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The world population is ageing and, because of this, the incidence of dementia has risen. According to the World Health Organization, approximately 50 million people have dementia worldwide, and 10 million new cases are diagnosed every year. The incidence of dementia is expected to reach 131 million people by 2050.1
Dementia has a tremendous impact on both the patient, and the family. Patients with dementia are unable to remember things, have a difficult time solving problems, and can become easily frustrated. Their sleep-wake cycle may become reversed and, at times, they may even become violent to the ones they love. Dementia occurs in older people but is not a normal part of the ageing process.
Dementia patients may reach a point where they need to be hospitalized due to behaviors which are not able to be controlled by their caregivers. Some of these behaviors include agitation, depression, aggression, and apathy.
I have been working on a unit which cares for dementia patients for three years. During this time, I have learned a great deal about this condition as well as common and not so common treatments. I have written other blog posts relating to dementia but this post will concentrate on the use of Snoezelen therapy for these patients.
A Snoezelen room is a controlled multisensory environment (MSE). Equipment in these rooms cause a variety of stimulation including tactile, auditory, olfactory and visual. Snoezelen rooms should provide a calm and comfortable environment for the patients. These rooms can be used for patients with autism, brain injuries, developmental disabilities as well as dementia. MSE’s are not inexpensive to set up. Associated costs could run from $10,000 to $30,000 and even more if complex, high-end equipment is used.
Assessing Unmet Needs
The Unmet Needs Model suggests negative behaviors in dementia may result from the inability to communicate one’s needs to caregivers. There are ways in which we can attempt to learn what these unmet needs are by trial and error. In the hospital setting, we often talk about the following possibilities that may make the patient uncomfortable.
- Pain – This one is difficult to assess. There are pain signs such as grimacing. The patient may also be suffering from a urinary tract infection, or other ailment.
- Constipation – Keep track of bowel movements. Constipation can be uncomfortable, and is usually easy to treat.
- Hunger – Offer food. Attempt to learn the patient’s food preferences by speaking to those close to the patient.
- Thirst – Offer fluids.
- General Comfort – How the patient is sitting, temperature, clothing, etc.
If these don’t help, the patient may be suffering from boredom. This is where the Snoezelen room can help. Always remember, dementia patients are people like us who have a disease and it is important to view them as such. What works for one patient, may not be effective for another. Get to know what the patient prefers and keep track of successful interventions. Always start with the basic needs described above. If the patient is in pain or uncomfortable due to being constipated, a Snoezelen room experience will likely have little effect on behavior.
Benefits of Multisensory Environments in Dementia Care
Later stage dementia patients are usually unable to seek out enriching and meaningful activities on their own. In fact, left to their own devises, they would quickly decline. Most of the time, they are completely dependent on others for their care. Older people are also less able to perceive sights, sounds, tastes, and smells which increases their risk of sensory deprivation.3
This can have a negative impact on health and wellbeing.4
Some believe that sensory experiences are able to trigger positive memories. This may promote a feeling of pleasure for the patient. Think about this in your own life. I believe we’ve all experienced being taken back in time when we’ve smelled something that triggers a positive time in our lives, or heard a song that takes us back to a happy time.5
The goal of the multisensory environment is to positively effect the dementia patient using sensory channels that are still intact.
The three main avenues by which a multisensory experience can be achieved are.
- Sensory enhancements of the patients living environment. This may include special units in long-term care facilities which provide staff specially trained to care for dementia patients, special activities geared towards these residents and involvement of the family.9
- Specially designed rooms or MSEs.10
Studies have shown that MSEs can be beneficial for dementia patients. Some of these benefits include.
I would like to point out that some of the medications utilized to combat aggressive and disruptive behavior can cause agitation.
- Increased alertness14
- Better communication with others.18
- Improved functional performance19
These positive attributes of MSEs leads to a more relaxed, engaged patient who gets along better with his or her peers.
Research also shows caregivers who utilize MSEs for their dementia patients have better job satisfaction and a better relationship with their patients.
This leads to improved patient care and reduced caregiver burnout.
Obstacles to Adding a Snoezelen Room to a Facility
Many facilities do not have the financial resources or space to implement a Snoezelen room. As mentioned earlier in the post, these spaces can get expensive. The institutions who have these rooms often under-utilize them. Another problem is deciding how to design such a space. There is much debate on exactly what to put into these rooms and research is still being conducted in this area.
Anti-suicide regulations can also hinder certain facilities from adding a Snoezelen room. This is especially true of psychiatric facilities where dementia patients may end up due to negative behaviors.
Perspectives of an Expert
I have the pleasure of sharing an office with an occupational therapist. Kendra Munroe, OTR/L works with our patients daily and was the person who designed our sensory room. Our main piece of equipment is a Vecta which was purchased from TFH Special needs Toys. This company specializes in sensory-focused equipment and toys which promote learning and living skills.
The Vecta Full Mobile Sensory Station can turn any room into a relaxing, distracting and empowering multi-sensory room.
According to Kendra, the sensory room “provides a safe and contained spot where the patients can explore”. She explains that you want to have different things available to engage their senses. Some examples include music that is tailored to the specific patients tastes, as well as things they can see or touch. Kendra also believes it is important to include things related to nature.
We provide weighted blankets by Salt of the Earth as well as quilts, stuffed animals, robotic pets, and a weighted baby doll to provide a realistic sensory experience.
Munroe stated that certain things are often neglected in sensory rooms, specifically regarding the geriatric population. She mentioned things that provide proprioceptive and vestibular input in particular. “This is why we put a glider in,” Kendra explains. We purchased a specific glider that locks in place when the patient attempts to stand. The Thera-Glide safety glider decreases fall-risk and rocks back and forth which is soothing to the patient.
Kendra does point out that there may be dangers involved with sensory rooms. She emphasizes that we must be trauma-informed with any of our treatment. We must be aware that small, enclosed spaces may bother some patients. We also need to be sure there are no objects or equipment available that the patient may throw due to confusion.
Dementia patients should never be left alone in a sensory room. They may become confused because the room is unfamiliar to them. They may damage the equipment, or injure themselves.
Munroe ended by saying that we really didn’t have many guidelines available to us when setting up our sensory room. We tried to provide a mixture of adult and pediatric sensory experiences that we believed would be most beneficial to our patient population.
I am a big supporter of sensory rooms. My thought is we should utilize all other treatment modalities prior to resorting to medications for dementia patients. All drugs come with side effects and currently there are no medications indicated for the behavioral and psychological symptoms of dementia.
Always try to meet the basic needs of the patient before moving on to other therapies. Assess for pain, hunger, thirst, constipation and comfort.
As a society, we have a responsibility to care for our ailing population. This includes the mentally ill. Unfortunately, none of us are immune from this debilitation condition. We can all learn about it, and try to limit our risk of developing dementia. I will continue to write about this subject as I believe it is very important.
If you have any questions regarding Snoezelen rooms or dementia in general please reach out to me. I have access to some of the best professionals in this area.
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Michael J. Brown, RPh, BCPS, BCPP
Mr. Brown is a Clinical Pharmacist specializing in pharmacotherapy and psychiatry.
Feel free to send Michael a message using this link.
- Prince, Martin, Adelina ComasHerrera, Martin Knapp, Maëlenn Guerchet, and Maria Karagiannidou. 2016. World Alzheimer Report 2016: Improving Healthcare for People Living with Dementia – Coverage, Quality and Costs Now and in the Future. London: Alzheimer's Disease International (ADI).
- Bauer M, Rayner JA, Tang J, Koch S, While C, O'Keefe F. An evaluation of Snoezelen() compared to 'common best practice' for allaying the symptoms of wandering and restlessness among residents with dementia in aged care facilities. Geriatr Nurs. 2015 Nov;36(6):462-6.
- Haigh, Judith, and Carol Mytton. 2016. “Sensory Interventions to Support the Wellbeing of People with Dementia: A Critical Review.” British Journal of Occupational Therapy 79 (2): 120–126.
- Kovach, Christine R. 2000. “Sensoristasis and Imbalance in Persons with Dementia.” Journal of Nursing Scholarship 32 (4): 379–384.
- Treadaway, Cathy, Jac Fennell, David Prytherch, Gail Kenning, and Andrew Walters. 2016. “Designing for Wellbeing in Late Stage Dementia.” Paper Presented at Well-Being 2016: The Third International Conference Exploring the Multi-Dimensions of Well-Being, Birmingham, September 5–6.
- LeDoux, Joseph. 1998. The Emotional Brain: The Mysterious Underpinnings of Emotional Life. London: Weidenfeld & Nicolson.
- Marques, Alda, Joana Cruz, Ana Barbosa, Daniela Figueiredo, and Liliana X. Sousa. 2012. “Motor and Multisensory Care-Based Approach in Dementia: Long-Term Effects of a Pilot Study” American Journal of Alzheimer's Disease and Other Dementias 28 (1): 24–34.
- Van Weert, Julia, Sandra Van Dulmen, and Jozien Bensing. 2011. Multisensory Stimulation in 24-Hour Dementia Care: Effects of Snoezelen on Residents and Caregivers. Saarbrücken: Lap Lambert Academic Publishing.
- Marquardt, Gesine, Kathrin Bueter, and Tom Motzek. 2014. “Impact of the Design of the Built Environment on People with Dementia: An Evidence-Based Review.” Health Environments Research & Design Journal 8 (1): 127–157.
- Sánchez, Alba, Ana Maseda, M. Pilar Marante-Moarb, Carmen de Labrab, Laura Lorenzo-Lópeza, and Jose Carlos Millán-Calenti. 2016. “Comparing the Effects of Multisensory Stimulation and Individualized Music Sessions on Elderly People with Severe Dementia: A Randomized Controlled Trial.” Journal of Alzheimer's Disease 52 (1): 303–315.
- Maseda, Ana, Alba Sanchez, M. Pilar Marante, Isabel Gonzalez-Abraldes, Ana Bujan, and Jose Carlos Millan-Calenti. 2014a. “Effects of Multisensory Stimulation on a Sample of Institutionalized Elderly People with Dementia Diagnosis: A Controlled Longitudinal Trial” American Journal of Alzheimer's Disease and other Dementias 29 (5): 463–473.
- Bidewell, John W., and Esther Chang. 2011. “Managing Dementia Agitation in Residential Aged Care.” Dementia 10 (3): 299–315.
- Ward-Smith, Peggy, Sarah M. Llanque, and Denise Curran. 2009. “The Effect of Multisensory Stimulation on Persons Residing in an Extended Care Facility.” American Journal of Alzheimer's Disease & Other Dementia 24 (6): 450–455.
- Strøm, Benedicte S., Siri Ytrehus, and Ellen-Karine Grov. 2016. “Sensory Stimulation for Persons with Dementia: A Review of the Literature.” Journal of Clinical Nursing 25 (13–14): 1805–1834.
- Goris, Emilie Dykstra, Katherine N. Ansel, and Debra L. Schutte. 2016. “Quantitative Systematic Review of the Effects of Non-pharmacological Interventions on Reducing Apathy in Persons with Dementia.” Journal of Advanced Nursing 72 (11): 2612–2628.
- Haigh, Judith, and Carol Mytton. 2016. “Sensory Interventions to Support the Wellbeing of People with Dementia: A Critical Review.” British Journal of Occupational Therapy 79 (2): 120–126.
- Marquardt, Gesine, Kathrin Bueter, and Tom Motzek. 2014. “Impact of the Design of the Built Environment on People with Dementia: An Evidence-Based Review.” Health Environments Research & Design Journal 8 (1): 127–157.
- Maseda, Ana, Alba Sanchez, M. Pilar Marante, Isabel Gonzalez-Abraldes, Carmen de Labra, and Jose Carlos Millan-Calenti. 2014b. “Multisensory Stimulation on Mood, Behavior, and Biomedical Parameters in People With Dementia: Is it More Effective han Conventional One-to-One Stimulation?” American Journal of Alzheimer's Disease and other Dementias 29 (7): 637–647.
- Collier, Lesley, Kathryn McPherson, Caroline Ellis-Hill, Jason Staal, and Romola Bucks. 2010. “Multisensory Stimulation to Improve Functional Performance in Moderate to Severe Dementia – Interim Results” American Journal of Alzheimer's Disease and Other Dementias 25 (8): 698–703.
- Maseda, Ana, Alba Sanchez, M. Pilar Marante, Isabel Gonzalez-Abraldes, Carmen de Labra, and Jose Carlos Millan-Calenti. 2014b. “Multisensory Stimulation on Mood, Behavior, and Biomedical Parameters in People With Dementia: Is it More Effective han Conventional One-to-One Stimulation?” American Journal of Alzheimer's Disease and other Dementias 29 (7): 637–647.
