How Sensory-Rich Experiences Can Help Caregivers Communicate Better With Elderly Patients

“Given the significant advancements in the field of neuroscience, it is now widely recognized that the different sensory-rich experiences human beings encounter every day help to ‘nourish’ the nervous system.”

AJ Ayres, 2005

As anyone who has ever been around someone with a cognitive impairment can surely attest, communication can be a challenge. Another challenge is their behavior. So what if I told you that the two are linked together and that you may have tools to manage these issues with items in your hall closet or storage box in your garage. 

Think about your emotions and your sensory processing systems… who hasn’t eaten ice cream to soothe a broken heart or cheated on their well-intended diet at the smell of freshly baked apple pie? The sensory input that we don’t even notice plays such an important role in our daily lives and has such a strong influence over our actions and behaviors. Therefore, one can understand how the body does not do well when such important information is withheld or given in a way that can be perceived as harmful. 

We Experience The World Through Sensory Systems 

There are eight sensory systems found in the body. They include the common ones, tactile, vision, auditory, olfactory, and gustatory and the not-so-common ones are vestibular, proprioceptive, and interoceptive. The job of each system is to receive stimuli from the outside of the body and send it to the brain. The brain needs this sensory input in order to determine if situations are safe, secure, etc.  This input helps you self-regulate your emotions. 

Sensory SystemsDefinition
VestibularMovement system: senses balance, to provide information about movement
ProprioceptiveMuscle and joint system: senses body position, location, and force of movement
TactileTouch system: the skin, largest sensory organ
VisualSeeing system: the dominant sensory system
AuditoryHearing system
GustatoryTasting system
OlfactorySmelling system
Source: STAR Center Foundation (2018)

When functioning properly, our sensory systems alert us to our preferences; like when soup is too hot or too cold. With elderly persons who have neurocognitive disorders, it’s very common for their sensory inputs to trigger a responsive behavior. 

Learning how sensory systems align with behavior can help us understand how a patient experiences their world. Sensory inputs tell us at what level they are experiencing stimuli and can be categorized as over-responsive, under-responsive, and sensory craving.

“Understanding sensory input can help us see behaviors as a form of communication.”

Three Types of Sensory Inputs

  1. Over-responsive – an exaggerated response of the nervous system. 
  2. Under-responsive – insufficient or inadequate response of the nervous system. 
  3. Sensory Craving – high level of input is needed to provide sensation from the nervous system.

In the chart below, find what behaviors are over-responsive, under-responsive, or sensory craving in order to understand what the behavior of your loved one is communicating. See if you can figure out what your loved one may be trying to tell you. They may be trying to communicate what they want through behavior.

Over ResponseUnder ResponseSensory Craving
VestibularRefuses to swing or do any activity with feet off groundWakes up with intense movementRolls self out of bed
ProprioceptiveUnable to sitSlouches 

Sits in one position
Always moving

Likes to lay in cushions, pillows
TactileAvoids touching messy textures

Doesn’t like types of clothing (tags..)
Unaware of messy body

Unaware of clothes being on wrong way
Fidgets with objects

Touches everything
VisualAvoids lights 

Pupil dilation
Complains of eye fatigue

Can’t focus on objects
Looks in mirror or reflective objects for long periods

Spins around, watches fans intensely
AuditoryCovers ears

Make loud noises to drown out loud noise
No awareness of name being calledMakes noise in quiet environment

Responds intently to fast or loud music
Gustatory (taste)Eats bland food

Prefers limited textures
Prefers spicy, sourOverstuffs mouth
Olfactory (smell)Agitation or anxiety with strong odorsDoesn’t notice foul smellsSeeks out strong perfumes or colognes

Improve Behaviors And Communication With Alerting And Calming Strategies

A way to improve behaviors can be as simple as offering a piece of ice to suck on, going outside, or spraying essential oils. As a nurse practitioner at ElderHealth, I like to use calming and alerting strategies to help improve the sensory experience of the patient. Now you can too! Consider incorporating alerting and calming strategies from the chart below into your loved one’s day. See if the behaviors and your communication improves.

Sensory SystemAlertingCalming
VestibularDancing, power walks, bouncing on a therapy ball, fast car ridesRocking chair, hammock,  porch swing, swaying to slow music
ProprioceptiveLight touch to palm of hand, hold cold items, cool shower, apply a cool washcloth to face, pet a cat or dog, hand fidget itemsWeighted vests or ankle weights, snuggle under blankets, play with putty, a soft toy, stress ball
TactileCold bath, ice, biting popsicle, sour, spicy foodsHeavy blankets, massage, stress ball, soft toy animal
VisualBright lights, flashlight, bright colors, artDim lights, wear sunglasses
AuditoryFast pace music, speak in a high and low voice, sound producing objectsSoft music, singing or humming, cover ears for unexpected noises, headphones, ear plugs
Gustatory (taste)Drinking ice water, sour, chewy, salty, cold foods, blowing bubblesDrink warm liquids, chewing gum, chewy or crunchy foods, decaffeinated tea or coffee
Olfactory (smell)Strong smells (peppermint)Soothing scents (lavender), oils, candles

References: 
Champagne, Tina (2018) Sensory Modulation in Dementia Care
Sensational Brain. Sensory Modulation Disorder: Education and Intervention ⋆ SensationalBrain

If these sensory system based strategies help you, please share your story with us by leaving a comment below!

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