Please note: as of this writing, I am pretty squarely into Stage 5, so some of this may not be as relevant to earlier stages. However, there will likely come a day when these words will take on a new meaning for you. As always, use what works for you.
As dementia progresses, sensory input can begin to overload one, particularly in the evenings. It is as if everything in your environment requires a piece of your brain, and you already don’t have enough pieces to go around. The result from too much sensory load and input, is agitation. Agitation in dementia, is less about emotional agitation, and more like how washing machines agitate clothes. It is movement and energy. It causes pacing.
There is a line from a song from the old break dancing days, by Grand Master Flash, that goes: “New York, New York, big city of dreams, but everything in New York ain’t always what it seems. You might get fooled if you come from out of town, but I’m down by law and I know my way around. Too much, too many people, too much. Too much, too many people, too much, Raaah!” That sort of sums up agitation from one’s environment in dementia.
Anyways, you can significantly reduce agitation and sundowning by making the environment at home more dementia friendly. How far you have to take it depends on the person needing the soothing environment.
In considering how to accomplish this, think reduce sensory input.
The energy around a person with dementia or Alzheimer’s should be calm, slow, low-key, peaceful, and soothing. Children, even calm ones, often have higher energy than the person with dementia. Even positive emotions, like excitement, can be too much. Negative emotions should be avoided altogether.
You should reduce moving objects as much as possible. Something are harder to avoid or eliminate altogether, like children, dogs, and activity, but reducing exposure of the person with dementia or Alzheimer’s to this things will go a long way in reducing agitation. Other things are easier to eliminate, like mobiles and turning off the TV.
The less decorations the better. Think Zen minimalism here. Avoiding patterns and bold, bright colors.
Keep sound to a minimum. Even soothing music and nature sounds, while wonderful and relaxing to you, are often too much input for people with dementia. Turn off the TV, unless they are watching it. Talk less, maybe even only when necessary, in quiet, comforting voices. Shut windows, if there is a lot of noise coming in.
Light is hard to balance for people with dementia.
Some have issues sorting out shadows. They may either interpret them as something else, or not be able to interpret them at all. Those who have issues with shadows will need constant light in a way as to reduce shadows…and reduce shadows that move.
For everyone else, softer lighting is best. The brighter the light, the louder it screams. But also enough light to see by.
Reduce clutter. The more objects one sees, the more the brain has to sort out, and the more taxing on one’s limited resources. In the same way, grocery or other shopping, can become visually overwhelming.
Make the floors safe to traverse. As it becomes more difficult to sort out moving, reducing things that a person with dementia or Alzheimer’s has to navigate in their environment is important.
Sensory input can come from one’s body as well. As dementia or Alzheimer’s progresses, it can be harder for a person to identify what they are feeling and why. Because of this, discomfort translates into a generalized feeling that produces agitation. So take a quick check over. Is one hot or cold, is one in pain, is one tired, did you miss a dose of meds, are one’s clothes bothering them, do you need to go the bathroom, are you hungry?
People who have dementia or Alzheimer’s become hyper-sensitive to the emotions that people give off. If you are experiencing fears, doubts, sadness, grief, frustration, or anger when you come at us, we will react negatively in return. Part of this is no longer being able to find the right words, part is that we rely on you to know what to do (so if you are angry, then we should be angry too)…we instinctively become like a zebra and fit right in with you, so lions will not eat us, and part of it is we can no longer hold multiple thoughts in our brains at the same time…we see your anger, and there is only that and not all we know about people and their anger.
As well, people with dementia and Alzheimer’s are grieving the loss of their own lives and function. We have just as much capacity to feel, but less ability to process through how we feel. Because of this, it is much easier for us to get down. When the world also treats us as useless, it is harder to feel like one matters. In a sense, we depend on others to help us right our own emotional state as well.
This is why it is imperative that the people around us are in positive moods.
In the end, reducing as much sensory input is key to controlling agitation.
Agitation is generally worse in the evening, so preemptively keeping evenings low-key and quiet will go a long way to reduce issues.
It can be very hard to get away from noise. The evenings in my house can be very challenging for me. My mother listens to the evening news, very loudly. My daughter and granddaughter often have the TV on and are playing in an effort to keep the baby awake until bedtime. When I go outside, the evening traffic of people coming home from work, and planes going overhead every 30 seconds, and trains. Even the sound of the wind in the leaves hurts. I dream of a plain white, sound-proof, room that I can sit and sleep in for hours for peace from sensory input.
When I am not agitated, I can handle more input. Mornings being the best.
Copyright August 21, 2015, all rights reserved.