See the Difference at Seasons

By Amy Sheridan, Program Director at Seasons Adult Day

The impact that noise has on people with dementia is rarely considered by others, and yet, noise that is acceptable to most people may be particularly distressing and disorientating for a person with dementia.
Of all the senses, hearing is the one that has the most significant impact on people with dementia in terms of quality of life. This is because dementia can worsen the effects of sensory changes by altering how the person perceives external stimuli, such as noise and light. As hearing is linked to balance this also leads to a greater risk of falls either through loss of balance or through an increase in disorientation as a result of people trying to orientate themselves in an environment that is overstimulating and noisy.

We know that often people with dementia respond on a sensory level rather than intellectually, for example, they will note the body language or tone of voice of staff rather than what they actually say (van Hoof et al, 2010). This sensitivity can change over time and even during the course of a day. This is because people with dementia have a reduced ability to understand their sensory environment. When this is combined with age-related deterioration in hearing, the reality is that people react to their environment rather than being supported or enabled by it.

This unique sensory room at Seasons was made possible
by donations in memory of Aggie Vines.

If other senses are overloaded at the same time as hearing (such as sight, touch, smell and taste) the effect can be a dramatic change in the behavior of a person with dementia. For this reason, mealtimes can be especially problematic depending on the environment. Research highlights the importance of appropriate background noise for maximum enjoyment at mealtimes, even for people who do not have dementia (Woods et al, 2011).

It was also identified that nursing home residents were more likely to pick at objects if subjected to continual noise, thus increasing agitation. Other research suggests that wandering behavior may be a way for the person with dementia to try to remove themselves from an overstimulating situation (Price et al 2007).

We also need to recognize how our care approach will influence noise levels. Below are some suggestions of things we can do to reduce noise levels.

• Limit the use of background music. Find out what music or songs individuals prefer and arrange for this to be played at an appropriate level for short periods of time.
• Turn off the television in the living room unless someone is specifically watching a program.
• Don’t talk across someone with dementia.
• Speak clearly and slowly and expect to repeat what you say.
• Be aware of any noises in the home that may be misinterpreted by the person with dementia and may result in hallucinations being wrongly suspected. This may include noise from a neighboring property, a clock ticking loudly, the central heating system, water pipes when the toilet is flushed or similar sounds that the person no longer recognizes and may be frightened by.
• Make sure hearing aids (and glasses) are clean and working.
• Talk to family members about all of the above points as they may find them helpful too.
• Good communication with the person who has dementia is essential to relieve anxiety, remember to use short sentences, repeat what you are doing and why, and don’t talk over the person.

A limited amount of noise can be a good thing. One study noted positive interventions when 30 minutes of appropriate music was played and appropriate meant that it was the musical choice of the individual with dementia and played for a limited time at a volume that could be heard but was not overly loud or overstimulating (Holmes et al, 2006). Calming and quiet music or singing may be helpful too.

Appropriate sound levels can improve communication as the person can focus on one interaction or task. While having no background noise at all may feel strange to some people – for example, an activities worker may feel more comfortable running an arts group with music playing in the background – silence or the simple low-level noise of conversation may actually help a person with dementia to concentrate on the task before them.

Often the benefits of silence for people with dementia are underestimated. A person with dementia may respond sometime after being spoken to if they are given enough time to process the information. We need to remember that a person with dementia may need silence to process information.

To learn more about Seasons Adult Day Health Services and how our environment can help your loved one living with cognitive changes, contact our Family Support Manager, Christin Rousseau, at 989-633-3767.