Sensory Modulation in Dementia Care

Despite most residential care homes being bussling environments with facility staff busily going about their day tasks, I liken it to that of morning rush hour at the central train station, where everyone has a sole focus on the destination they need to reach by a certain time and with very little meaningful interaction taking place.

There is often a significant lack of individual resident engagement beyond the standard morning personal care. Now don’t get me wrong, many facilities have wonderful activities such as bingo, word games, bowling or even external entertainment, which are great for those residents that are cognicent enough to enjoy and partake. It is those residents that have shorter attention spans or in the mid to later parts of the disease that can often be forgotten on the monthly activity schedule and for these residents insufficient stimulation can result in isolation, depression and complete withdrawal. Such lack of appropriately pitched stimulation can manifest in wandering, sleep disturbance and distress. Equally too much stimulation can result in some residents feeling overwhelmed and acting out.

It is imperative that we are offering our residents a variety of appropriately pitch activities and an environment that is appropriate for the individual’s needs, that promotes improved cognitive function, helps maintain self-care abilities and offers them suitable opportunities to be engaged through all our senses. So how are we best placed to promote a Sensory Care Home?

The Sensory Care Home

Varied levels of sensory stimulation should be provided throughout the facility to help residents remain orientated and engaged and offer opportunities for residents to self modulate their amount of stimulus. Daily activities that stimulate a number of senses and can be titrated in intensity can be easily integrated into a residents care plan in accordance with a residents mood and physical or emotional needs. For example afternoon wandering can often be circumvented completely with a well planned opportunity for engagement and sensory stimulation in the early afternoon, such as remeniscience with a photo book, familiar sounds such as birds or and smells such as lavender or pepemint. The level of stimulation a resident requires is individually dependent and possibly time dependent. Snoozlen type rooms have been soon to be hugely effective in some residents particularly in later stages of the disease where the requirement for single stimuli maybe more effective then mutilple.

What else can we do to help promote sensory modulation?

By working together the care-workers, divertional therapists and residents we can stimulate each of the senses and keep the individual happy and healthy. Deafness and visual impairment can increase isolation, so make sure they are tested regularly and any hearing or visual aids are functional and up to date.

Sight

• Reset tables with tableware and offer residents opportunities to help in this process. Too often once the days main meals are served, rows of tables are left bare and unset, which then leaves the space feeling often open, bare and void of identifiable stimuli that may help an individual with dementia appropriately engage in the environment.
• Take advantage of views by placing seating areas facing windows and drawing curtains back.
• Adjust the lighting, bright lights will energise, while dimness may aid rest.
• Strong colours can be stimulating, so choose these in areas for activity and pick restful tones in bedrooms.
• Assist the individual in taking care of their appearance and picking clothes, accessories and make-up.
• Make gardens and outdoor spaces easy to access and arrange outdoor activities to safely enjoy the sunshine.
• Choose non-abstract paintings and encourage family photos in bedrooms.
• Make rooms homely and not institutional is often a concept that is thrown around. There is plenty of resources available about the careful use of colour, art, tactile furniture and the introduction of natural elements such as plants, water features and aquariums to help make the environment stimulating and safe, but we should be careful when trying to replicate the home like care environment that we continue to avoid the instituational creep

Touch

• Offer massage to hands, head or shoulders.
• Manicures and hair care can improve self worth and provide a caring touch.
• Hold hands.
• Think of the texture and feel of throws, cushions and clothing. Velvet, satin and soft wools can be appealing.
• Activities like gardening, baking or pet handling can be enjoyable and tactile.

Taste

• Providing interesting meals with new and varied tastes.
• Offer fresh fruit and vegetables for health and flavour.
• Consider textured foods like popcorn or jelly.
• Use hot and cold foods for different taste sensations.
• Stimulating snacks could include sherbert or citrus fruits.
•  Group cooking and tasting activities can be fun and stimulate all the senses.

Hearing

• Provide the opportunity to experience and enjoy music with dancing, singing, clapping or shaking maracas and tambourines.
• Exercise to music can improve fitness and stimulate the senses.
• Play music or put on the TV.
• Invite musicians or singers to perform concerts.
• Chat with people.
• Organise group activities such as games or quizzes.
• Don’t be afraid to allow silence, avoid clashing sound sources and be sensitive that noise may be irritating or upsetting.

Smell

• Use scented flowers.
• Consider aromatherapy, lavender for example can be calming and soothing.
• Choose perfumed massage creams or oils.
• Create a sensory area in the garden with scented herbs.
• Open windows and doors (when safe) to allow pleasurable scents like coffee, baking or mown grass to flood in.

Movement and position

• Changing seating positions, adding cushions or reclining.
• A rocking chair or beanbag can provide a different experience.
• Stimulating head and arm movements, passively moving arms or legs for people who are less able to move.