VisionAware

by Audrey Demmitt, R.N., and VisionAware Peer Advisor

What Caregivers Can Do to Minimize the Visuoperceptual Mistakes Caused by Alzheimer’s Dementia

Alzheimer’s dementia causes a continual decline in visual and cognitive functioning. Your loved one will struggle to make sense of the world around them and it can be a profoundly distressing and lonely experience. Caregivers can promote a safe, supportive, and calming atmosphere by making some changes to the physical surroundings.

Consequences of Visuoperceptual Mistakes for Someone with Alzheimer’s

Visuoperceptual mistakes can cause confusion, anxiety and frustration in the care receiver. Their safety and independence can also be compromised. Consider the following examples of problems your loved one may encounter:

• They may see an “intruder” in a mirror or window reflection. This may prompt them to refuse to go into a bathroom because it appears occupied and result in incontinence.
• Some may mistake images on the TV for real people and become frightened.
• They may have difficulty positioning themselves on a chair or on the toilet if there is a lack of contrast or lighting, causing fear, a fall or even incontinence.
• They may appear confused or restless in an environment that is visually overstimulating and difficult to navigate.
• You may notice problems locating people or reaching for objects, even though they may be in front of them because of other distracting visual information such as patterned wallpaper.
• They may have trouble feeding themselves, unable to find their drinking glass or see food on the plate.

Creating Safety and Comfort in the Environment

The goal of care for someone with Alzheimer’s is to promote safety, health and as much independence as possible for as long as possible, even as your loved one declines. Begin by evaluating the living space for safety, comfort, and functionality:

• Are there fall risks like cluttered rooms and throw rugs?
• Is there enough of the right kind of lighting?

Next, consider what seems difficult or upsetting for your care receiver that may be explained by visual confusion.

• Do they have trouble finding the bathroom?
• Do mirrors or shiny surfaces confuse them?

Think about the visual deficits discussed earlier: motion detection, decreased color and contrast sensitivity, lack of depth perception, and narrowed visual field. See “How Alzheimer’s Affects Vision and Perception.”

Suggestions to Decrease Visual and Perceptual Confusion in the Home

• Deliberate use of colors can help significantly. For example, mashed potatoes served on a brown plate with a white tablecloth are more visible than on a white plate. Use colorful cups and glasses instead of clear ones.
• Increase color and contrast in a room to help define objects and make it easier to navigate. A dark-colored sofa on a light-colored carpet will stand out more. A toilet is easier to see if there is contrast with the wall behind it. Painting baseboards with contrasting color to the walls may help distinguish where the wall ends and the floor begins. You may need to experiment to see what works best for your loved one as color and contrast may not work well for some people with Alzheimer’s.
• In general, avoid colors in the blue-violet range since they all look the same and use the color red which is easier for most people to see.
• Improve lighting levels around the home. Lighting should be even and should minimize shadows – some people resist going near dark areas in hallways and rooms. Increase the wattage of light bulbs and add additional task lighting.
• Reduce the amount of glare in a room by using shades or curtains. Eliminate glass and other shiny surfaces. Close curtains and blinds at night.
• Place contrasting colored mats or thresholds in front of doors and steps to help locate stairs and entrances. Paint the edges of stairs to define them and install handrails and banisters.
• Avoid noise, glare, insecure space and too much background distraction, including television and complex patterns in carpet, upholstery and wallpaper. Monitor room temperature for comfort.
• Create a Memory Book with individualized words or pictures to cue the steps of a task or prompt recognition of people and objects. Use simple and bold colored pictures or signs like wash hands, brush teeth.
• Place a large print label on the bathroom door to help with orientation and location.
• Set up the environment to enhance freedom of mobility within the confines of a safe space. Place a large stop sign in bold print on gates/doors.
• Use simple adapted devices like large button phones and TV controls, large print calendars, talking clocks, tactile markers on appliances, and adapted kitchen tools, to foster independence and enable activities they can still enjoy.
• Use pre-chopped vegetables, mixes, and ready-made sauces to make cooking easier.
• Consider reading to the person or using audiobooks if they are no longer able to read print. If they miss reading the newspaper or watching TV – radio programs can help them keep up with current events.

Don’t Neglect Eye Health and Vision Care

If your loved one has not had a recent eye exam, make an appointment and be sure to let the optometrist know about the dementia. It is important to keep prescription glasses up to date and labeled for near vision (reading) and distance vision (watching TV). Check that glasses are clean and encourage them to wear the appropriate glasses for the task. Remind your loved one to wear sunglasses when outside to manage light sensitivity, which seems to be worse for people with Alzheimer’s. If cataracts or other age-related eye conditions are present and contributing to poor sight, talk to an optometrist about how to have them treated.

In the case of someone with Alzheimer’s disease, independence can be thought of as the ability to perform and engage in any activities that foster quality of life for as long as possible, to include personal care, leisure, social, and spiritual life. Caregivers play a vital role in this goal but will need to recognize limitations and declining abilities in their loved one and make adjustments accordingly. With some careful consideration, planning and creative interventions, caregivers can minimize distress and improve levels of safety, enjoyment and independence for their loved one with Alzheimer’s disease. Read more information on visuoperceptual issues with Alzheimer’s.