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A holistic approach to care looks beyond a diagnosis and considers the way an individual interacts and engages in daily life. This considers the whole person: their physical, mental, social and emotional needs as well as their values, beliefs and life history.
Dementia is most commonly associated with deterioration in memory and cognition, but changes can also occur in the sensory cortex of the brain, influencing a person’s sense of sight, hearing, smell, touch and taste. These sensory changes can lead to heightened confusion, anxiety and dysregulation. Recognising certain behaviours as a form of communication and understanding the impact of sensory changes, enables a person’s needs to be better met. This holistic, person-centred approach can enable a person to be better supported and improve caring relationships, benefiting quality of life for both the person with dementia and their carer.
We understand that the physical and emotional demands on carers are difficult and often overwhelming. However, dedicating a little time as a “dementia detective” can help to understand the root cause of a person’s changing behaviour and potentially reduce stress for both parties.
It’s important to stress that not everything mentioned will be a part of every dementia journey. The following suggestions are based on common questions asked of Wayfinders and strategies that have worked for some. Remember that every person experiences dementia differently; what works for one person may not for another.
Any changes could be due to medical reasons or side-effects of medication, so it’s always worth checking with a GP if there are any sudden or unexplained changes. It is also important that the person has regular eye, hearing and dental checks.
Communication
Communication challenges in dementia can be due to cognitive changes resulting in difficulties with understanding, word-finding or semantics. However, challenges may also be related to the following:
Environment: Try to avoid noisy environments and background noise as they can heighten confusion and stress as filtering sound becomes more difficult.
Hearing: Hearing changes can affect confidence, leading to a person becoming withdrawn and isolated and less likely to communicate. If required, ensure a hearing aid is worn and make sure the batteries are operating properly. Speak clearly and slowly and position yourself in front of the person in line of sight. You could try using gestures or using written words or images.
Nutrition
Changes to taste, loss of appetite or excessive eating may be due to memory issues. A person may forget when to eat or that they have already eaten due to impaired cognitive processing skills, but the following sensory changes should also be considered:
Taste: Altered taste buds may result in preferences for sweeter foods or stronger flavours. Try seasoning or using natural sweeteners like honey. Experiment with different foods to understand preferences. Dental hygiene should also remain a priority so perhaps try an alternative flavour if mint products are unfavourable.
Smell: Experiencing altered smells can change a person’s entire perception on food, and they may therefore choose not to eat it. Any changes in smell can also affect taste. Environmental smells may put people off from eating so try to avoid cleaning dining areas with strong scented sprays or using diffusers or candles that may be overpowering.
Sight: Food items on a plate may be misinterpreted as non-food items. Food may go unnoticed if it is a similar colour to the plate e.g. white sandwich on a white plate. Visual changes with depth or peripheral vision may limit what is viewed if not placed in the appropriate line of sight
Touch: People can develop increased sensitivity to certain textures, becoming less tolerant of some foods. Sometimes, if the sense of smell or taste is diminished, increased touch sensitivity can be used positively to identify food through touch. Finger foods may be appropriate in these cases and may also be a solution for difficulty coordinating using cutlery.
Washing & Dressing
Difficulty getting washed or dressed may be a cognitive issue with task recall, processing and sequencing or could also be due to:
Touch: A sense of touch can become heightened or dulled, depending on the unique experience of the individual. Sometimes pressure from shower water may become painful, or the feeling of certain fabrics may feel uncomfortable, including labels in clothing. On the contrary, if the sense of touch has diminished, some people may find comfort in heavy weighted clothing.
Temperature regulation: Ability to regulate and sense temperature may be altered. If the person is over or under sensitive to water temperature, they may be less likely to wash. This can also be an issue when trying to dress appropriately for the weather.
Smell: If sense of smell is affected, washing powders may be overbearing or scented body products may no longer be appreciated.
Movement & orientation
Dementia can cause issues with both excessive and reduced movement. This may be a consequence of cognitive and functional decline, or memory issues. However, it can also be impacted by sensory and environmental changes.
Visual: Visual changes can alter how a person interacts with their environment and their level of movement. Objects such as dark floor mats or shadows may be misinterpreted as obstacles or holes in the ground. A person’s peripheral vision may change and therefore limit awareness of surroundings. This can cause a fear of walking or falling, especially if balance is an issue.
Pain: Sometimes a person may limit movement because of a pain that they are unable to identify or communicate
Environment: It is helpful to use high levels of colour and contrast in room designs, especially to distinguish between flooring, walls and furniture. Colour can also be useful to highlight doors and doorframes. Avoid busy patterns and ensure that there is good natural light throughout the day. Try to minimise shadows in the evenings so that it is easier and safer to navigate around. Door signage can also be useful and encourage people to move between areas more independently.
Working towards holistic person-centred care can make a significant impact on the wellbeing of the person living with dementia. If you would like to talk about any sensory changes you’ve experienced, or noticed on behalf of a loved one, give our Wayfinders a call on 01243 888691. They offer one-to-one support for anyone affected by dementia
You can join us at our Carers holistic workshop in March where we will be looking at some practical solutions to support a person with everyday activities that they may struggle with as a result of sensory changes.