Most of us take the noise around us for granted; after all, we live and work in the midst of a large, noisy city. Even so, it shouldn’t surprise us that noise (usually defined as “unwanted sound”) can be the cause, not only of annoyance, but of aggression, hypertension, high stress levels, hearing loss, increased confusion, depression, and sleep disturbance, even falls, among other physical effects. There is even speculation that, historically, the word “noise” is related to a French word for seasickness.
Not only can noise intrude on our peace and quiet, it can get in the way of everyday communication by blocking, distorting or changing what we are trying to hear. For the person with Alzheimer’s, these problems with noise can be magnified because of the person’s loss of the ability to understand or distinguish among sounds in the environment. As Al Power, M.D. notes:
"Competing sounds in the environment can lead to difficulty in focusing one’s thoughts or attending to conversation. Beyond the sounds that are considered “intrusive,” it is also important to look at our conversation. What is the tone of our voices? Do we sound relaxed, positive, warm and engaging? Or do we sound harried, stressed, angry or abrupt? As one’s ability to process the details of language becomes challenged, the tone of the voices in the environment creates a stronger effect than the actual content of the comments.”
The problem of noise in healthcare facilities evidently goes back many decades. Florence Nightingale in her Notes on Nursing wrote about how unnecessary noise can damage a patient and the importance of quiet. In your visits to your relative or friend, you may have noticed certain sources of noise, including call-bell systems, squeaky wheels, loud TVs and radios, oxygen concentrators, ice machines, overhead pagers, bed/chair alarms, air/heat ventilation systems, ventilator alarms, cleaning equipment, meal trays, staff conversations and vocal patients. Imagine being subjected to a constant barrage day and night, especially if you came from a calmer, tranquil home environment—is it any wonder you would feel anxious or agitated, even without suffering from dementia?
As noted, people with dementia are less able to handle multiple and competing stimuli and may be overwhelmed by too much activity. It has also been shown that hearing is the sense that has the most significant impact on people with dementia in terms of quality of life. It is therefore important to realize that even noise levels that seem tolerable to staff and caregivers may be distressing and disorienting for your relative, particularly at certain times of the day, e.g., shift changes and mealtimes. This could result in troubling behaviors, including wandering, which may be a way for the person to try to escape an untenable situation.
What are some practical steps that can be taken to help your relative deal with noise issues? Communication with the facility’s staff is obviously key. They may be interested in a recent noise analysis conducted by the Isabella Geriatric Center in Northern Manhattan (See sidebar for links and further information). To seek solutions to their noise problems, Isabella created two “Noise” workgroups. One workgroup decided to look at the noises made by machines and equipment, and the other workgroup decided to concentrate on noise created by people (such as calling out or moaning by residents in distress, or the hubbub of staff when shifts change). Members of these groups consisted of Nursing Assistants, family members, Security, Housekeeping and Finance, among others. Over time, the workgroups came up with a number of ways to reduce noise, including securing prompt service for rattling air units and squeaky wheels on carts, eliminating bed and chair alarms and overhead paging, and lowering the conversation levels at the nursing station/office on the units.
The workgroups also looked at the noise created by residents who, because they are in distress, often call out or moan. Not surprisingly, they concluded that the only effective approach is to learn as much about the resident as possible, including investigating the potential causes of the resident’s distress, as well as what brings him or her comfort. This takes time and requires the participation of family, friends, and staff who interact with the resident; however, it can bring about a real improvement for the person who is suffering.
To help ensure their comfort, you can focus on specific approaches for your relative:
- Work with facility staff to make sure that they have appropriate, working hearing aid devices
- Observe your relative during mealtimes, when the sounds of trays, cutlery, crockery, other residents and staff may be overwhelming. Talk with staff about the impact on your relative, and work with them to achieve a calmer environment
- Turn the television off in their room if it is not being watched or appears to distract or upset them
- Observe whether they are comfortable or not when in a day room when the TV is on; if uncomfortable, talk with staff about either turning the set off, turning it down, or helping your relative to another location. The same concern applies to group activities: if your relative appears overwhelmed, help staff find an alternative
- Make appropriate use of music. Loud background music can be annoying and make conversation difficult. Conversely, however, soothing music favored by your friend or relative may produce a calming effect. (See sidebar link to “Music and Memory.”) Also, iPods can make it possible for people to enjoy music privately, without disrupting other nearby residents
- Take note of noises in close proximity to the resident and speak to staff about what measures can be taken to reduce noise levels
- Don’t attempt to isolate the person completely. Sensory under-stimulation can also lead to increased stress, depression and decline in engagement with other people
- If the person is acutely sensitive to noise, you may need to request a room reassignment further away from the nurses’ station, mechanical equipment or vocal patients
- Don’t talk across someone or talk to staff as though your friend isn’t present
- Be aware of the impact of your own voice, or that of other family members and friends who visit, not just on your relative, but for other residents as well
Understanding your relative’s needs and capacity to tolerate noise and working closely with staff to identify and alleviate offending sources will go a long way toward solving the noise dilemma and improving their overall quality of life.