Perception and hallucinations

4. How to support someone with visuoperceptual difficulties

There are many ways you can help to reduce visuoperceptual difficulties for a person with dementia. By being aware of this type of problem, you will be able to better support them.

Careful attention to eye care and visual health

  • Arrange regular eye checks, and inform the optometrist of the person’s dementia. This will help when arranging appointments and getting the right treatment.
  • If the person wears glasses, check that they are clean and they have the right prescription. Encourage the person to wear them as and when necessary.
  • Check the person is wearing the correct glasses for a specific activity, such as reading. It can help to label the glasses, the case or to have a different colour frame for different activities – for example, red frames for reading and black frames for watching television.
  • Research has shown that multifocal glasses can increase the risk of falls in people when they are outside the home. Therefore, it may be useful to have separate glasses for distance (for the outside) and reading (for things up close).
  • If the person has cataracts, talk to an optometrist or their GP about how to have them treated.

Environmental adaptations

An occupational therapist (OT) can offer advice on ways to maintain ability and independence with daily activities. This can include information and advice on assistive technology (devices or systems that support a person to maintain or improve their independence, safety and wellbeing, eg medication prompts or locator devices). They can also advise on adaptations and equipment for the home (eg grab rails or adapted cutlery). If an assessment from an OT would be helpful, speak to your GP, consultant or social services.

General tips

  • Try not to make too many changes to the person’s environment (eg keep furniture and other items in the same place). This can help the person feel confident and reduce their fear of tripping or falling.
  • Use colour. For example, having a different colour toilet seat to the bowl (eg a black toilet seat on a white toilet). A red plate on a white tablecloth is easier to see than a white plate.
  • Colour can also be used to highlight important objects and orientation points (eg the toilet door), or for camouflaging objects the person doesn’t need to use (eg light switches or doors).
  • Improve lighting levels around the person’s home. This can reduce visual difficulties and help to prevent falls. Lighting should be even around the home and should minimise shadows – some people resist going near dark areas in corridors and rooms.
  • Try to avoid ‘busy’ patterns (eg on the walls or floors) and changes in floor patterns or surfaces. They may be seen as an obstacle or barrier and the person may avoid walking in these areas.
  • Reduce the risk of trips and falls by removing clutter and obstacles.
  •  Remove or replace mirrors and shiny surfaces if they cause problems.
  • Close curtains or blinds at night.
  • Consider assistive technology products such as automatic lights.

Practical tips

· If a person fails to recognise an object, don’t draw any unnecessary attention to the mistake. Avoid asking questions that might make them feel ‘put on the spot’. If appropriate, give the object to the person and explain how it is used. If they do not accept this explanation, try not to argue with them. Ignore the mistake and listen to what they are trying to say. Being corrected can undermine a person’s confidence and they may become reluctant to join in conversations or activities. Therefore, it is important to focus on the emotions behind what is being said, rather than the facts or details.

  • If the person struggles to recognise people, ask friends and relatives to introduce themselves. If the person doesn’t recognise somebody, it can be distressing for them as well as for those around them. If this happens, try to reassure the person and find tactful ways to give them reminders or explanations.
  • Try to make activities accessible for the person. For example, if the person enjoyed reading but is no longer able to, think about audiobooks instead.
  • Consider adapting activities to make the most of the person’s abilities, eg cooking using pre-chopped vegetables and ready-made sauces.
  • At mealtimes, it may help to describe the food and drink, where it is on the table and where cutlery is, if appropriate.
  • After you’ve used something, try to leave it where it was or in a familiar place, eg keys in a fruit bowl.
  • Let the person know where they are, who they are with and what is going on.
  • Tell the person when someone enters or leaves the room.
  • If you’re giving the person medication, explain what it is, what it is for and what you are doing.