Caring for Dementia

Understanding potential environmental triggers that lead to responsive behaviours can provide proactive support and create a cohesive living environment. Dementia can significantly impact cognitive functioning and behaviour, and certain environmental factors can intensify symptoms or trigger challenging behaviours. Let’s explore some common environmental triggers and examples of related responsive behaviours.

Noise and Overstimulation:

1. Background Noise:

• Constant background noise from TVs, radios, other conversations, and dishes clanking can be overwhelming, leading to increased confusion and agitation. With dementia, the part of their brain used to filter sensory information is not working effectively, so naturally, they will have difficulty filtering out the irrelevant sensory information such as background noise.

2. Busy Areas:

• Walking through crowded hallways with staff, residents, and visitors can cause someone with dementia to become frustrated, upset or angry depending on the interactions they have along the way. Also, having a lot of visually stimulating objects and patterns could also cause someone to feel overwhelmed, potentially leading to agitation.

3. Group Activities:

• Participating in group activities with multiple stimuli can overwhelm some people, leading to sensory overload, For example, a group singing session with loud music and enthusiastic participants may trigger a person to yell or perhaps withdrawal from the activity.

4. Mealtime Crowds:

• The dining area in a long-term care home, or any type of facility is particularly triggering to people with dementia. Not only is dinner around sundowning time, but it is a time where there is an increase in environmental stimulation. Everyone makes there way to the dining hall at around the same time, multiple conversations going at once, music/television playing in the background, staff rushing around trying to get everyone their meals on time, residents who wander or need cues to sit and eat may be up and about. It’s a very challenging time for responsive behaviours.

5. Public Events:

• Attending public events such as parties or celebrations with loud music, bright lights, and unfamiliar faces can be overwhelming for someone with dementia. For example, attending a family wedding with a large crowd and festive atmosphere may trigger responsive behaviours such as confusion, exit-seeking and agitation.

6. Medical Environments:

• Visiting medical facilities with alarm bells, fast paced environment, disgruntled people, loud equipment, and unfamiliar surroundings can intensify anxiety and agitation. For instance, undergoing medical tests or procedures in a busy hospital setting may trigger distress, confusion and disorientation in some individuals.

9. Traffic and Transportation:

• Traveling in busy traffic or crowded public transportation can be disorienting and overwhelming. For example, navigating a busy bus terminal or crossing a crowded street may trigger anxiety and confusion.

Recognizing and minimizing exposure to these overstimulating environments can help reduce agitation and distress, promoting a more comfortable and supportive care environment.

Unfamiliar Environments:

1. Hospital Transfers:

• Being transferred to a hospital for medical treatment can be disorienting de to unfamiliar surroundings, unfamiliar staff, and unfamiliar routines. For example, transitioning from a familiar nursing home to a hospital setting may trigger confusion and distress if they don’t recognize the people caring for them.

2. Vacation or Travel:

• Traveling to new destinations or going on vacations can also be disorienting for dementia patients due to changes in surroundings and routines. For example, staying in a hotel or visiting relatives in a different city may cause confusion and restlessness if they are not familiar with their environment. Additionally, travelling may disrupt sleep/wake schedules, which could lead to an increase in responsive behaviours.

3. Moving Homes:

• Moving to a new residence, whether it’s a different house, apartment, or assisted living facility, can be highly stressful. Even those who are in a long-term care homes, and have to switch rooms whether on a different unit or the same unit, can cause confusion and potential responsive behaviours.
  
  It’s best to give ample time for people with dementia to become familiar with new surroundings. There is a big difference between knowing where you are and not liking it, and not understanding where you are at all. For those who don’t understand where they are, they may require some extra support, comfort and reassurance. Where as, someone who knows where they are and doesn’t like it, may need encouragement to become involved and participate in stimulating activities and social groups.

4. Moving Furniture:

• Rearranging furniture or making changes to the layout of living spaces can be disorienting. For instance, rearranging the furniture in their bedroom or living room may cause anxiety and frustration, as they try to navigate the new layout. Due to the deterioration of the brain, people with dementia have difficulty retrieving new memories, and navigating new surroundings. Keeping things simple, and consistent will allow the brain to rely on muscle memory for routine, and not have to attempt to retrieve new memories or navigate new areas.

Understanding the impact of unfamiliar environments on dementia can help caregivers anticipate and address potential challenges, ensuring a smoother transition and minimizing distress for individuals living with dementia.

Lack of Routine and Structure:

1. Changes in Meal Times:

• Skipping or delaying meal times can disrupt the routine and lead to confusion, especially if they have held the same routine for years. For example, a person transitioning into a new facility may be accustomed to eating breakfast every morning at 6:00am, but the facility doesn’t serve breakfast until 8:00am. In these cases, you may ask the facility if your loved one can be set-up in the dining room with a bowl of cereal at 6:00am so they can continue with their daily routine.

2. Medication Schedule Alterations:

• Altering the timing or dosage of medications can disrupt the daily routine and lead to confusion or resistance. For instance, changing the timing of medication administration may lead to certain conditions not being managed appropriately such as pain or mood alterations.

3. Lack of Activities:

• A lack of structured activities or engagement throughout the day can lead to boredom and restlessness. For example, having long periods of downtime with nothing to do may trigger wandering or exit-seeking as they search for something to stimulate their minds.

4. Inconsistent Caregivers:

• Inconsistent presence or availability of caregivers can disrupt the sense of security and routine. For instance, alternating caregivers, changes in caregiver schedules or frequent turnover of staff may trigger anxiety or distress, as they may not feel comfortable with someone who isn’t familiar with their routine. This is why it is extremely important to have a care plan made for your loved one, whether in a facility or at home, a care plan can ensure that everybody who cares for your loved one is following the same approach, communication techniques, and routine.
  
  Work with Caring for Dementia’s behaviour support specialist to devise a custom care plan for your loved one to ensure all carers are on the same page.
  Learn more about or Care Planning Service here.

5. Unpredictable Events:

• Unpredictable events or changes in routine can disrupt the sense of stability and security. For instance, unexpected visitors or last-minute appointments may trigger anxiety or anger. We especially noticed this while working as a recreation therapist. Many of the people with moderate/late stage dementia are unaware of the activities happening in the home on a daily basis. When they are invited to the program (usally about 10-15 mins before) they are excited and want to go, but they present with anxiety. This can be observed by: frantically checking their pockets, looking for their purse, make sure their windows are closed, some will say “oh I can’t today I have to stay here in case of…”. It’s very common to spot anxiety especially when introducing something new or unpredictable.

Maintaining a consistent routine and structured environment is essential for promoting stability and well-being in dementia patients. Caregivers should strive to minimize disruptions and provide a predictable and supportive care environment to enhance the quality of life for individuals living with dementia. Try to have every appointment/task/activity written in clear view, or simply talk about it during conversation through out the day. “We’re going for a walk later” “I can’t wait to go for our walk”

Poor Lighting and Visual Clutter:

1. Dimly Lit Spaces:

• Poorly lit areas, such as dimly lit hallways or rooms, can make it challenging for people with dementia to see and navigate their surroundings. This can lead to increased disorientation and risk for falls, and accidents. For example, navigating a poorly lit hallway at night may trigger anxiety, hesitation or fear in some individuals.

2. Harsh Lighting:

• Bright or harsh lighting can be uncomfortable, leading to sensory overload and overstimulation. For instance, overly bright fluorescent lighting in common areas may trigger discomfort or irritability.

3. Shadows and Reflections:

• Shadows and reflections can be confusing, leading to misinterpretation of their surroundings. For example, seeing shadows or reflections in mirrors could trigger suspicion or fear.

4. Cluttered Spaces:

• Cluttered or overcrowded living spaces can be overwhelming, making it difficult for people with dementia to focus and navigate their surroundings. For example, a cluttered living room with excessive furniture and decorations may trigger restlessness and confusion, as they attempt to focus on all the different objects.

5. Complex Patterns and Designs:

• Complex patterns or designs on walls, floors, or furniture can be distracting and confusing. For instance, intricate wallpaper patterns or busy carpet designs can cause a misinterpretation of the environment, triggering different actions and behaviours. It is important we are mindful that their brains do not always process the same visual information that we process. Peripheral vision, spatial awareness, and depth perception can be affected causing them to misread objects and people in their surroundings.

6. Lack of Visual Cues:

• Lack of clear visual cues or signage can make it difficult for those living with dementia to navigate their surroundings and locate important areas. For example, poorly marked exits or restroom signs may trigger confusion, frustration or wandering.

7. Inadequate Contrast:

• Lack of contrast between objects or surfaces can make it difficult for people to distinguish the difference. For instance, light-coloured furniture against light-coloured walls may blend together and trigger difficulty in spatial perception for some individuals. This could cause potential falls, anger or frustration as they attempt to navigate their environment.

Minimizing poor lighting and visual clutter is essential for creating a safe and supportive environment for people with dementia. Caregivers should strive to ensure adequate lighting, reduce visual distractions, and provide clear visual cues to enhance the well-being and safety of individuals living with dementia.

Emotional States of Others:

1. Caregiver Frustration:

• People wth dementia are able to sense when caregivers are frustrated or stressed, most times they will absorb the feelings and it becomes part of their mood. For example, if a caregiver becomes visibly frustrated while assisting with daily tasks, it may trigger a negative response in the person, setting the interaction up for failure. It’s so important that we remain calm, even in highly stressful situations, as to ensure our emotions aren’t being passed off to the person we are caring for.

2. Fellow Resident Conflict:

• People with dementia can be hypersensitive to others in their environment, whether it’s due to fear, anger or jealously. It’s common for individuals to perceive reality different than what it is, and for that reason you can see co-resident conflicts increase. For example, a person may believe that another resident is staring them down, this could cause fight or flight response, potentially causing a conflict. When in reality, the person just has very late stage dementia and ”dead staring” is a common symptom.

3. Caregiver Impatience:

• People with dementia may pick up on cues of impatience from caregivers, which can cause feelings of frustration and even embarrassment. It’s important that we allow people with dementia to work at their own pace, as it may take their brains longer to sequence certain tasks. Alternatively, they may be unable to sequence tasks altogether and require verbal cues for each new task in the sequence.
  
  For example: Brushing their teeth, they may need to be told to:
  1. Grab the toothbrush
  2. Grab the toothpaste
  3. Open the toothpaste lid
  4. Squeeze the toothpaste onto the brush
  5. Brush teeth.
  We have to remain positive and enthusiastic throughout any process to avoid potential feelings of frustration or embarrassment.

4. Lack of Emotional Support:

• People with dementia may feel unsettled or distressed if they perceive a lack of emotional support from caregivers, fri3ends or other residents. For example, if a patient is grieving the loss of a loved one and receives minimal comfort or empathy, it may escalate feelings of loneliness or sadness. It’s important we provide an empathetic and compassionate environment for those living with dementia, it’s equally important they feel they are living in a empathetic and compassionate environment.

Recognizing the impact of caregivers’ and co-residents’ emotional states is essential to providing compassionate and supportive care. Caregivers should strive to maintain a calm and positive demeanor, while also seeking support and resources to manage their own emotional well-being.

Sensory Stimuli.

1. Loud Noises:

• Loud noises, can be overwhelming, especially if the person is attempting to concentrate on something such as another person talking or the radio. For example, the sound of a vacuum cleaner or banging noises may trigger anger if the person is unable to filter out that background sensory information.

2. Strong Odors:

• Strong odors, such as cleaning chemicals, essential oils, or perfumes, can be overpowering and trigger discomfort, annoyance or even an allergic reaction. For instance, the smell of bleach or ammonia used for cleaning may cause someone discomfort leading to wandering/exit-seeking.

3. Uncomfortable Temperatures:

• Extreme temperatures, either too hot or too cold, can be uncomfortable, and affect someone’s mood and well-being. We’ve all had the hottest day, in the middle of August with no A/C, we’re quick to anger when we are uncomfortable. For example, being in a room that is too hot may trigger disrobing, discomfort or agitation.

5. Uncomfortable Seating:

• Rough textures, improperly fitted wheelchairs, hard chairs and uncomfortable beds are a few examples of seating that could trigger responsive behaviours. For example, and improperly fitted wheelchair may cause discomfort leading to attempting to stand up. This action could cause a person to fall more frequently.

7. Unpleasant Sounds:

• Certain sounds, such as alarms or sirens, or even someone singing can be triggering for people. For instance, listening to a roommate singing out of key may cause someone to be irritated leading to exit-seeking, anger, or aggression.

9. Unpleasant Touch:

• Unpleasant tactile sensations, such as rough handling or uncomfortable touches, can be distressing, casing fear in some individuals. For example, being touched too roughly during personal care activities may trigger resistance, refusal or aggression in some individuals.

Minimizing exposure to overwhelming sensory stimuli is essential for creating a comfortable and supportive environment for dementia patients. Caregivers should be mindful of the sensory needs of individuals and make adjustments to their surroundings to promote their well-being and comfort.

Conclusion

By identifying and minimizing environmental triggers, caregivers can create a supportive and calming environment for people with dementia, reducing the likelihood of challenging behaviours and enhancing their overall well-being. Strategies such as maintaining a consistent routine, providing adequate lighting, minimizing environmental stress, and being mindful of external stimuli can help mitigate the impact of environmental triggers.