Perception refers to how the brain interprets sensory information, including sight, sound, touch, taste, and smell. In dementia, changes in perceptual processing can cause misinterpretations, confusion, anxiety, and behavioural responses, significantly affecting a person's experience in a nursing home setting.
Visual Perception Changes
Many forms of dementia, including Alzheimer’s disease and Lewy body dementia, affect the visual cortex and spatial processing, leading to:
Difficulties with Depth Perception & Spatial Awareness
- Steps and patterned carpets may appear as holes or obstacles, leading to falls or hesitation.
- A shiny floor may be perceived as wet, making individuals reluctant to walk across it.
- Difficulty judging distances can make it hard to navigate corridors or reach for objects.
Distorted Colour and Contrast Perception
- Reduced contrast sensitivity may make it hard to distinguish objects from their background (e.g., white plates on a white table).
- Poor contrast between the toilet and the bathroom walls may make it difficult to locate the toilet.
Misinterpretation of Shadows and Reflections
- Shadows may be seen as objects or people, causing distress or confusion.
- Mirrors can be distressing, as the person may not recognise themselves and perceive a stranger in the room.
Top Tips
- Use contrasting colours for furniture, doors, and eating utensils.
- Minimise reflective surfaces or remove mirrors if distressing.
- Improve lighting to reduce shadows and glare.
- Use non-slip flooring with uniform colours.
Auditory Perception Issues
Changes in auditory processing can lead to:
Heightened Sensitivity to Noise
- Background noise (TVs, alarms, conversations) may feel overwhelming and cause agitation.
- Some individuals may struggle to distinguish relevant sounds from background noise, making conversations difficult.
Misinterpretation of Sounds
- Echoes in large rooms may sound like voices.
- A ticking clock or the hum of an appliance may be perceived as murmuring voices or a threat.
Top Tips
- Provide quiet spaces to reduce overstimulation.
- Use soft furnishings to absorb sound and minimise echoes.
- Speak slowly and clearly, reducing background noise during conversations.
Tactile Perception Changes
Changes in touch sensitivity can result in:
Heightened or Reduced Sensitivity to Touch
- Some individuals may be overly sensitive to textures (e.g., certain fabrics or bedding).
- Others may have reduced pain perception, increasing the risk of pressure sores, burns, or injuries.
Top Tips
- Use soft, familiar fabrics for bedding and clothing.
- Monitor for signs of pain or discomfort, even if the person does not verbally express it.
- Provide sensory objects such as fidget blankets or textured items to provide comfort.
4. Olfactory (Smell) and Gustatory (Taste) Changes
- A diminished sense of smell can lead to reduced appetite or an inability to detect spoiled food.
- Some individuals may develop hyposmia (reduced smell perception), affecting their ability to detect hazards like smoke or gas leaks.
- Taste perception changes may result in a preference for sweeter or saltier foods.
Top Tips
- Offer strongly flavoured foods to stimulate appetite.
- Regularly check food freshness, as individuals may not detect spoiled food.
- Ensure smoke alarms are functional, as the person may not perceive danger.
Body Awareness and Proprioception Changes
Proprioception (the ability to sense body position and movement) can be affected, leading to:
- Difficulty recognising body parts (e.g., not realising a hand belongs to them).
- Clumsiness or difficulty coordinating movements.
- Reluctance to initiate movement, as the person may not perceive their own position in space.
Top Tips
- Provide gentle physical prompts and guided movement during transfers.
- Use weighted blankets or vests to improve body awareness.
- Encourage gentle exercises to maintain mobility.
Hallucinations and Delusions
(Common in Lewy Body Dementia & Alzheimer’s)
Perceptual distortions can cause hallucinations (seeing, hearing, or feeling things that aren’t there) and delusions (strong false beliefs).
- Visual hallucinations are particularly common in Lewy body dementia.
- Objects may be mistaken for people or animals.
- Some may believe care staff are impostors, leading to distress or aggression.
Top Tips
- Avoid arguing; instead, reassure and validate feelings.
- Use soft, indirect lighting to reduce shadow-based hallucinations.
- Maintain a consistent environment to reduce confusion.
Impact on Daily Living in a Nursing Home
These perceptual changes can significantly affect independence and behaviour, leading to:
- Increased falls risk due to depth perception issues.
- Refusal to eat or drink due to changes in taste and smell.
- Withdrawal from social interactions due to difficulty processing noise and conversation.
- Agitation or aggression due to misinterpreted sensory input.
Conclusion
Perception changes in dementia greatly influence well-being in nursing homes. By adapting lighting, colour contrast, sound levels, and tactile experiences, staff can create a calm, supportive, and dementia-friendly environment. Person-centred care ensures that each resident's unique perceptual challenges are acknowledged, reducing distress and enhancing their quality of life.