The Snoezelen® Approach to Dementia Care
The use of Snoezelen® and Multi Sensory Environments is now main stream practice in the care of older people with dementia and is supported by a number of organisations including the National Institute of Clinical Excellence (NICE). The NICE guidelines ‘Dementia: Supporting people with dementia and their carers in health and social care (2006)’ specifically mention the use of Multi Sensory Environments to manage anxiety and agitation in people with dementia in preference to medication. They state ‘Health and social care staff in the NHS and social care, including care homes, should work together to ensure that some of these options (including MSEs) are available, because there is some evidence of their clinical effectiveness’ (NICE Guideline 42: 220.127.116.11).
They also state ‘A range of tailored interventions, such as reminiscence therapy, multi sensory stimulation, animal-assisted therapy and exercise, should be available for people with dementia who have depression and/or anxiety’ and ‘should be followed before a pharmacological intervention is considered.’ (NICE Guideline 43: 18.104.22.168 / 22.214.171.124)Evidence supporting this approach includes two Randomised Controlled Trials exploring the effect of the Multi Sensory Environment approach on functional performance and a further trial exploring the effect of Multi Sensory Environments on mood and behaviour (Collier et al., 2010; Staal et al., 2007). Both these trials suggest an improvement in function and mood and behaviour beyond that achieved by a pharmacological approach. For example, Collier et al, achieved a success rate of 67% whereas Hemels et al. (2001) suggest traditional antipsychotics have a success rate of between 56-63% and Cornegé-Blokland et al.(2012) suggest an even lower rate of 50%.
People with dementia who develop non-cognitive symptoms that cause them significant distress or who develop behaviour that challenges should be offered an assessment at an early opportunity to establish likely factors that may generate, aggravate or improve such behaviour. The assessment should be comprehensive and include:
- the person’s physical health
- possible undetected pain or discomfort
- side effects of medication
- individual biography, including religious beliefs and spiritual and cultural identity
- psycho-social factors
- physical environmental factors
- behavioural and functional analysis conducted by professionals with specific skills, in conjunction with carers and care workers.
Individually tailored care plans that help carers and staff address the behaviour that challenges should be developed, recorded in the notes and reviewed regularly. The frequency of the review should be agreed by the carers and staff involved and written in the notes.For people with all types and severity of dementia who have co-morbid agitation, consideration should be given to providing access to interventions tailored to the person’s preferences, skills and abilities. Because people may respond better to one treatment than another, the response to each modality should be monitored and the care plan adapted accordingly. Approaches that may be considered, depending on availability, include:
- multi sensory stimulation
- therapeutic use of music and/or dancing
- animal-assisted therapy
These interventions may be delivered by a range of health and social care staff and volunteers, with appropriate training and supervision. The voluntary sector has a particular role to play in delivering these approaches.Health and social care staff in the NHS and social care, including care homes, should work together to ensure that some of these options are available, because there is some evidence of their clinical effectiveness. More research is needed into their cost effectiveness.
Psychological interventions for people with dementia with depression and/or anxiety
Care packages for people with dementia should include assessment and monitoring for depression and/or anxiety.