are also common for individuals with dementia and can be caused by medications or infections. Downing recommended just going with it when they think they see a child playing in the empty backyard, or try to distract them with a puzzle or game. Misinterpreting the world around them – mistaking the rug pattern for bugs crawling on the floor – is a typical problem that can also be remedied with increased lighting, especially at night.
While it’s possible for a person with dementia to have normal hearing, the brain cannot always make sense of words, Downing explained. They might hear someone say “pass the salt” but not understand what salt is and become confused. Dementia can also cause hypersensitivity to noise and loud music, resulting in agitation. Remedy it by:
- Limiting background noise like radio or TV during conversations
- Speaking slowly and clearly
- Using hand gestures (pointing to a chair to indicate you want them to sit down)
Sense of smell might be diminished, intensified or lost. Help manage the issue by:
- Treating allergy or sinus problems
- Throwing away expired food
- Avoiding too much salt, which can increase blood pressure and risk of stroke
- Installing smoke detectors
It’s not uncommon for someone with dementia to crave more intense flavors like sour pickles or sugary desserts, so give them fresh fruit, honey with cottage cheese, or applesauce instead. And place sugar and salt out of sight so they’ll be less likely to use it.
With some forms of dementia, overeating or compulsive eating can be an issue because individuals forget they already ate or never feel full. Sticking to a mealtime routine can help solve the problem.
Weight loss can be another side effect of dementia. Keep nutritious snacks handy and serve smaller meals – they’re easier to digest – instead of three large ones.
Fortunately, people living with dementia don’t lose their ability to respond to touch, which can be used as a form of communication.
However, a person living with dementia might experience hypersensitivity to touch, Downing warned. Water hitting their skin in the shower, for example, can feel like icicles and cause them to lash out. And late-stage dementia causes more sensitivity around the mouth, hands, feet and genitals. Even trimming toenails can be a battle, she explained. To keep them calm and comfortable, play soothing music and approach them from the front, and tell them what you’re going to do before you do it. Watch for facial expressions and body language that convey pain, as they might lose the ability to describe unpleasant sensations.
Did you know that engaging in simple touch can reduce stress?
It’s important to focus on what your care recipient can do and regularly engage all their senses, Downing said. She suggested these activities:
- Look at family photo albums.
- Listen to their favorite music.
- Take a nature walk. Encourage them to touch the leaves. Smell the air. Listen to birds chirp.
Making accommodations for the sensory changes caused by dementia will help reduce or eliminate any frustration your care recipient might feel—and make everyone’s day a little easier.