The Snoezelen® Approach to Dementia Care
The use of Snoezelen® and Multi Sensory Environments is now main stream practice in the care of older people with dementia and is supported by a number of organisations including the National Institute of Clinical Excellence (NICE). The NICE guidelines ‘Dementia: Supporting people with dementia and their carers in health and social care (2006)’ specifically mention the use of Multi Sensory Environments to manage anxiety and agitation in people with dementia in preference to medication. They state ‘Health and social care staff in the NHS and social care, including care homes, should work together to ensure that some of these options (including MSEs) are available, because there is some evidence of their clinical effectiveness’ (NICE Guideline 42: 184.108.40.206).
They also state ‘A range of tailored interventions, such as reminiscence therapy, multi sensory stimulation, animal-assisted therapy and exercise, should be available for people with dementia who have depression and/or anxiety’ and ‘should be followed before a pharmacological intervention is considered.’ (NICE Guideline 43: 220.127.116.11 / 18.104.22.168)
Evidence supporting this approach includes two Randomised Controlled Trials exploring the effect of the Multi Sensory Environment approach on functional performance and a further trial exploring the effect of Multi Sensory Environments on mood and behaviour (Collier et al., 2010; Staal et al., 2007). Both these trials suggest an improvement in function and mood and behaviour beyond that achieved by a pharmacological approach. For example, Collier et al, achieved a success rate of 67% whereas Hemels et al. (2001) suggest traditional antipsychotics have a success rate of between 56-63% and Cornegé-Blokland et al.(2012) suggest an even lower rate of 50%
If the Snoezelen® Multi Sensory Environment is constructed to meet the sensory needs of the person with dementia it has the potential to be more effective than pharmacology in managing mood and behaviour problems whilst having little or no side effects.
The Following is from the NICE guidelines pertaining to the treatment of Dementia using Sensory Rooms
Non-pharmacological interventions for non-cognitive symptoms and behaviour that challenges
People with dementia who develop non-cognitive symptoms that cause them significant distress or who develop behaviour that challenges should be offered an assessment at an early opportunity to establish likely factors that may generate, aggravate or improve such behaviour. The assessment should be comprehensive and include:
- the person’s physical health
- possible undetected pain or discomfort
- side effects of medication
- individual biography, including religious beliefs and spiritual and cultural identity
- psychosocial factors
- physical environmental factors
- behavioural and functional analysis conducted by professionals with specific skills, in conjunction with carers and care workers.
Individually tailored care plans that help carers and staff address the behaviour that challenges should be developed, recorded in the notes and reviewed regularly. The frequency of the review should be agreed by the carers and staff involved and written in the notes.
For people with all types and severities of dementia who have comorbid agitation, consideration should be given to providing access to interventions tailored to the person’s preferences, skills and abilities. Because people may respond better to one treatment than another, the response to each modality should be monitored and the care plan adapted accordingly. Approaches that may be considered, depending on availability, include:
- multi sensory stimulation
- therapeutic use of music and/or dancing
- animal-assisted therapy
These interventions may be delivered by a range of health and social care staff and volunteers, with appropriate training and supervision. The voluntary sector has a particular role to play in delivering these approaches.
Health and social care staff in the NHS and social care, including care homes, should work together to ensure that some of these options are available, because there is some evidence of their clinical effectiveness. More research is needed into their cost effectiveness.
Psychological interventions for people with dementia with depression and/or anxiety
Care packages for people with dementia should include assessment and monitoring for depression and/or anxiety.
For people with dementia who have depression and/or anxiety, cognitive behavioural therapy, which may involve the active participation of their carers, may be considered as part of treatment. A range of tailored interventions, such as reminiscence therapy, multi sensory stimulation, animal-assisted therapy and exercise, should be available for people with dementia who have depression and/or anxiety.
For the patient with dementia the world can be a very fragmented and confusing place. Without carefully constructed environments and interactions that focus on their remaining skills they are likely to experience isolation, confusion and sensory deprivation. Many of these problems can result in disorientated, confused behaviour. The link between sensory deprivation and mental health has been frequently documented. Richman ‘69 reflected on the link between sensory stimulation and elderly people with mental health problems as being ‘a fact of life leading to poor function’
Dementia affects over 750,000 people in the UK. Clinicians and managers report dissatisfaction with current healthcare options available for people with dementia. Multi Sensory Environments (MSEs) utilising advanced stimulating equipment targeting the senses, have been successfully used with individuals with dementia, with learning disabilities and in palliative care. Despite this, no controlled studies have been conducted until now.
Residents receiving Snoezelen® care demonstrated a significant treatment effect with respect to their level of apathetic behavior, loss of decorum, rebellious behavior, aggressive behavior, and depression. During morning care, the experimental subjects showed significant changes in well-being (mood, happiness, enjoyment, sadness) and adaptive behavior (responding to speaking, relating to caregiver, normal-length sentences).