Dementia Care across Settings


            Approximately 24.3 million individuals are living with dementia globally, with about 4.6 million fresh incidences of diagnosis annually. The magnitudes of persons affected will double every two decades to 81.1 million by the year 2040. The majority of individuals with the complication usually live in developing nations and was 60% by 2001, and will rise to 71% by the year 2040 (Fleming & Purandare, 2010). There are always environmental challenges as concerns working to provide the individual-focused care, irrespective of the care milieu, for instance, care homes, acute hospitals, and day centres, and whether the background is novel or old. The enhancement of the modifications can be by the nurses and nurse heads, like the present matrons and nurse counsellors, in most cases (Dewing, 2009; Fazio, Pace, Maslow, Zimmerman, & Kallmyer, 2018). The adjustments augment the health of the dementia patient, add to the conception of a more therapeutic care location and also grant a more pleasing working environment for the team.

One of the most palpable sources of sensory incentive is noise, and when overlooked or mishandled, can become imperative cause of under or overstimulation for the dementia patient. Evaluating and transforming the levels of noise in the environment can contribute to offering dignified care for the elderly persons with dementia plus those with a series of sensory and cognitive destruction (Waller, Masterson, & Finn, 2013). For that case, modifying the noise in the environment enhances the older adults’ rendezvous in their usual every day activities. Following the appraisal of the current research, there was an implementation of the setting modification in the workplace that reduced the excessive noise in the room to observe alterations in the behaviours and eminence of life in the elderly with dementia.

Literature Review

Rationale for Environmental Modification

            Provide a Memorable Environment. The majority of individuals who go into the dementia care amenities come from calm backgrounds where not a hint of the noises habitually came across in dementia care facility subsist. Besides, it is also apparent that the individuals with dementia are capable of recalling their distant history more effortlessly than their topical past (Joseph & Ulrich, 2007). Therefore, the design of the acoustic environment must be in such a way that it becomes as recognizable as possible to the dementia patients (Hayne and Fleming, 2014; Wiener, Gould, Shuman, Kaur, & Ignaczak, 2016). For that to happen there has to be a control of the unusual sources of noise and the acoustic locale planned to re-establish a home-like environment as strongly as possible (Gramegna & Biamonti, 2017).

Reduce Unnecessary Stimulation. Usually, persons with dementia react on a sensory echelon relatively than rationally, for instance, they may note the voice tone or body expression of the care giver or staff instead of what they essentially utter. Such sensitivity can adjust with time and even in the course of a day given that those with dementia have a diminished capacity to comprehend their sensory setting (Conti, 2019; Chaudhury & Cooke, 2014). When combined with age-correlated decline in hearing, the individual will react to the environment instead of being enhanced or facilitated by it (National Disability Authority, 2015; Alzheimer’s Association, 2017).

If there is an overload of other senses concurrently as hearing such as smell, taste and sight, the impact can be a spectacular change in an individual with dementia’s behaviour (Halsall & MacDonald, 2015). For that case, the staffs taking care of the patients with dementia usually recognise mealtime as being particularly challenging. Investigators have discovered characteristics and positions associated with greater echelons of sensory stimulus in environments for those with dementia. In an ethnographic study in an accomplished nursing facility, finding was that there is an association between overstimulation and loud noise such as clapping, crying, and singing among others together with terrifying occurrences and disruptive actions from others. Reducing avoidable stimulation does not imply removing the entire sources of noise as that can also result in boredom and exhibiting of the problematic manners by the sick due to under-stimulation (Bolton, Yates, Williamson, Newton, & Codinhoto, 2012). Instead, the focus should be on offering the right types of noise, at the right intensity, and at the right period (Day, Carreon, & Stump, 2000).

Highlight Helpful Stimuli. Although considerable losses are in association with dementia, those with the disorder retain various talents and abilities which normally lie quiescent unless brought out deliberately, and thus, suitable sensory spur is the major way for wakening the latent memoirs and skills. The sounds of nature like the singing birds and rustling of wind through the long grass and trees are some of the identified sources for giving an accommodating stimulation to those with dementia in the residential care setting (Alzheimer’s Society, 2016). In the outdoor areas, flower planting can be applicable so that the patients can listen to the birds singing as they extract juices from the flowers (Alzheimer’s Association, 2009; Dementia Training Australia, n.d).

Action Plan

Concise Description of the feature to be customized and the present effect on the individuals with Dementia

The amount of noise inside the lounge or common room is the modification that will demand transformation in my current place of work for caring for those with dementia. Presently, the environment around the room is noisy most of the time as a result of staffs and those around walking and talking to one another in loud voices and even over the phone. In the morning before breakfast, the care giving staff will start controlling the unnecessary sound from those around such as loud music for the adjustment. Besides, there will be flower planting all over the compound to attract bees and birds that can provide helpful stimuli through their singing and making the environment lovely and familiar with the right noise at the right time. Presently, the excessive unnecessary noise from those around overstimulates those with dementia thus resulting in frustration, confusion, agitation, and illusions. Therefore, by reducing excessive noise and providing the appropriate ones, those with dementia will become familiar with the setting and even reduce their stress levels and also enhance their behaviour and quality of existence.


Aims of Goals

1.      Improved happiness and satisfaction with life for the persons living with dementia.

2.      Reducing the levels of frustration, illusions, and agitation for the patients with dementia given that the diminution in them hopefully improves the daily activities for the patients.

3.      Facilitating the sick individuals with dementia to take pleasure in the outdoors from indoor through active consciousness to the milieu hence the escalated involvement in the daily routines.


Main steps and activities to be taken to attain aim/ objectives

Key steps and activities Resources (Including Personnel) Timeline
Oral endorsement from Wellness and Lifestyle administrator if the excessive reduction of noise as a modification can be implemented as component of my present task reviewing the home. Accessibility to Wellness and Lifestyle administrator 3 minutes
Assessment for cheerfulness and reviewing of the DEMQOL-Carer with 3 elderly patients living with dementia. The staff will use the flyers to record the baseline data Every assessment will go for 3 minutes summing up to 18 minutes
Planting of flowers around by the staff members from 3-4 PM Care staff or Physio staff 15 minutes, for 3 weeks
Promoting the patients with dementia to take part in the daily outside routines. Every staff Every day
Repeating and reviewing of the cheerfulness and DMQOL-Carer test on with 3 dementia patients. The staff will use the flyers to record the outcomes Each test will take three minutes totalling to 18 minutes
Review behaviour occurrences 3 weeks before modification and 3 weeks of adjustment, then comparing the events on the number of cases reported. Completed by the Wellness and Lifestyle administrator and me 15 minutes
Review attendance of actions before modification and after the process and recording the changes in partaking such as increment, decrement, or constant. Completed by me 12 minutes


Criteria for Valuation

1.      Cheerfulness Test ()

2.      DEMQOL-Carer (to evaluate the quality of existence in the individuals with dementia both before and after change)

3.      Examination of attendance of involvement in actions

4.      Assessment of alterations in behaviour cases in the patients

Summary Statement of the Achievements

·         The persons suffering from dementia became more active and became more involved in activities.

·         There was a reduction in the behaviours of agitation and illusions from those with the disorder, that is to say, fewer cases reported.

·         The individuals became more contented with their new environment than before making the adjustments.



Following the implementation of reducing excessive noise in the place of work for about one month, the outcomes of the evaluation were constructive and thus the onset of improvements. When I first introduced the idea to the other staff members, almost every one of them embraced it, and that found when already I had started analysing the wellness and existence milieu of those suffering from dementia. Finally, it shocked the entire team as the outcomes of the reduction of excess noise and planting flowers to enhance the natural noise like those of the birds led to major improvements in the life of those living with dementia. From the first day of modification, the individuals with dementia started becoming more active and even became more involved in the daily activities as usual.

Besides, there was enhanced participation from the care staff given that the place became much conducive for assisting the sick with their recovery. There was an increase of about 3 to 6 in the residents taking part in the provided daily actions, and also, just a small number of those with dementia experienced agitation and illusions, with the majority engaging themselves through slight conversations with the caring staff. Indeed, most of the patients started enjoying their new environment and even took a stroll to the doors just to have a good view of the beautiful scenery created by the humming birds (World Health Organization, n.d). That supports the research which shows that the introduction of the multi-sensory stimulus improves the mood and behaviours just like the introduction of an activity group (Purandare, 2010; Social Care Institute for Excellence, 2015). The outcome of the modification was advantageous in both the activity and involvement levels comparable to the other settings that also offered reduction in excess noise and introduction of the right sounds.

            With escalated participation level for those with dementia, there was also a cutback in the behaviour events reported, and that transpired after duration of 2 weeks. The majority of the elderly with dementia became more active and familiar with the new milieu and even persuaded the staff to engage them in some activities. Nonetheless, there were some problems with the modification as some individuals somewhat tried to resist the planting of flowers as it was a destruction to the environment and the birds were also becoming a nuisance. After a bit of explanation of our expectations, they soon gave us a chance to continue with the plan and the majority came to love the changes eventually.

Implications for Practice

Reducing the excessive noise and planting of flowers around to bring the natural noise of the birds is more beneficial both in the long and short term, and as a result, the caring staff for individuals with dementia should always encourage the action. For now, I am planning of examining the improvement in lighting in the places for the individuals living with dementia, and it will take approximately three months. As I engage in the study as a component of a foundation for baseline information, I anticipate further coming up with other areas of transformation that will improve the conditions and the lifestyles of the persons with dementia.


            The excessive noise usually impacts the patients with dementia in various negative ways, and sometimes even extends to the caring staff; for instance, it may slow down the healing process and increase agitation. Conversely, certain types of noise can assist in reducing anxiety and distress in the persons living with dementia like the humming of various birds within the compound. For that case, the setting transformation of lessening the unnecessary noise and establishing the right one in the dementia care home is very vital as it leads to the improvement in the behaviour and manners in the sick individuals (Dementia Enabling Environments, 2018). Through the completion of the modification plan, I have come to realize that just the simple tasks of planting flowers and reducing excess noise can make the individuals suffering from dementia start living a positive life through the improvement in their mood and behaviours.

Moreover, it has also come to my realization that trying something new in the dementia setting can be beneficial for both the caring team and the dementia patients even if it is a thorn in the flesh like the case of endeavouring to plant flowers which is a difficult task. At first the staff thought it was of no significance but ultimately came to believe it was a great achievement, and as for the patients, they were in a comfort zone and resisted the changes but soon accepted the new environment. Finally, by taking part in the modification project, my comprehension and knowledge as regards the importance of the surrounding to those with dementia has improved, and hence, I plan to undertake another environmental modification such as improving light in the room.







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