Sensory Stimulation in the Elderly

Introduction

Sensory stimulation is the method in which a person’s level of consciousness can be altered.

We have 7 different senses as human beings. The senses are:

  • Visual - Vision

  • Olfactory - Smell

  • Gustatory - Taste

  • Auditory - Hearing

  • Tactile - Touch

  • Vestibular - Movement

  • Proprioception - Where our bodies are in space

In order for our brains to develop during infancy, we need exposure to all these different senses. The same is true when we have a nervous system debilitating disease like dementia. When we are young, we use the senses to orientate ourselves to our environment, time of day, weather, whether or not food is edible etc. When we get older, the same is true, but two things that become more important are our quality of life and prevention of deterioration.

In order to facilitate this, correct sensory stimulation is important.

The value of sensory stimulation

  • It increases consciousness of self and environment

  • Activates motor responses and reflexes

  • Decreases sensory deprivation

  • Improves range of motion

  • Supports normal muscle tone

  • Increases attention span and focus

  • Improves controlled movements

 

The optimal environment for sensory stimulation

The environment must be as quiet as possible with natural light. No sudden interruptions or loud noises.

 

How does sensory stimulation work in the elderly

We have to know the person well in order for sensory stimulation to have its optimal effect. If an unknown song for instance is presented, there will be no significant triggers for the specific person, but if he/she hears a lullaby that his/her mom used to sing the impact of the auditory stimulation is so much bigger.

The idea of sensory stimulation in the elderly is to provide them with a better quality of life in general as well as helping them to be better orientated to person, place and time.

Specific stimulation in a system can either be inhibitory or activating. For instance, the taste of something sour is activating, where the taste of something sweet is generally inhibitory. Again it is important to know the person well, because if he/she did not enjoy sweet things, the taste of sugar might be activating for them.

 

Different sensory stimuli and the influence

 Visual system

Present to patient in a dark room

                 Activating stimuli

  • Flashing lights

  • Watching television

  • Change in environment, moving outside

                 Inhibiting stimuli

  • Following a flashlight in the dark

  • Sitting in a dimly lit room

Auditory system

Present to the patient anywhere in the house without possibility of sudden interruptions              

                Activating stimuli

  • Old records

  • Listening to the radio by using earphones

  • Loud noises

  • Different animal sounds

Inhibiting stimuli

  • Calming lullabies

  • Nature noises

  • Soft calming sounds

 

Gustatory

Present the stimuli with a dropper while the patient is seated or place small amounts in the mouth.

                Activating Stimuli

  • Sour sweets

  • Bitter sweets

  • Vinegar

  • Lemon juice

                Inhibitory stimuli

  • Yogurt

  • Cheese spread

  • Anything sweet

  • Anything salty

 

Tactile system

Present to patient in a temperature controlled environment to reduce the need for excessive clothing

                Activating stimuli

  • Using a baby brush to brush arms and legs against the hairline

  • Light touch up and down exposed body parts

  • Quick fleeting touch

  • Use different textures to rub

  • Vibration

                  Inhibitory stimuli

  • Deep massaging

  • Rubbing down extremities with a firm grasp

Olfactory system (Smell)

Present to patient before mealtimes and be on the lookout for autonomic nervous system signs like sweating, tachycardia or gagging. Present on an earbud. Hold it close to the nose, but take care not to touch the nose.

                Activating stimuli

  • Spices

  • Sulphates

  • Mint

  • Lemon

                 Inhibitory stimuli

  • All smells known to the patient

  • Coffee

  • Vanilla

  • Almonds

Vestibular system

The system is located in the inner ear and based on the speed and angle of head rotation. Ensure that the environment is safe when movements are being performed. This might be the most challenging stimuli to give, but it is very important. Swivel chairs are great tools as acceleration and rotation can be achieved using them.

                Activating stimuli

  • Fast movement

  • Stop and start movement

  • Rotation

  • Head in the upside down position

                Inhibiting stimuli

  • Rocking

  • Slow movement

  • Rhythmic movement

 

Proprioceptive system

This system registers where the body is in space by informing the brain of where the joints are at a given time. This system registers tension in the muscles and ligaments as well as movement in the joints. When this system is stimulated it may reduce the risk of falling.

                Activating stimuli

  • Fast movement of the joints

                Inhibiting stimuli

  • Stretching

  • Joint compressions

  • Do these rhythmically and smoothly

 

Environmental adaptations

It is always helpful to start early when working with a patient who has cognitive decline. We want to establish new routines and make them aware of certain things while they still have the cognitive capacity for it. Introducing new coping mechanisms when it is too late, often leads to the caregiver and patient becoming frustrated.

It is important to have a big calendar up in the patients room where he/she then has to mark down every day in order to orientate themselves to the year, month and date. It is useful to have 2 different coloured pens to alternate in case the patient forgets that he/she has already marked the date.

Big digital clocks in every room are important as the brain struggles to read the time on analogue clocks later in life. It is also important to have a note next to every clock that informs the patient of important hours in the day, like breakfast or lunch time.

A steady routine is of utmost importance. As far as possible, this routine should stay the same from day to day and where not possible it should stay the same from week to week. The patient must be made aware of the routine and a laminated copy can be kept next to the bed, in the bathroom and in the lounge to help with orientation.

Clothes in the cupboard must be placed together according to what will be worn per day. Therefore a pile of shirts and a different pile for underwear should be avoided. The clothes should be put together by days.

A tick list in the bathroom is also handy. There should be a list of things that has to be done, like brush teeth, wash face, put cream on, comb hair etc.

On every door leading out of a place with possible dangerous aspect a sign needs to be put up which reads for example… “oven off?”, “tap closed?” etc.

Lastly if differently coloured arrows can be placed on the floor leading to specific places, for example the bathroom, kitchen, room and dining room it will better orientate a person to where they will need to go and how to get there.