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There are many things that can affect people who struggle with dementia, which all should be considered especially when planning aging-in-place scenarios for seniors and those with other disabilities.

A recent article explores how two fundamental aspects of sensory stimulation, noise and light, affect the person with dementia and discusses some of the implications that nurses need to consider to create more therapeutic care environments. In fact, sensory stimulation can have a significant effect on the wellbeing of people with dementia.

Jan Dewing, Professor of Aged Care and Practice Development at the University of Wollongong (Australia), explains how, with some simple modifications, the care environment can be made more therapeutic. “There are environmental challenges when working towards providing person-centered care, regardless of the care setting—whether it is acute hospitals, day hospitals/centers and care homes, and whether the setting is new or very old. In most cases, modifications can be made by nurses and nurse leaders such as modem matrons and nurse consultants.

According to Dewing, in most cases, modifications can be made by nurses and nurse leaders such as modem matrons and nurse consultants. “These modifications will enhance the wellbeing of the person with dementia, contribute to the creation of a more therapeutic care setting, and offer staff a more pleasant working environment.”

Noise and light are the two most obvious sources of sensory stimulation in the environment, and when ignored or mismanaged, they can become important sources of under- or over-stimulation for the person with dementia.

“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,” notes Dewing. For the most part, staff can have a significant degree of control over levels of light and noise in the care environment and nurses need to set up processes to ensure that they take responsibility for managing them as part of daily patient care.

There is also an increasing amount of research in different fields to show that the environment is an important, but sadly often undervalued and even ignored resource, in dementia care. “This can be partially explained by historical inadequate resourcing of, and undervaluing of, services for older people. Consequently, the environment has not always been given the priority it deserves,” adds Dewing.

More recent discussions about care homes propose that there are tensions around the rigid interpretations of health, safety, and infection control regulations—as well as the goal of providing more meaningful and homely environments for people with dementia. “Some call for creative solutions that address safety concerns from all points of view. In this debate, we should keep central what is best for the person with dementia,” she says.

The physical and social environment in all care settings can have a significant effect on caring experiences, day-to-day living, overall well-being, and quality of life. In the end, the ultimate challenge is to ensure that the goal of ‘home’ is achieved while at the same time having a safe enough working environment.

There are many situations, in various care settings, where people with dementia exhibit what are often referred to as ‘behavioral problems,’ such as anxiety and agitation, which are partially a consequence of being in an environment that is not dementia friendly or enabling. Dewing explains, “At the core of this is often sensory overload or underload from noise and light sources. The best environment can enable the person with dementia to achieve maximum independence and wellbeing. A very poor environment can result in the person with dementia experiencing an unnecessary increase in their disability, ill health, declining care, and even agitation or different types of aggressive responses.”

For example, noise disturbs rest, relaxation, and sleep—it can also increase anxiety, and affects family and communication at visiting times. Sudden noises, such as when equipment is dropped or when doors are slammed, cause a startle reflex, which as well as causing various physiological responses in the person with dementia, can also increase the sense of disorientation and insecurity. Further, people with dementia exposed to periods of continuous noise experience increased alterations in memory and other cognitive functions, increased agitation, less tolerance for pain, and feelings of isolation. This then affects the person’s ability to understand and cope with aspects of care and treatment.

Visual stimulation is equally important. Clear, bright lights that are well positioned can make light bounce off walls and add brightness to a room or space. Poor lighting and lighting that is poorly positioned may cause a glare—especially if it reflects off highly polished floors and table tops, or glossy walls and doors. “Such glare can be distracting or even reduce a person’s mobility. It has been estimated that older people generally require between two to three times the amount of light as younger individuals. Researchers concluded that lack of illumination may induce a higher risk of accidental falls for people with dementia and for other residents,” Dewing notes.

An ongoing lack of natural daylight, along with either low levels of interior lighting or interior lighting of the clear fluorescent type left on for prolonged periods, not only affects people during the day but can also affect sleep patterns. Recent research has found that high-intensity ambient light (bright light therapy) in public areas of a psychiatric hospital and in long-term care facilities, improved sleeping patterns and the circadian rhythms of 66 people with dementia. It was found that night-time sleep increased by approximately 60 minutes in participants exposed to all-day light therapy, with the increase most prominent in participants with severe or very severe dementia.

Dewing states that nurses and healthcare practitioners need to believe that sensory stimulation can have a significant effect on the person with dementia. “Developing greater insight and learning more about this area are important preparations for making changes in the environment. Creating a therapeutic environment for people with dementia does not happen by chance—it requires systematic intervention.”

She adds that the key to change is aiming to achieve a balance of sensory stimulation for older people with dementia, so that noise and light are neither excessive nor too minimal. “Achieving this balance requires a long-term commitment and assessment of noise and light levels in the environment. This is the first step to providing a more person-centered and dementia-friendly environment—making modifications to the environment can reduce disability and dependency and increase wellbeing.”

Ways to achieve her suggested balance can include investing in a meter that measures light and noise levels accurately and produces evidence for audit and evaluation; the use of plain-colored curtains on windows helps absorb some noise; and installing acoustic wall panels can reduce noise levels. Ensuring that regular maintenance and replacement are carried out on equipment can also help to reduce noise. Dewing further explains that modifying aspects of the visual environment can be enabling for the affected person and reduce sensory over or underload.

Lastly, Dewing concludes that modifying noise and light in care environments is everyone’s business and nurses are in a good position to co-ordinate this. “After observing how noise and light affect sensory stimulation in care environments, it is possible to find simple and effective interventions—and taking action will help the care setting to be an easier, more comfortable place for the person with dementia. Finally, enabling the person with dementia to stay below their stress threshold by modifying noise and light levels can mean the person will then be more able to collaborate with caregiving.”