Creating Calm with Sensory Tools in Dementia Care

[00:00:03] Are you caring for a loved one with dementia? You don't have to figure this out all on your own. Welcome to Truth, Lies & Alzheimer's, the show that helps you reimagine a new relationship with your loved one, a relationship a little more free of stress and anxiety. Join host Lisa Skinner and her 30 plus years of experience as she guides you on a new path

[00:00:28] to a better relationship with those you care for. Here's Lisa. Hello everybody! Welcome to the Truth, Lies & Alzheimer's. I'm Lisa Skinner, your host. Thanks for being here today. I appreciate you tuning in. Today's topic is using sensory objects to de-escalate stressful moments in dementia care.

[00:00:56] And we can all relate to that, right? So these sensory objects such as a fidget blanket, for example, or other similar anxiety, repetitive behavior, support objects, can and do help de-escalate the stressful moments that we all experience in dementia care giving by giving a safe,

[00:01:23] engaging way to redirect nervous energy, reduce internal distress, and create predictable sensory input. And that can lower the alarm level in our brains enough to make our people that we care for more receptive to reassurance and to problem solving.

[00:01:51] How and why it can be effective? Because they provide a physical outlet for arousal. You know, when someone is agitated, their body is often in a heightened state. For example, they're pacing, they're restless, they're irritable, and they're scanning for surrounding threats.

[00:02:14] Their hands and attention are pulled toward the sensory texture, such as pockets and zippers or weighted elements, which can and does reduce the momentum of frantic behaviors. They reduce cognitive load. Because anxiety often comes with racing thoughts and uncertainty. So something like a fidget blanket gives a concrete task.

[00:02:44] They can feel this, move that, check the pockets if they have them, which can crowd out unhelpful rumination. They support regulation through sensory input.

[00:03:01] And many people, as studies have shown, regulate much better with consistent sensory feedback, including ones that contain firm pressure, predictable textures, and or small movements. And these can help the nervous system calm down without requiring the person to fully explain what they are feeling.

[00:03:29] It improves focus and engagement. And during escalation, as we know, reasoning is so difficult. So, engagement with a calming activity can shift attention from threat-focused ideas to something manageable in the moment. They offer agency in a very respectful way.

[00:03:56] Presenting a sensory object as a choice, in other words, instead of just kind of shoving it in their face, you might say something along the lines of, Would you like to hold this? Or would you like to use this? And that, in itself, can reduce the power struggles that worsen agitation. They create a behavioral bridge. What do I mean by that?

[00:04:24] Well, it can be much easier to transition from a point of escalation or turning that point of escalation to a much calmer interaction if there's an immediate step.

[00:04:41] And holding something like a fidget blanket or some of these other sensory objects while you're speaking to the person you care for and waiting for that person to use it before addressing the topic or the situation at hand.

[00:05:01] And one of the things that I absolutely love about these sensory products and I have been seeing them used, witnessing them used for 30 years. And I've seen some pretty remarkable positive outcomes as a result of augmenting the situation by using these sensory products.

[00:05:26] And one of the things that I absolutely love about them is they don't argue the person out of whatever their belief is at that moment. They help by lowering stress so the moment becomes safer and more workable.

[00:05:45] So I created a couple scenarios for you that hopefully you'll be able to relate to as a real life situation that, you know, does commonly come up with dementia caregiving. So this scenario, a caregiver's person who has dementia insists he wants to go home. Is this sounding familiar at all?

[00:06:16] He's not getting any positive response from his caregiver. He feels that she's not listening to him. So he becomes angry. He starts pacing and he's throwing things in a suitcase. Now, in this situation, agitation may be driven by his disorientation.

[00:06:40] He doesn't believe he's at his home because it doesn't look familiar or he's afraid or he has a strong need for familiarity. And being in control of the situation. So here's how a sensory object can help. It can channel his restlessness and give him a structured alternative.

[00:07:07] While you, the caregiver, address the underlying reassurance needs. Which is typically in this case, familiarity, security and comfort. So use the object to redirect the pacing activity, the packing energy and offer it in a way that fits that particular situation.

[00:07:35] So let's, let's use this as a hypothetical. While he is near the suitcase and he's just, you know, frantically putting things in there. Invite him to hold or carry the sensory object. Choose features that occupy his hands. For example, let's say it is one of these fidget aprons or vests or blankets.

[00:08:05] And they often come with zippers and fabric straps and Velcro, Velcro patches. So point these out to him. And even if you just take his hand and say, you know, touch something that feels nice. And then maybe he will catch on and start playing with it. Start holding it. Because that's what you want. And suggest find and feel the different areas.

[00:08:33] Now, how does this actually deescalate that situation? It does in what changes moment to moment. Pacing is often an activity of self-regulation in motion. Hand-based tasks can become a steadier regulatory channel than walking.

[00:08:56] As he becomes absorbed in manipulating the parts, the intensity of anger can drop and the body can therefore slow down. And this is why it can be so effective. Dementia-related escalation often improves with sensory grounding and predictable routines rather than debating about whatever the reality is.

[00:09:26] Because keep in mind, your reality is probably going to be very different from his reality. In this particular situation, he insists on going home because he doesn't believe he is home. Now, as you know, he truly is. But you've probably already experienced that there's nothing you can do or say to change his reality.

[00:09:52] So, the sensory object provides a job for him that doesn't require remembering facts. And sometimes having to remember things if you're peppering your loved one with questions of the person you care for. It just adds to their frustration because it points out that they have cognitive decline.

[00:10:20] So, here's a practical approach. Offer the sensory object calmly. And then avoid repeated bargaining. For example, you're not going blah, blah, blah. Or stop packing. Instead, focus on safety and comfort. That's probably what he is yearning for. With simple options.

[00:10:48] Pair it with low demand language while he engages. And continuously tell him, you're safe. I'm here with you. Here. Hold this. We'll get ready together. And don't forget, a safety note here. Ensure the sensory object can't be used to choke.

[00:11:11] In other words, it doesn't have or contain small parts that the person cannot get tangled up in anything with long cords or loose attachments. Okay. Now I'm going to describe another scenario. This particular woman that you may be caring for, you may have already experienced this.

[00:11:39] All of a sudden, she believes her late husband is alive and waiting for her. So she becomes extremely worried that he will be unbelievably angry at her. And she's worried that he's going to be hungry. And it's her duty as the wife to race home and fix him his dinner.

[00:12:05] Now here, the escalation is likely driven by emotional urgency and fear of harm. Her fear is that he'll be upset and she must fix it. She doesn't like to see her husband upset. Who does? So in this case, a sensory object can lower the anxiety that she is displaying.

[00:12:34] So she can be supported without intensifying the conflict about whether he's real or not. You know he's not. She believes he is. So use the object to reduce that threat focus that she feels. And when she's panicked, her attention is locked onto the imagined consequence, which for her is, he's at home waiting.

[00:13:03] He's going to be angry. He's going to be hungry. He's going to be hungry. And here's where a sensory object can give her hands something to do. So her attention can then shift away from the threat narrative. So how does this deescalate the escalating situation?

[00:13:26] Her nervous system is now in a state of high, high arousal. So sensory engagement can help her calm down enough to tolerate you reassuring her. Feeling regulated may reduce the urge to repeatedly check or call out or seek immediate proof.

[00:13:52] And this is why it can be effective in this situation. Because in grief or trauma related states and some cognitive conditions, our intense emotions almost always override logical correction.

[00:14:14] By not directly disputing the belief, you avoid arguing into a state of escalation and the fidget sensory object supports the regulation first. And then once she starts to calm down, then you reassure. So here's a practical approach for this scenario.

[00:14:40] Offer the sensory object as a comforting tool while you validate her feelings. You could say something along the lines of, Esther, I can see how worried you are and I'm here to help you. Let's get through this minute together. If appropriate, combine it with a gentle task.

[00:15:03] For example, would you like to help me with something comforting like holding this blanket while we figure out what our next plan is? If she needs dinner reassurance, consider a brief calming simulation strategy. Hey, Esther, let's go set the table. I'd love your help.

[00:15:31] We can prepare something warm without insisting on the factual premise. So here's what I recommend you don't do. Don't say your husband's not here in a heated moment. Don't say your husband. That's going to increase her distress and her defensiveness. Guaranteed. Avoid rapid questioning. Keep your language simple and steady. Okay.

[00:16:01] One more scenario I'd like to illustrate for you. This is a woman who is in her mid stage of Alzheimer's disease. And she has a tendency to become very suspicious and accusatory.

[00:16:23] So in this particular scenario, she has accused her caregiver of stealing her very, very precious bracelet. Because she doesn't remember where she hid it. So she lashes out at her caregiver.

[00:16:41] So this scenario likely involves shame, fear, mistrust, and a threat to her safety and identity, especially when her memory is not so reliable anymore.

[00:16:58] Here's where a sensory object can help because it reduces emotional intensity and it supports grounding, making it much, much easier to redirect and solve the problem calmly. Use the object to interrupt the situation that is escalating and support her emotional regulation.

[00:17:24] You can do that by placing the object within her reach and offer it as a tool for calming, not as a test or punishment. Now the features that are most helpful involve careful hand movements.

[00:17:42] So again, what could be helpful are playing with buttons, textured panels, small zip pathways, and smooth, calming, worry-free surfaces. How is this going to de-escalate this particular scenario? Well, lashing out often correlates with acute arousal.

[00:18:11] Occupying hands can reduce that fight readiness, which is a very basic instinct of ours. You've heard of it, fight or flight. When she engages with the object, you may gain a window into lowering her defensiveness. And this is why it can be so effective.

[00:18:37] In moments of mistrust, people may not process our explanations. You need to first lower the state of arousal that she is currently in to make a conversation possible. Then the object can help shift her from accusation mode to, oh, I can do something with my hands mode.

[00:19:07] And as soon as she starts, you'll see it act as a calming effect. So here's a practical approach. Avoid using any language that will continue to escalate this situation. In other words, try not to say something along the lines of, that's not true. In other words, you didn't take her bracelet.

[00:19:34] Use validation and boundaries and say, Carmen, I understand how upset you are. I can help you. I'm here to also help you find your bracelet. I know how important it is to you. Then you could try to redirect. Let's look for it together. And you can hold this while we both look.

[00:20:02] Use a structured search routine. But ask permission before moving any items around and check her likely hiding places step by step. Check her pockets, check her blankets, her bedside area, the laundry basket. She needs safety and dignity reassurance in this situation.

[00:20:28] So it's always helpful to keep your toe neutral and nonjudgmental. Don't forget, this is her truth. She believes what she is saying. The goal is to reduce shame and regain her cooperation. So here's some general tips that make a sensory object work better.

[00:20:55] Offer it early, not at the peak of a crisis. The earlier you introduce sensory grounding, the easier it is to prevent full escalation. You know, those catastrophic reactions or complete meltdowns that we've all witnessed? Well, we've kind of contributed to them. Use as a companion tool, not a distraction.

[00:21:22] Present it as comfort or assistance and avoid using it to silence or ignore someone. Match the person that you care for's preference. Some prefer firm pressure or a weighted object. Others prefer light textures and things that move or can be cuddled. Observe what feels soothing to your individual and keep your demands low.

[00:21:53] Don't ask the person to calm down. That's just going to kind of reset and put that scenario back into escalation mode. Or try to explain anything. Let the regulation happen through senses and the use of her hands first. And pair it with calm communication.

[00:22:19] Even the best sensory tool works better with a calm, steady, soft voice. Using simple sentences and reassurance. Reassurance goes a long, long way when a person's in a heightened emotional state with dementia.

[00:22:42] Change the approach a bit with familiar cues, more triggers nearby and often a need for quick, low conflict regulation. Now, there is a slight difference between the scenarios that I illustrated for you.

[00:23:07] If you are in a more institutional setting like assisted living or a skilled nursing care facility or a memory care. Kind of using those same three scenarios as our same examples. I'm just going to point out the home focused ways to use a fidget object to help deescalate in those three scenarios.

[00:23:35] So home specific ways to use a sensory object are to keep it accessible and ready. Put a sensory object in a consistent spot like the arm of the chair that she's sitting in. A bedside drawer near the living room where agitation often starts. And in a crisis, offering it feels less sudden and less like a new rule.

[00:24:04] Use the home environment to ground her or him. Pair the object with a familiar routine like sitting in the same chair, offering the same glass or mug, bathrobe, same background music if that helps that you know she loves or he loves. A familiar setup lowers the threat and makes the sensory tool even more effective.

[00:24:34] You can reduce the friction between you with fewer words and fewer choices. At home, conflict often escalates when you add debates, multiple questions or instructions. Use short phrases while they hold the object. So, I'm just going to recap scenario one.

[00:25:03] The gentleman with dementia. He wants to go home. He's angry. He's pacing. He's packing. Offer the blanket as a ready to go companion. While he's handling the suitcase, place the object in his hands or drape it over his arm like something that he can carry. And the goal here is to convert a frantic motion into a hand engagement.

[00:25:32] Home safety adjustments need to be considered. If wandering is possible, move the tempting exits or bags slightly out of immediate reach. Not hidden aggressively. Just reduce the access. Keep keys, sharp items stable and out of sight. What to say while this gentleman is using the sensory object? Tom, you're safe.

[00:26:01] I'm here with you. And you can keep this with you. We'll get ready together. Okay? Permission. In scenario number two, where the woman was worried about her late husband and believing he's alive and waiting for her at home. Okay. Do not argue about the belief. Anchor her emotion first.

[00:26:25] At home, the kitchen table is often the same scene she's trying to fix. Right? Offer the sensory object near that area so her hands can engage while you reassure. Use a calming task substitute and pair that object holding with one simple comforting activity.

[00:26:50] Like setting up a plate, getting a warm drink, preparing something that's familiar to her. This reduces the he will be hungry slash mad loop that is circulating in her head over and over and over again long enough for regulation. So what to say?

[00:27:17] I can see how worried you are and I completely understand. Let's get through this moment together. I have a suggestion if it's okay with you. Let's go into the kitchen and make us a nice warm cup of tea. I think there might even be some cookies in there too that I baked earlier this morning. I said, would that be okay with you?

[00:27:43] And you'll see a pretty quick de-escalation in that situation. And then our last story where the woman living with dementia accuses her caregiver of stealing her bracelet. She lashes out. So what you want to do, first off, create a soft reset before you start searching.

[00:28:10] In homes, accusations often spike because the person feels shame or fear of being judged. So offer the sensory object immediately to lower, to first lower her arousal. Then start checking. And again, to reiterate, use permission and slow structure. You can say, I'm going to help you look. May we check this together?

[00:28:40] Get her buy-in, her okay. And while she holds the sensory object, check likely places one at a time. Near a familiar storage area like a bedside drawer, sofa area, pockets of the day's clothing, a laundry basket. And here's what to avoid in this scenario. Saying things like, oh, that's impossible. You're wrong.

[00:29:06] Especially during the peak moment of her emotional state. And hopefully this has been extremely or will be extremely helpful for all of you who are caring for people or have loved ones who live with Alzheimer's disease and related dementia. Because these things happen. They're very, very common.

[00:29:34] And don't understand how we can deescalate these situations from turning into complete and total meltdowns. Then that's what you're really going to have to deal with. And it's not a very pleasant situation. There are effective ways to turn these situations into positive outcomes. And I just shared three of them with you. So put them to use. Put them into place.

[00:30:01] Fidget objects are incredibly valuable when these unexpected situations show up in our day-to-day caregiving routine with people living with Alzheimer's disease and dementia. Okay. Don't forget to stop by and visit us at mindingdementia.com, our website. And I'll be back next week with another brand new episode of the Truth, Lies, and Alzheimer's show.

[00:30:31] I'm Lisa Skinner, your host. And I hope you all have a wonderful rest of your week. And my wish for everybody is to be happy and stay healthy. Till next week. Bye-bye. Thank you for listening to Truth, Lies, and Alzheimer's. We hope you found something in today's episode that helps. We understand that caring for a loved one with dementia can be the challenge of a lifetime. But you don't have to do it alone.

[00:31:02] If you're ready for exclusive access to even more great content and resources, head on over to Facebook and join Lisa's Minding Dementia Support Group. We're a community of like-minded caregivers, and we're here to help.