Memory loss is the most well known problem associated with Alzheimer’s Disease and other dementias (ADRD). However, the decline in the ability of the brain to process visual information is also profound. Such visual changes are all but unknown to both the general public, as well as to many professional caregivers.
As long as these visual processing changes remain little known — coupled with the decaying judgment and cognitive abilities typical in dementia — navigating ADRD will remain unnecessarily painful and difficult for both care partners and patients alike. However, once understood through the lens of Habilitation Therapy, such knowledge becomes a powerful tool to improve safety, functioning, relationships, and general quality of life for everyone involved with a person with dementia.
Habilitation Therapy (HT) is a comprehensive behavioral approach to caring for people with dementia. It focuses not on what the person has lost due to their illness, but on their remaining abilities. HT creates and maintains positive emotional states in the person with dementia through the course of each day. It is considered by the Alzheimer’s Association to be a best practice for taking care of ADRD patients. (Alzheimer’s Association, 2011) Fairly simple to understand, HT can be profound in its positive impact on dementia patients and their care partners.
HT maintains that people with dementia cannot leave the reality they inhabit — care partners must meet them in that world. (Alzheimer’s Association, n.d., p. 139) This means that family and other caregivers must imagine what it is like to experience visual processing as a person with ADRD does. It is only then that the underlying causes of difficult behaviors can be understood, and methods to prevent or limit them can be developed. For example, these might include providing additional visual cues, or clarifying or eliminating confusing ones.
In general, “less is more” in the space occupied by an ADRD patient, allowing them to function better with less confusion and distraction. Organizing clutter and reducing the number of objects in a room can help them be more independent for longer. Feeling more self-sufficient improves the ADRD patient’s feelings about him- or herself, and makes life easier for care partners, too. (Alzheimer’s Association, 2011)
Changes to the Environment for Someone With Alzheimer’s
While vigilance must be maintained and approaches honed as the disease progresses, simple but vital changes to the dementia patient’s environment can make a real difference in quality of life, safety and ability to function more independently. Applying our understanding of what isn’t working right in the visual cortex of the ADRD brain is central to creating the right interventions.
Here follow some concrete examples.
Wandering. Wandering is when a person with dementia leaves a safe place where they are supposed to be, to strike out for… well, it’s sometimes hard to say where they believe they are going. They can quickly become lost and unable to return to safety; they can even die of dehydration or hypothermia. Due to confusion and panic, they may also assault someone who unwittingly frightens them. Wandering is a problem to be taken very seriously.
Due to their inability to perceive depth or dimensionality, Habilitation Therapy will use this knowledge to reduce or stop wandering behavior. When a large black floor mat is placed in front of every exit accessible to people with ADRD, often their brain interprets the mat as a bottomless pit that must be avoided. Of their own accord, they may lose interest in the doors.
People with dementia need highly contrasting colors to pick out different objects. Painting an exit door, doorknob and its surrounding wall and trim all the same color can make an exit disappear for a person with ADRD. Installing floor-to-doortop drapes on the windows – as well as over an exit door – and keeping the drapes shut can make the door seem like it’s just another window. This, too, can eliminate wandering. (Moore, 2010)