No matter your cognitive status, you experience the world through your senses. As cognitively alert individuals we choose the sensory stimulation with which we surround ourselves. As graduate students, we were assigned cubicles for our in-house studies. As a student who had years in the workplace, I had experienced much more pleasant office assignments. This was my first cubicle and my least favorite environment for productivity. I adapted by using earphones with calming music, situating my desk in my favored spot, and decorating my padded walls with encouraging art. I also found that a spicy potpourri made it more pleasant as did a drawer of chocolate choices. By addressing my sensory preferences I improved my productivity, my desire to come to the office increased and my overall demeanor was brighter.
This need to have a positive sensory environment is just as powerful for an individual with cognitive deficits. Unfortunately the executive function and power of choice is often diminished. So the feeling of claustrophobia, the disgust at the lack of style, the desire for a better taste, and more pleasant sound are often translated into behavioral manifestations. Dementia behavior is unmet need. It could be a physical need, like hunger or thirst. Or it could be a need for engagement, a release from boredom, or a sensory need.
The television is a perfect example. The husband who loved to watch 60 Minutes is suddenly unable to sleep afterward, may become more aggressive, or may wander off to a quieter space. His senses are overloaded by what was once enjoyable. Watching golf however may be something he enjoys.
These behaviors may not manifest for up to 36 hours past the event. This is why Linda Burhan’s suggestion that you keep a behavior diary is helpful. If the caregiver looks back at the sensory stimulation in the past few days, the trigger may be identified.
Another example is the mother with dementia who used to love eating at the mall eatery but is no longer willing to even take a seat. The sensory stimulation is no longer tolerable. But she does like to eat at a quiet cafe before the lunch crowd descends.
So how do we address the sensory needs of our loved one with cognitive decline? We can document the behavioral manifestations, determine a possible trigger and try something else. It is a shotgun approach, but it is far superior to not addressing the sensory needs or the resulting behavior. Or we can take the time to record our loved one’s past sensory pleasures. This can be done with family and friends as well as with your loved one. The workbook Feathering Your Nest, Creating a Blueprint for Comfort provides some guidance in discovering sensory preferences.
As a cognitively alert individual, had I been unable to employ my sensory preferences, I too would have shown behavioral manifestations. Being late or absent from my cubicle. Having extended lunch times outside my office. Wandering the halls for conversation or heading home. Not unlike some behavioral manifestations exhibited by individuals with cognitive loss.
As a teacher in Aging Studies at USF, I would tell the story of my shortest motel stay. My husband and I were returning from a wedding in NY and decided to spend the night in Cooperstown, NY. Not being baseball fans, we were clueless as to the significance of Little League weekend. Or the fact that it was Saturday night of the Little League Championship. Several savory motels were all booked. We finally found a room at a reclaimed Ramada, now run by a couple from Delhi. Not considering myself a fussy guest, I still felt very uncomfortable with the bathroom which was extremely unclean. It was great to have the owner immediately attend to the situation while we went out for dinner. Upon our return, there was a spotless bathroom.
Unfortunately the cleaning product stunk. Smell is my primary sense. The smell reminded me of truck stop restrooms. It was not a cleaner ever used in my family. It was quite aromatic and to my nose, offensive. I closed the door, ran the fan, and went to bed trying to ignore the aroma. To no avail. We left at 3:45 am, neither of us able to sleep. As I told my students, if my children choose a place that uses that cleaner, I will be escaping regularly.
As the individual with dementia regresses cognitively, the senses become the primary engagement frontier. As a recreation therapist I was honored with many memories from my group members. While making a fruit salad one afternoon, Ira took hold of the banana and shared the story of the growing boats in Baltimore. The sight of the banana prompted the story of watching the freighters being unloaded at the harbor. As the ships were unloaded, the boy Ira saw the ships growing right out of the water. Some of the bananas always found their way into Ira’s bicycle basket. Had there been no visual and olfactory sense of the banana, that story would have lain dormant amongst so many others.
Anegada Da Vida, by Iron Butterfly. That was the one song that captivated David during Fitness Fun. His early onset dementia resulted in perpetual wandering with very few focused moments. He was the youngest of our memory community, a good 15-20 years younger the other residents. The music that captured the others, left David roaming. Until Anegada Da Vida. The power of the auditory sense. When he moved to another country for care, we provided an engagement kit that included a recording of his favorite tunes.
As a caregiver of a family member with dementia, we were overwhelmed with behavioral manifestations and clueless as to a solution. Sadly we had few clues about Dad’s sensory preferences. He had been a very busy, private man whose occupation had a Top Secret security clearance. Medication became the solution, which ultimately led to a nursing home.
Had we known then what we know now.