A person with dementia may have trouble perceiving the world around them correctly. During the course of this disease, they may experience altered perception, which can lead to visual problems.  Learn more about how these visual problems can affect daily living, and draw on tips on how to create a dementia friendly environment in the home.

Visual problems

Here are the visual problems a person with dementia may develop:

• misperception of what is there-the person sees one thing as something else
• loss of depth perception
• decreased peripheral vision
• poor colour discrimination

How they may see things

Everything changes experientially for a person living with dementia. In terms of altered perception, the problem comes from damage to the visual system. The visual perceptual difficulties can have an impact on the person’s orientation, communication, affect how they move around their environment and may even cause responsive behaviours.

Dementia expert Teepa Snow says that the vision field changes as the dementia progresses. Initially, it may feel like the person is seeing through a scuba mask, to then seeing through binoculars, and finally to basically seeing through one eye.

The person may experience problems in:

• Judging distance. The inability to relate to space by misjudging distances and where objects are. This can cause frequent bumping into objects and/or people.
• Negotiating changes in floor covering, as this may be perceived as a change in level. For example, jumping over a dark metal transition strip may look like a crevasse or dark tiles may look like a hole to the person.
• Misinterpreting a shiny floor–may be thought of as wet and appear as a spill or even a body of water.
• Judging the depth or number of stairs especially when going down the stairs.
• Misinterpreting objects for people (for example clothing on a chair, pole lamps, coat rack)
• Becoming confused or restless because the environment is visually over-stimulating (has ‘too much going on’). Examples: a room with patterned wallpaper, bright lights, vibrant colour or too many signs.
• Bathing.  The water may be perceived to be much deeper than it is, or the individual may believe they are at risk of drowning. Understandably, the person may then refuse to bathe.
• Peripheral vision. The field narrows and the person focuses only on what is directly in front, therefore looking either straight ahead or down (for example, when out shopping, the person with dementia may lag behind the caregiver as they can see them better when the caregiver is in front of them, as opposed to walking beside them).
• Difficulty reaching for things, such as a cup of tea or door handle
• Sitting. The person may cautiously put a hand on the edge of the seat, brush the edge of the seat with a lower leg, and then sit on the edge. Although the person may be encouraged to move to the middle, he or she may not be sure where the middle is or how far down, or how far over to go.
• Eating. The person may have trouble eating if everything looks the same and has no depth or contrast (for example, white tablecloth, white plates, clear drinking glasses)

Dementia-friendly environments can help

Making adaptations  in the home environment can help a person with dementia to remain independent and maintain their dignity. Regular reviews should be undertaken to make sure the environment remains dementia-friendly as the needs of the person with dementia changes.

• Use colour to highlight orientation points such as coloured stripes or textures to define each step. Use coloured handrails to highlight the direction of slopes or staircases.
• Avoid busy patterns, changes in floor surfaces or patterns such as heavily patterned rugs on wooden floors.
• Replace mirrors or shiny surfaces if this is causing a problem.
• Ensure there is adequate lighting and avoid dark corners.
• Avoid rearranging furniture in a familiar environment,
• Ensure that the area is clutter and obstacle free.
• Use colour to highlight objects that need to be seen. For example, a coloured toilet seat, a red plate, and red handled cutlery, and coloured glasses rather than clear ones.

Tips for caregivers

• Arrange for good eye care (have regular eye tests and make sure glasses are current, clean and with the correct prescription).
• Don’t rush. Allow for plenty of time, encouragement and support the person as they move around the environment. Slow down your own movements.
• Anticipate the situation and explain the environment. Walk first on to changing floor surfaces to demonstrate it is safe.
• Acknowledge what the person is seeing and reassure them you are there to help. Avoid correcting the person. Telling them what they are seeing is wrong will only increase anxiety and distress.

Altered perception and hallucinations

Hallucinations are false perceptions that can be caused by dementia. When a person with dementia hallucinates, they may see, hear, smell, taste or feel something that isn’t there. Visual hallucinations are seeing things that are not real and often include people, children and animals that are not present. Hallucinations are different from the manifestations of altered perception.

While altered perception might look very strange to us as caregivers, the person with dementia is simply responding to the world as they see it. If we were seeing what they were seeing we’d probably respond in the same way.

Have you made changes in your home that have helped with altered perception?