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  • Writer's pictureCrystal Dickerson

Dementia & Vision Changes: Compassionate Caregiver Techniques

By: Crystal Dickerson, Positive Approach to Care Certified Independent Dementia Trainer

Have you noticed how a Person Living With Dementia (PLWD) will often have a “startle” response when you are giving care? This can result in fear, flight, or fight responses – none of which are a good outcome when you’re trying to help.

The Problem: Consider how changes in vision can contribute to this startle response and refusal to allow care.

In early dementia, the PLWD has a decreased visual field that we call Scuba Vision. That equates to about a 125 degree field of vision. A normal 75 year old has about a 145 degree visual field. So if you are approaching with hands-on care from the side or from the waistline down, the person will not see you reaching in. If someone surprised YOU with a touch you didn’t expect, especially if it’s in your intimate areas, what would you want to do? Yell, hit, or run?

By mid-stage, the visual field of a PLWD (Person Living With Dementia) is like wearing a pair of Binoculars, only about 90 degrees. That’s a visual field of about 12 to 18 inches round. Their attention can only go to one field at a time. They have a Social field of vision (up and out) or a Task vision (down and in).

Watch what happens at meal times when the PLWD gets distracted by conversation at the table (Social vision). They will sometimes forget that they have a plate in front of them (that’s Task vision) and stop eating.

In late-stage dementia, vision becomes Monocular because the wiring in the brain has become so degraded. This causes a lack of depth perception and an inability to determine when something is coming toward them with any accuracy. That means they will be even more startled when they feel a touch they did not expect. Monocular vision also leads to an increased risk of falls.

What is the solution?

We need to change our approach. We can avoid startling (frightening) the PLWD and have more success in caring for them, but WE are the people who have to change. Our brains are capable of adapting, not theirs. They are doing the best they can with what they have left.

“Positive Approach to Care” teaches Positive Physical Approach and Hand Under Hand, both of which help direct the attention of the PLWD and utilize the sensory-motor connections that remain, to engage the PLWD in assisting with care tasks. When they are physically helping with the task, they do not startle and the positive results will surprise you.

If you’d like to learn more, and develop YOUR care skills, check out the workshops available on my website at to sign up.

Contact me with any questions at .

On January 18 or 27, join me for a FREE workshop to learn about all the sensory changes in dementia and how we can help compensate for those in our care, Sensory Changes That Threaten Your Loved One’s Safety.

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