Snoezelen interventions originated in Denmark as a means of encouraging physical and social interaction among children with developmental disabilities. This multi-sensory stimulation treatment targets the primary senses through the use of lighting effects, textured surfaces, music and various odors and has recently been applied to the dementia population. While few research studies have been done, most agree that individuals with dementia demonstrate in-session improvements in behavior with Snoezelen therapy. That is, when a person with problematic behavior, such as agitation, is introduced to the Snoezelen environment, his or her behavior tends to improve by the end of that treatment session. However, there has been little evidence of long-term benefits after multiple treatments, which became a major goal of this study.
|Treatment at a glance Each resident targeted for Snoezelen intervention was accompanied to the Snoezelen Room by staff at least one time per week during the treatment interval. Staff allowed the resident to explore the Snoezelen environment to determine which components of the intervention most appealed to that resident. Residents were encouraged to interact with the Snoezelen equipment for at least 15 minutes during each session. Residents were given a free choice to utilize as much or as little of the room as they wanted. The Snoezelen equipment was available in all five sensory modalities. Some equipment is interactive (bubble tube and fiber optic spray) while other equipment is passive (projector and aromatherapy). Interactions with staff were also at the resident’s discretion.|
ACTS Retirement-Life Communities constructed a Snoezelen room at its Southampton Estates community in Pennsylvania to test the impact of Snoezelen treatment on residents who have a diagnosis of memory impairment or dementia and experience agitation or social isolation. When the room was completed, staff was trained in the use of the equipment by a representative of FlagHouse, Inc., a Canadian company that sells Snoezelen equipment in North America. Participants for research were then identified at the time of their quarterly minimum data set (MDS) assessment.
Residents whose MDS suggested problems with agitated behavior or who appeared to be withdrawing from social interaction were selected for the study. The researcher met weekly with certified nursing assistant (CNA) staff on Sunshine Gardens, the memory support neighborhood at Southampton Estates, to clarify the behaviors captured by the MDS.
|The Snoezelen room at Southampton Estates, an ACTS Retirement-Life Community.|
Other functional data was gleaned from the clinical record. These indicators included the number of depression symptoms acknowledged on the MDS, the number of as necessary (PRN) medications used for treating agitation during the month prior to the MDS, the number of activities attended in the month prior to the MDS, the number of agitation indicators acknowledged on the MDS, the number of falls in the month prior to the MDS, the number of activities refused in the month prior to the MDS, the number of regularly ordered psychiatric medications at the time of the MDS, the number of reportable incidents in the month prior to the MDS, and the number of psychiatric hospitalizations in the month prior to the MDS.
Once identified, residents were given Snoezelen interventions at least one time per week for the next 13 weeks. Thirteen weeks were chosen for this interval as a new quarterly MDS would be due at that time. At the conclusion of the 13-week interval, the above measures were repeated. The following exception should be noted: where pre-intervention measures were collected for the period preceding the initial MDS, follow-up measures were collected for the same length of time following the period of intervention. For example, post-intervention activities attendance was measured for the month following the post-intervention MDS.
For each Snoezelen session, staff completed a checklist indicating the date and duration of the session as well as which Snoezelen tools were employed and rated the residents’ behavior before, during, and after the session, indicating positive or negative changes. The number of sessions during the treatment phase varied from 10 to 15 sessions. Within-session results for the 15 participants who completed the protocol showed that six demonstrated improvements in behavior after every session. Fourteen of fifteen subjects showed improvements in more than half of the sessions they attended, which is consistent with previous research.
|Graph A. MDS Agitation Scores|
|Graph B. Cohen-Mansfield Agitation Scores|
|Graph C. Adult Functional Adaptive Behavior Scale Scores|
|Graph D. Depression Scores|
In order to gauge the impact on depression, the average number of mood (depression) indicators noted on the MDS was recorded before and after Snoezelen treatment. Treatment was followed by a marked decrease in depression indicators (see graph D above).
During the course of treatment, the total number of PRN medications administered for problem behaviors during the month prior to treatment was compared to the month following and found only a slight decrease. No difference was noted in the number of routinely administered psychiatric medications from pre-treatment to post-treatment.
Attendance at activities was recorded as well and it was found that following a course of Snoezelen intervention, residents were slightly more likely to attend activities, yet there was no appreciable difference in the rates of activity refusal from pre-treatment to post-treatment. What was the most interesting finding, however, and one that significantly impacts quality of life for the participants, is that the total number of falls for the group pre-Snoezelen treatment was 17 and was reduced to five after a full course of treatment.
This study replicated previous findings suggesting that single Snoezelen sessions can be beneficial in changing behavior in the dementia population. More importantly, this study demonstrates evidence of longer-term gains across a three-month (13-week) period of regular Snoezelen intervention, and the two main hypotheses—that participants would have decreased agitation and increased social functioning—were supported.
Though it was noted that staff initially considered this intervention to be more time consuming when compared to pharmacological interventions, the benefits to a resident’s quality of life were multiple. Pharmacological interventions have unwanted side effects not seen in Snoezelen intervention, such as sedation, fall risk and movement disorders. Once staff recognized the calming effects of Snoezelen, they began to see this as a viable intervention that creates a better relationship between staff and residents and has a demonstrated long-term effect on behavior.
The positive results of this study support the expanded use of the Snoezelen intervention, particularly in memory support living environments. ACTS will seek to implement this intervention in its other life care communities as physical space and funding will allow and also intends to pilot a mobile Snoezelen cart that may be utilized in a variety of settings.Rochelle A. Robbins, PhD, is associate professor of Psychology at Holy Family University in Newton, Penn. Elsie S. Norton is senior vice president of Quality Care and managing director at ACTS Gerontological Research Institute in Ambler, Penn.