Guidelines for an improved sensory experience for those struggling with dementia
The Pittsburgh Sleep Quality Index (PSQI) can be used to help the dementia health care team evaluate the sensory interventions by assessing the patient’s quality of sleep.
The PSQI is a questionnaire used to assess one’s quality of sleep over a one-month period. A score is generated based on the 19 questions provided which can then be used to diagnose sleeping disorders.
Pittsburgh Sleep Quality Index
Click on link below to access a PDF copy of the PSQI –
Pittsburgh Sleep Quality Index
A list of measures should be referred to for testing the new design implications. The purpose for this is to know if these sensory applications are in fact working and at what rate.
This can be a crucial first step to take so that the financial burden can be evaluated and the hospital team as well as the designers and architects can determine whether these sensory aspects are necessary or not, within their particular environment.
Considering the control of sound transmission between certain areas such as patient rooms and mechanical or high traffic spaces, will improve patient sleep patterns. This can happen with improving the Sound Transmission Class (STC) ratings of dividing walls.
An STC of 45 is recommended between rooms and corridor and 65 STC between rooms and mechanical spaces (Design and Dementia, 2011).
Adding sound masking devices to rooms with staff control function, can allow staff to lower the noise level in the rooms during the night time and control the intensity of sound in the dining room and lounge during activities.
Addressing noise sensitivity does not mean eliminating all noise (this can lead to under-stimulation), but rather providing the right kinds of noise at the right level at the right time.
Strategies:
· Consider the control of sound transmission between certain areas of the building.
· Situate bedrooms away from, and not adjacent to, high-noise areas such as dietary, utility, programming and/or administration.
· If resident rooms are adjacent to noisy areas, design dividing walls with Sound Transmission Class rating of 45-65 depending on noise source levels (45 for owing water, 65 for mechanical). Consider soundproofing dividing walls between bedrooms as well.
· Ensure quieter lounge areas are available for those who do not want to be immersed in noisy activity
Strategies:
· Reduce hard surfaces and increase sound absorbing textiles/drapes/carpet (e.g., sound absorbing ceiling and wall tiles, carpet or cork flooring). Likewise, acoustical wall treatments may be used.
· Consider how the architectural features of the space might affect the acoustics, for example domed ceilings might reflect sound.
· A large room will be louder, therefore consider breaking down rooms into smaller areas
· Apply sound absorbing materials to walls and ensure that the surface material is damage resistant and below shoulder height.
Strategies:
· Lubricate squeaky doors, windows and wheels, leaky toilets or faucets routinely.
· Ensure upkeep of mechanical lifts to reduce noise.
· Use cleaning equipment (i.e. wax oor machines, vacuums) at appropriate times for the resident such as cleaning halls when residents are in the dining room.
· When possible, purchase equipment and machinery that is low noise.
· HVAC equipment and ductwork should provide resulting sound levels that do not exceed noise criterion NC 25 in bedrooms, NC 35 in dining areas, NC 40 in toilet/ shower rooms, and NC 35 in all other occupied spaces.
· Soundproof HVAC equipment by utilizing sound attenuation measures.
Research has shown that guidance for lighting design for people with dementia, should not be limited to the consideration of visual tasks or compensation for deteriorating eyesight. The well-being of those who are physically and cognitively weak is affected by their overall exposure to the circadian cycle. Their freedom from anxiety and the extent to which they can continue the activities they enjoy depend on their perception of the whole place, as well as on the physical support that the building provides. The importance of lighting as an element in design for older people has been observed in architectural practice while there is increasing evidence that lighting is a significant component of a therapeutic environment.
Dementia is primarily a disease of later life, so recommendations for those with dementia must be set within the context of the lighting requirements of the older person. Sources within residents’ elds of view should be of low luminance or indirect rather than small and bright. They should also be positioned away from users’ directions of sight. Windows should have means of excluding low-elevation sunlight; windows at the ends of corridors and on lines of sight should also be avoided. However, windows providing natural or interesting views is almost universally welcomed, and the presence of a view may have beneficial effects on the health of dementia sufferers and people confined within a building. Window positions and sill heights should be related to the probable activities of people, in particular, whether they are walking, standing or sitting.
Other recommendations listed in this article: The lighting of rooms should not create dark areas where contrast with the brighter parts of the room inhibits vision. As well, reflections in shiny materials can cause both disability and discomfort glare. They hinder perception of the actual surface and mask the surface’s underlying colour; matt surfaces are preferable.
Increase the visibility of tasks; this enhances the ability to see differences of brightness and colour. Integrate diurnal daylight cycle; this ensures that residents have sufficient daylight exposure to minimize the risk of SAD and to ensure that they experience a 24-hour cycle of light and dark.
Provide potentially therapeutic views to enhance opportunities for social interaction. Preferred views are of natural scenes rather than the built environment; people confined within a building often enjoy seeing the activities of people outside. Window positions and sill heights should be related to the probable activities of people, in particular whether they are walking, standing or sitting. Seating and areas for social interaction should be provided beside view windows.
Lighting should support activities, enabling residents to continue activities they enjoyed through their lifetime and enhance opportunities for social interaction.
There should be recognition of ‘place’; interior spaces should be recognizable by dementia sufferers with no memory of recent experience. The information given by all the senses must be consistent. The clues to the nature of the room must be consistent with a common sense understanding of the building.
Luminous textile combines multi-colored LEDs seamlessly within textile panels that also soften sound. You can choose the size and number of panels as well as how you arrange them. Luminous textile panels, made with re rated Kvadrat textiles, are completely integrated, making them very easy to install.
The combination of elements used in each luminous textile panel creates acoustic properties that absorb sounds. These textile helps dampen sound and soften echoes. The combination of soft, diffused light and the aesthetics of the material creates a
very special effect that has an almost dreamlike quality. They come in a wide
range of sizes and can be arranged in infinite ways. One huge mood wall can be created as a sensational backdrop or scattered individual panels can cover a wall and display fluid content across them. These images help distract the patients in a positive way, giving them something to focus on. Recordings from Philips’ online standard portfolio can be chosen to add decorative aspects or to produce a natural ambience; one could also upload their own content. These natural themes help people feel connected to the outside which helps create a pleasant and relaxing atmosphere, for both the patient and staff. The reduction of a hectic atmosphere also lends to faster recovery times for the patients as it helps them be calm and cooperative. The luminous textile is easy to control with any device that is connected to the panel network.
Assessing and modifying light and noise levels in the environment can contribute to providing dignified care for older people with dementia and for other older people with a range of sensory and cognitive impairments.
In an environment where there is no education, audit or regular evaluation of noise and light levels, sensory stimulation can become unbalanced. There are many situations, in various care setting, where people with dementia exhibit what are often referred to as ‘behavioral problems’, such as anxiety and agitation that are partially a consequence of being in an environment that is not dementia friendly or enabling. At the core of this is often sensory overload or under load from noise and light sources.
Most care settings are noisy places. Older people would not be used to the levels of noise, the continuous noise and noise associated with movement going on around them in their own homes. Background noise from telephones and machines, trolleys and other pieces of equipment, the television and radios all increase auditory stimulation. The motion of people coming and going also adds another layer to auditory stimulation.
Noise levels in hospital can become a form of environmental pollution. Sudden noises, such as when equipment is dropped or when doors arc slammed, cause a startle reflex, which as well as causing various physiological responses in the person with dementia, can also increase their sense of disorientation and insecurity.
Assessment of noise and tight levels in the environment is the first step to providing a more person-centered and dementia-friendly environment.
Threshold of acute hearing – 0 dB
Rustle of Leaves – 10 dB
Sleeping, studying, whispering – 30 dB
Conversation, comfort – 50-60 dB
Safety Threshold – 85 dB
Rock Band – 120 dB
Threshold of Pain – 130 dB
Sensory for Dementia 