Dementia-friendly environments: Noise levels

The impact of noise on people with dementia

The impact that noise has on people with dementia is rarely considered by care staff or managers on a day-to-day basis. And yet, noise that is acceptable to care staff may be particularly distressing and disorientating for a person with dementia, especially at busy times of day such as shift change-over and mealtimes.

Having a good acoustic environment can support inclusion and reduce confusion in people with dementia.

McManus and McClenaghan (2010)

The training DVD Supporting Derek (Watchman et al, 2010) shows the detrimental effect that low-level noise has on a resident with dementia called Derek. This DVD shows that background noise that staff find acceptable is actually overwhelming for Derek, and this leads him to become increasingly and unnecessarily agitated and confused.

Explaining the link between dementia and distress caused by noise

Of all the senses, hearing is the one that has the most significant impact on people with dementia in terms of quality of life. This is because dementia can worsen the effects of sensory changes by altering how the person perceives external stimuli, such as noise and light. As hearing is linked to balance this also leads to a greater risk of falls either through loss of balance or through an increase in disorientation as a result of people trying to orientate themselves in an environment that is overstimulating and noisy.

We know that often people with dementia respond on a sensory level rather than intellectually, for example they will note the body language or tone of voice of staff rather than what they actually say (van Hoof et al, 2010). This sensitivity can change over time and even during the course of a day. This is because people with dementia have a reduced ability to understand their sensory environment. When this is combined with age-related deterioration in hearing, the reality is that people react to their environment rather than being supported or enabled by it.

If other senses are overloaded at the same time as hearing (such as sight, touch, smell and taste) the effect can be a dramatic change in the behaviour of a person with dementia. For this reason, care staff often identify mealtimes as being especially problematic. Research highlights the importance of appropriate background noise for maximum enjoyment at mealtimes, even for people who do not have dementia (Woods et al, 2011).

Cohen-Mansfield and Werner (1995) identified that nursing home residents were more likely to pick at objects if subjected to continual noise, thus increasing agitation. Other research suggests that wandering behaviour may be a way for the person with dementia to try to remove themselves from an overstimulating situation (Price et al 2007) (for more on this, see the feature on Walking in the section, Behavioural challenges). 

Noise problems in bathrooms

Specific rooms can have specific problems: acoustics in the bathroom can be particularly difficult. Flowing water, and the flush of the toilet, for example, can create a confusing or sudden noise (for more on this, see the feature on Toilets and bathrooms in this section). Yet singing in the bathroom can be lovely and may even help with reducing agitation if it is a song or tune that is recognisable and enjoyed by the person with dementia.

Noise problems in dining areas

Within the dining area the noise from a television or radio that often is not listened to or watched, staff talking to each other and the clatter of dishes and cutlery all contribute to a sense of disorientation. Removing unnecessary noise can reduce the risk of behaviours such as aggression and frustration in response to an environment that is too noisy or inappropriately noisy, such as music played continually that is not enjoyed or recognised by the person (for more on this, see the feature on Kitchens and dining areasin this section).

Noise problems in open spaces

Be aware of open spaces: some sounds appear louder in open spaces, for example noises from crockery in a kitchen and dining area, the wheels of a tea trolley or the sound of conversations or laughing. Shift changeover can be especially noisy in a care home, just as the start and end of the day can be in day facilities and this is often noticed most in common open spaces.

Noise problems at night

Noise at night can result in disturbed sleep which in turn can lead to problems during the day, such as lack of concentration, and difficulty communicating and performing during the day. 

Staff working at night need to be aware of the importance of noise reduction, and be alert to whether noise from equipment such as a tumble drier or a security light can be heard at night. Some noises, for example a washing machine, may be absorbed into the normal sounds of daytime but seem much louder during the quiet of the night.

Physical changes to help reduce noise levels

Marshall (2001) has long been an advocate of designing buildings in a way that supports people who have dementia, enabling them to remain independent for as long as possible. Not only does this enhance self-esteem, it also reinforces the person’s identity and quality of life. Appropriate stimulation is still required but not so that it overwhelms the senses. Appropriate stimulation means something that is familiar enough to be understandable, but does not create boredom.

As care providers, offering appropriate levels of stimulation for people with dementia will almost certainly mean trying to reduce noise levels. This applies both to the interior of a building and externally, in both working and social spaces. We need to consider noise within all care settings where people with dementia live and socialise, whether this is a formal care environment or a persons own home.

Three main areas to examine when thinking about noise reduction and acoustics in a building are:

(McManus and McClenaghan 2010)

McManus and McClenaghan (2010) recommend the following strategies:

Practical changes to help reduce noise levels

As well as making changes to the physical environment, we also need to recognise how our care approach will influence noise levels. Below are some suggestions of things we can do to reduce noise levels.

In a care home and day facility

In a person's own home

In a hospital

Managing noise positively

A limited amount of noise can be a good thing. One study noted positive interventions when 30 minutes of appropriate music was played and appropriate meant that it was the musical choice of the individual with dementia and played for a limited time at a volume that could be heard but was not overly loud or overstimulating (Holmes et al, 2006). Calming and quiet music or singing may be helpful too, for example, on a one-to-one basis if a person with dementia is awake during the night.

Appropriate sound levels can improve communication as the person can focus on one interaction or task. While having no background noise at all may feel strange to some people – for example, an activities worker may feel more comfortable running an arts group with music playing in the background – silence or the simple low-level noise of conversation may actually help a person with dementia to concentrate on the task before them.

Often the benefits of silence for people with dementia are underestimated. A person with dementia may respond some time after being spoken to if they are given enough time to process the information. We need to remember that a person with dementia may need silence to process information.

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