3.12 Strategies to help with sensory and perceptual changes

Some people with dementia experience changes in vision, hearing, balance, or how they perceive the environment. These changes can cause confusion, misperceptions or fear, making everyday tasks more challenging.

Visual misperceptions or hallucinations

Misperceptions are misinterpreting sensory information. Jude got a fright when she saw a person in her bedroom late at night. When the lights went on, she was relieved to find what she thought was a person was the way her dressing gown was draped over a chair.

• During the day, reduce shadows, glare, or visual clutter, consider the position of mirrors in the environment to help reduce misperceptions.

Hallucinations are seeing things that aren’t there. Hallucinations are very real to the person having them.

• Stay calm and avoid arguing about the reality of what they are seeing. Reassure the person by saying something like, “I understand you are seeing …. although I can’t see it.” Then try redirecting their attention or moving the person to another location. If what they are seeing is frightening, give reassurance that you are there to keep them safe.

Noise sensitivity

Many people become agitated or anxious in noisy environments. Noise can quickly overwhelm the brain.

• Try to limit background noise, such as turning off the TV or radio when having a conversation.
• Provide quiet spaces for breaks when out or at home.
• Visit the shops during “Quiet Hour”. Most major supermarkets have a low stimulation hour where lights are dimmed, announcements over the PA are not made and no music is played. This helps people who may become overwhelmed with the additional sensory input.

Spatial awareness difficulties

This means difficulty judging distances, depth, height or how objects (such as clothes) relate to your body. This can result in difficulty in navigating stairs, moving through crowded areas or getting dressed. It increases your risk of falls. Colour contrast can both help or hinder spatial awareness. Dark colours recede and can look like holes, light colours come forward and may look like steps up. Swirly patterns on carpet may look like they are moving. This is a common symptom of a dementia called posterior cortical atrophy (PCA).

• Offer gentle guidance and support when walking in unfamiliar spaces, spaces with patterned floors or steps.
• Encourage use of assistive devices like handrails, walking aids, or mobility supports.
• Consider highlighting the edges of steps with stick on contrast tape.
• Consider moving dark door mats. It the person stops, steps right over or moves around they may see the dark mat as a hole.
• Highlight needed items such as a contrasting-coloured toilet seat.

Tips for lighting, contrast, and environmental design

Many simple home adjustments can support daily functioning. See 3.13 Create a dementia-friendly home for guidance on lighting, colour contrast, reducing clutter, and using familiar appliances and fittings.

By understanding sensory and perceptual changes and adjusting the environment and routines, you can reduce anxiety, improve safety, and support independence for the person with dementia.