One of the main reasons we should focus more on the social environment that we create for persons living with dementia is the 3rd of the six main core instincts that we operate from: our willingness and ability to respond to threats.
This is probably one of the most common cave-man-ish visuals you have held in your head at one time or another, the image of a hairy man, poised with a spear, prepared to “chuck it” at a wild animal. You have probably seen this similar scene in museums, art galleries, history books. We can easily conjure up this image and glean from it the concept of kill or be killed, the instinct of survival at its core.
Fortunately we do not have to ward off dangerous creatures in our day to day lives, but we still have the instinct to respond (desperately if necessary) to direct or perceived threats. Unfortunately this instinct runs so deep, I feel that this may be a root cause to the amount of violence we are continuing to witness in our society today.
The social environment, more than the frightening physical one from our ancestors, can create real and imagined threats to our livelihood, causing us to want to and act upon it with a response. Most of the threats that we encounter are human to human, perceived differences, misunderstanding and miscommunications. Perceiving a foreboding risk, we prepare to fight to protect ourselves and our clan. We “proactively” attack what might hurt us.
Within living settings there are all types of things that can create a sense of threat to a person living with dementia including sounds, touch, observations and visual images (just to name a few). As I have said many times to many people, when we observe a behavior or reasonable reaction, it is most often an emotional response to the environment surrounding the individual (whether perceived or real).
Often going unnoticed by staff and caregivers alike, we are responsible for the environment we create for our loved ones and therefore we are responsible for the response and the outcome. When a more modern day, realistic violent “shoot’ em up” movie is played in a memory care unit, it may create very different experiences to a black and white John Wayne movie. I am not saying that only black and white movies are appropriate, but I am commenting on the choice of film and what it may elicit: loud, life-like, violence and gore that is unrecognizable compared to a recognizable source of entertainment that may be recollected.
Daytime television shows that capitalize on the arguments that ensue as the guests and host appear can create a very hostile environment. The interactions can be visually upsetting, encompass a volume of hostility, and provoke potential triggers of threats to on-lookers.
An argument amongst staff can be the perfect breeding ground for angry, frustrated and irritable residents. Not only is there a lack of control perceived by the on-lookers, but the volume, pitch and tone of the staff indicate that there is something they should be on-guard for.
Bright lights, cluttered environments and chaotic noises coming from overhead speakers can be a trigger to feeling overstimulated. When a PLD experiences sensory overload they often do one of two things. Either they seek a space to shut down to recapture a quieter location or they express outwardly to attempt to reduce the stimulation. Sensory stimulation, when provided appropriately in the appropriate environment and time, can be very useful in creating a connection. When tons of “stuff” is going on in the background, it can quickly become the main focus to a PLD.
Remember that our brain is an amazing machine that works to give us the most information possible. If one area of the brain has deficits, other parts will compensate. When a person is living with dementia, there may be other sensory input structures that overcompensate. This means that we (the caregivers) need to be much more aware of the visual, auditory and tactile environment we create and allow, so that we can minimize environments that induce a sense of threat, chaos and eventual reasonable responses to such.