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The influence of cuddling and ‘snoezelen’ on people suffering from dementia

The influence of cuddling and ‘snoezelen’ on people suffering from dementia

Smelling, seeing, feeling and hearing; the four human senses, helping you to discover the world and place things into perspective. The senses are extremely important for every human being, but especially for people with dementia. “Snoezelen” is a way of activating the senses in a cosy room, which can be very beneficial for people with dementia. In a ‘snoezel’room residents can enjoy scents, touching, music, warmth, tastes and light.

Snoezelen: sniffing and dozing

The word ‘snoezelen’ was coined by contracting two Dutch words: snuffelen and doezelen. “Snuffelen” means sniffing, exploring something by using the senses and “doezelen” means dozing, experiencing a relaxing and peaceful sense of warmth and passivity.

People can snoezel individually or in a group. There can be dedicated snoezel rooms designed to sooth and stimulate the senses; smelling, tasting, feeling, hearing and seeing. In the room are for example perfumes, flowers, drinks, special lighting or glowing, colourful objects and music. There can also be pillows, cuddly toys, dolls or sand to touch and feel. The aim is to create a soothing and relaxing atmosphere for residents, a place where they can be at ease.

The origin of snoezelen

Snoezelen, or controlled multisensory environment, originates from the seventies in ’s Heeren Loo in the Netherlands. One of the inventors, Ad Verheul, was working as a therapist voor the residents. 80% of the residents there have multiple disabilities. At that time these people were viewed as being residents. They stayed in wards and were looked after by nurses. There were few stimuli and challenges and so they were in bed most of the day, staring at the ceiling. To change this passivity, Ad Verheul and one of his colleagues explored  how they could activate the residents. Ad knew from his Art School education that the environment can have a positive effect on humans. Ad and his colleague started to place mobiles above the beds. This caused people to react, by an eye or arm movement. They called this experiment ‘primary activation’. At a conference they discovered that similar experiments were done in other nursing homes. In one of the homes, Haarendal, the word “snoezelen” was used. This word was adapted by Ad Verheul and from then on the term has stayed with us to indicate controlled multisensory stimulation therapy.

Snoezelen in practice

Snoezeling is mostly done by individuals in homes where there are snoezel facilities. By observing the people and conversations with their kin, carers try to find out about the resident’s life and his or her likes and dislikes. The snoezelroom can be tailor made on the basis of this information. Favourite music, familiar scents and soft objects can help to enhance the effect of snoezeling. Caretakers are trained to use snoezelen effectively and to find out about the people’s preferences.

Results of snoezelen

Research done by NIVEL shows that seniors suffering from dementia living in nursing homes who snoezel daily, are less passive, less defiant and less aggressive. They tend to complain less and take more pleasure in the contact with their carers. Likewise, the carers experience the benefits of snoezelen. They are more satisfied with the quality of the care they can offer, with the contact they have with the residents and with their own professional development. They reported to feel less stressed. The NIVEL survey also shows that the carers feel more confident when they use snoezelen. They are able to better deal with the more difficult behaviour of the residents and know what can cause them feel more at ease.

Short term effect

Other research also supports the positive effects of snoezelen. 75% of all nursing homes in the Netherlands already have a snoezel room where residents can relax. However, research has shown that the beneficial effect of the room disappears when residents come back to the communal room, which is mostly rather sterile. In order to attain a long-term effect snoezeling should be part of daily care.

Julia van Weert, professor of Health Communication explains that care in nursing homes has always been task focused: at 10 a.m. every resident should be dressed and at 5 p.m. they have to have dinner. By combining the stimulus of the senses with daily care, carers focus on residents instead of tasks. The clock shouldn’t be leading. This change of focus is quite a cultural change.  

Creating small snoezel corners in the corridors is a way to take care of daily snoezeling. A plus side would be that persons with dementia don’t wander, but stop and sit at the snoezel corner. The quality of life of the residents can be considerably improved by creating these spaces in the homes.

Kozie helps the residents to snoezel where they want, because the KozieMe pillow is portable. This means that the carers can bring snoezeling to the residents instead of bringing the residents to a snoezel space. So, everybody can enjoy snoezeling, also the people with reduced mobility.

 

 

Sources:
https://www.werkenindeouderengeneeskunde.nl/specials/belevingsgerichte-zorg-bij-dementie/snoezelen/
NIVEL onderzoek naar de effecten van snoezelen op stemming en gedrag van demente verpleeghuisbewoners en werkbeleving van verzorgenden
https://www.zorgwelzijn.nl/snoezelen-heeft-positief-effect-op-ouderen-en-zorgverleners-de-klok-leren-loslaten-zwz012589w/

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How does music evoke memories in people suffering from dementia?

How does music evoke memories in people suffering from dementia?

Every human being has a memory that stores recollections and retrieves them when there is a stimulus. It  is difficult for people suffering from dementia to retrieve these memories because the memory is deteriorating slowly. Then how is it possible that there are certain songs that do evoke memories in dementia. 

Thinking in images

People are visual thinkers. We store memories in images and pictures because these are easy to organise. When relating a recollection, people see the images associated with it. Every day we collect new memories and thus new images. The memory is never full, except when there’s too much information to store in a short time.

The memory not only accumulates images, but can also recognise things, for example; a route that has been taken before, the meaning of a specific word or what a USB- stick looks like. In dementia no new images, so no new memories, are stored in the brain. People in the early stages of dementia don’t really forget information, but they are unable to store it. During later stages, memories and images fade away more and more. First the latest memories disappear, following the steps back to older memories. This is caused by the shrinkage of the top two layers in the brain, which is explained in the article: Dementia and the brain.

Evoking memories using well-known sounds

The images or memories can be evoked when listening to a familiar sound or song. Petr Janata, Psychology Professor at UC Davis’ Center for Mind and Brain explains that the lobe that is activated by music lies in the middle prefrontal cortex region, right behind the forehead, and is one of the last regions affected by Alzheimer’s disease. He thinks it’s as if we use a familiar song as a soundtrack for a video played inside your head. The song triggers a memory, bringing back a person or a place, which in its turn evokes a certain feeling.

The song that will evoke memories needs to be familiar. Music you listened to when you were between 15 and 20 years old triggers the most vivid sensory flashbacks. Frans Hoogeveen, lecturer Psychogeriatry and co-founder of Radio Remember, says: “These are songs we listened to a lot when we felt young and free. Moreover, we listened to the songs very often, which makes the memory-traces still deeper”.

Music evoked autobiographical memory

The scientific term for a memory strongly connected to a song is  “a music evoked autobiographical memory”. When you hear a well-known song from your past, the rhythm comes in through your ears and the basal ganglia, which is related to checking movements and to the rewarding system, is activated.  Simultaneously, the brain stem is activated, mobilising the motor neurons in the spinal cord, which also control the muscles. This causes you to move to the music, by e.g. moving your foot or swaying your hips to the melody. The melody entered the auditory cortex through the brain stem, causing you to recognise the song after the first few notes, and your superior frontal gyrus and pre-motor cortex to be activated. Because the music is stored in your brain together with the memories from the past, they will emerge when hearing familiar sounds, bringing the feeling of that time along.

Therefore music can cause such emotion-laden responses.

Despite the fact that brains shrink in case of dementia, the oldest memories stay in tact the longest. The most recent memories disappear first, going back to the age of 21. The reason for this age boundary is unknown. People suffering from dementia aren’t able to access these memories independently, but music or familiar sounds are a means to tap into these memories and connected emotions.  

Kozie can help to evoke memories through familiar sounds. Are you interested in Kozie? Please contact our team.

 

 

Bronnen:
‘De wondere wereld van de dementie’ by Anneke van der Plaats & Bob Verbraek.
‘Why do the songs of your past evoke such viviv memories?’ by Psychology Today
‘De therapeutische werking van muziek’ by Laura Kemp
‘Wat muziek doet met je brein’  by Jop de Vrieze
‘Hoe brengt muziek het verleden dichterbij?’ by Erik Scherder

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The brain and dementia.

The brain and dementia.

The brain of a person suffering from dementia is damaged. How does dementia affect the brain and cause the symptoms of the disease?

The 4 levels in the brain.

In a nutshell, the brain can be divided into 4 levels, which in their turn can be separated into the subcortical and the cortical brain.

The 2 lower levels make up the subcortical brain, or the emotional brain. The lowest layer, the sensory brain, is responsible for the reception of simple sensory stimuli, whereas the second lower level processes the stimuli. At this level the amygdala causes emotions to come into existence, for example the so-called fight or flight reflex.

The cortical brail consists of the two upper levels and is called the thinking brain. This part of the brain processes the more complex tasks. At the third level emotional consciousness is developed.

Here the healthy brain gives meaning to things around us.

At the lower levels emotions occur, but in the thinking brain emotions are conscious and can be thought about before any action is taken. Finally, at the fourth and highest level of the brain the various brain functions come together. We are aware of our surroundings and ourselves and we can make choices to act responsibly.   

Dementia damages the thinking brain as well as the top level of the subcortical brain.

Fight or flight

The thinking brain accommodates many cognitive functions along with the memory. Because the thinking faculties slowly disappear when people suffer from dementia, they grow more and more fearful while they increasingly depend on the emotional brain. If people suffering from dementia experience something, which at first they thought was scary as being not scary at all in reality, they are not able to store this experience in the memory. So they can get anxious about things that happen perhaps every day, time and again. When people are afraid they can either fight or fly. But residents can also behave aggressively because of their anxiety.

The brain and dementia

There are more than eighty-five forms of dementia, of which Alzheimer is one. In the final stages of dementia, the weight of the brain can have decreased from 1,500 to 300 grams. This ‘loss’ mainly takes place in het thinking brain. As a result people tend to behave more and more impulsively. This behaviour is triggered by external and internal stimuli. Nowadays an average person receives a larger number of stimuli per day than an average medieval person in his whole life. People with a healthy brain can shut themselves off from this overdose of stimuli, but people suffering from dementia cannot. Thus they become restless and can be aggressive and can behave in an undesirable way.  This is a natural reaction according to Dr A. van der Plaats. She says that the more a brain is damaged, the more the behaviour of that person depends on his or her surroundings. The environment can be positive or negative. If it’s positive, it will prompt positive behaviour, and vice versa.

Too few stimuli

People suffering from dementia need an environment with dynamic stimuli. Too many stimuli will arouse agitation, as will too few stimuli. Residents will search for stimuli when there’s a lack of them and they will start wandering, which is a well-known phenomenon in care homes. They can’t deal with silence either. Residents don’t like to be in their own room, because there are few stimuli there. Even at night they might be wandering because they haven’t had enough incentives during the day to be able to sleep well.

It’s essential to make sure the environment of people with dementia contains enough stimuli and a relaxed atmosphere. This will help to lessen behavioural problems, such as aggression. It will also not only improve the quality of life of residents, but it will also decrease the workload for care home staff.

Kozie helps to create a favourable environment by means of products that bring about sufficient stimuli. KozieMe allows residents to evoke stimuli themselves. When they touch the KozieMe pillow, they hear familiar sounds. Would you like more information about creating stimuli by means of the Kozie product? Please contact our team!

 

 

Sources:
‘De wondere wereld van de dementie’ byAnneke van der Plaats and Bob Verbraek.
‘Het beschadigde brein’ – by Karin Schokker

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