Dementia Gateway: The environment

Case study: Stop that noise!

James was becoming distressed by noise at his day centre.

Background

James had been attending Middich Day Centre for people with dementia for two years when he began to hesitate about getting into the minibus that came to pick him up in the mornings. At the centre – a single room in a church hall – James sat at the doorway and didn't join in activities that he had enjoyed previously. James started complaining about the noise and increasingly appeared to be confused and disorientated within the building, especially at mealtimes or tea times.

It was vital that the staff and volunteers adopted a consistent approach to ensure much more acceptable noise levels.

Read the full case study:

Understanding the situation - 1. Research and development findingsOpen

As a result of taking advice, the manager of the centre watched the training DVD 'Supporting Derek' (Watchman et al 2010). This demonstrated the effect of noise on people with dementia, especially noise that seems acceptable to others. The manager then used this DVD in training sessions for staff and volunteers. The DVD was based on extensive research, and in particular highlighted findings that recognise the importance of music and singing for people with dementia, but only if used appropriately: see the work of Holmes and others (2006) and van Hoof and others (2010).
Understanding the situation - 2. Views collected from key peopleOpen

James's wife, Margaret, was worried that he would be unable to continue attending the centre as this resource provided her with vital respite. Previously he had returned home calm and in good humour from the day centre, but recently had been agitated and distressed.

Staff and volunteers had developed a relationship with James and wanted to make his time at the centre as enjoyable as possible, but they were becoming frustrated that he no longer wanted to join in with activities.

As a result of the training sessions, staff started to think about each area where noise may be having an impact on James's experience at the day centre and what, if anything, they could do to minimise the problems. They realised that the start of the day at the centre was particularly chaotic and noisy. All the members arrived at the same time either in a minibus or taxis and were greeted enthusiastically by staff and volunteers in the entrance hallway.

Background music was played during activity sessions and over lunch. Staff and volunteers frequently forgot it was on as they had stopped noticing it themselves.

The staff identified that lunchtime and tea and coffee times were particularly noisy. This was due in part to the clatter of the tea trolley but mostly because it triggered a buzz of activity among the centre volunteers, all keen to help.

The staff then thought about the acoustics in the building. They could see that the use of a single room in a church hall was not ideal: it lacked separate kitchen and bathroom facilities, had a high ceiling and occasionally they could hear noise from adjoining rooms. And yet this was the only space that was available – so they had to adapt it as best as possible. Having only one room made it difficult if some people didn't want to join in an activity or became distracted by noise in another part of the room.
ActionsOpen

James changed his times at the centre. Instead of a bus picking him up with others he was collected by a taxi that brought him a little after the start time, by which time the centre was calmer and quieter. His taxi arrived earlier to take him home at the end of the session. Staff and volunteers decided that not so many of them should be in the entrance hall when members arrived.

Staff and volunteers stopped playing music routinely. They found out more about what type of music members liked and were selective about what they played, on which day, depending on who was attending. Music was no longer played as constant background noise, but instead was used selectively for time-limited periods, for example to introduce singing sessions. Much more spontaneous singing took place. While this still created a certain noise level, the actual noise was more appropriate and stimulating than the previous background noise.

Staff agreed to keep using the tea trolley – they felt this was an important visual cue that helped members recognise that it was tea time. However, they did take cutlery and crockery into the hall before the group arrived each day, in order to reduce the sharp noise of it being placed down and moved on the metal trolley. A rota system was started so that only one volunteer at a time helped to give out tea and coffee – this drastically reduced the amount of movement, activity and noise at that time.

Large, thick full-length curtains were bought to help reduce the echo and sound reverberation in the room. Wall hangings were used for the same purpose.

Working within the restrictions that they had, staff tried to partition the room using screens. This slightly reduced the noise of conversations elsewhere but was successful in visibly removing distractions, which meant more one-to-one work could take place. The manager also tried to negotiate the use of another room next to the current space to enable a quieter space to be available. Staff and volunteers were more aware of their own noise levels, for example they stopped speaking to each other across the room or into the kitchen.
ResultsOpen

By starting later and finishing earlier, and travelling by taxi, James found his journey to the centre was much more acceptable and one that he stopped resisting. The combination of approaches adopted by the day centre helped to reduce anxiety levels not just for James but for other members too, which the staff had not expected to happen.

It is important that these changes were reviewed regularly as James's interaction with others and with his environment would change as the dementia progresses. However, for the time being it enabled him to continue at the centre willingly and for his wife to benefit from his attendance.
Advice for othersOpen

In this case study, it was vital that the staff and volunteers adopted a consistent approach to ensure much more acceptable noise levels in the centre throughout the week. This meant involving volunteers in training, because it was important that everyone understood the importance of reducing unnecessary noise, along with other aspects of dementia care.

Steps that the day centre took were explained in the newsletter issued to families. This meant that families were able to develop a greater awareness of the impact that background noise can have on people with dementia, even if it seems an acceptable level to them. This raised awareness of the importance of reducing noise levels at home.
Financial implications Open

The changes suggested in this case study don't need to have any cost implications. The most important thing was that the staff developed an increased awareness of their own impact and the impact of the environment.

For some organisations, this may mean investing in training, either for individual staff or for senior staff on a 'train the trainer' basis. This may offer a longer-term return on investment, particularly if the organisation has a high staff turnover.

When planning a new service or new building, if specific attention is paid to acoustics then money can be spent on floating floors and insulation for example. The more investment and planning that takes place at this time, the better the resulting design in terms of supporting people with dementia.

If you are working within an established service rather than a new building then for minimal outlay design features can be added that will minimise sound travelling between rooms in the building such as heavier curtains and wall hangings. For more on this, see the feature on 'Noise levels' in this section.

The most important thing to remember costs nothing at all – turn off the television or radio!