When we recently discussed the way texture-modified foods are described on menus, one residence leader raised the idea of the “sensate experience.” It is a useful way of thinking about something much larger than food.
The Sensate Experience in Dementia Care: Why the Senses Matter
A sensate experience is one that is experienced through the senses — what we see, hear, smell, taste and touch, as well as sensations such as warmth, movement, pressure and texture. In a residence, these experiences are happening all day, whether anyone has deliberately planned them or not.
The question is: What are those experiences communicating to the resident?
Let’s Start Here: Food Is a Good Place to See the Difference
Food is one of the clearest examples of how a sensate experience involves much more than the functional task itself.
Consider a resident who requires texture-modified food. From a clinical perspective, the priority is clear: the food must meet the resident’s prescribed texture and swallowing requirements.
But the resident does not experience a meal as a nutritional calculation.
They experience:
- what the food looks like;
- how it smells;
- its temperature;
- the texture in the mouth;
- the taste;
- the appearance of the plate;
- the sounds and atmosphere around them;
- the way the food is described;
- and the manner in which it is presented.
Even the words on a menu contribute to the experience.
“Pureed chicken, pureed carrots and mashed potato” may accurately communicate the texture, but it puts the modification at the centre of the meal.
“Roast chicken with carrots and creamy potato” describes the meal — something familiar and recognizable.
Where the prescribed texture must be identified for safety, policy or care requirements, it can still be stated clearly and separately:
Roast Chicken with Carrots and Creamy Potato
Pureed
The point is not to hide or minimize the prescribed texture. It is to distinguish between describing the meal and identifying the clinical modification required to serve it safely.
The food may be nutritionally identical, but the experience is not.
And that is the larger point: a meal is not simply something we provide. It is something the resident experiences.
The Whole Residence Is a Sensory Environment
The same principle extends far beyond meals. Walk through a residence and consider what a resident encounters.
What does the hallway sound like? Is there constant background television, alarms, carts, conversations and equipment?
What does the dining room smell like before lunch? Can residents smell food being prepared, or does the environment primarily smell of cleaning products?
What does a resident feel when they wake up? Warm bedding? A cold floor? Someone touching them before they understand who is there?
What do they see? Familiar belongings and recognizable spaces — or signage, equipment and institutional furniture?
What does bathing feel like? The temperature of the room, the water, the towel, the person’s hands helping them, the pace at which things happen?
What does the afternoon feel like? Sunlight through a window, music, movement and conversation — or long periods with very little sensory interest?
These may appear to be small details. To the person experiencing them, they can make up much of daily life.
Sensory Experience Can Support Identity
Sensate experiences also connect strongly to life history. The smell of coffee may be associated with someone’s lifelong morning routine.
Freshly turned soil may mean something entirely different to a lifelong gardener than it does to someone with no interest in gardening. A particular piece of music may evoke movement, emotion or familiarity.
The feel of dough in the hands may connect with decades of baking.
A man’s aftershave, a familiar hand cream, the weight of a real tool, crisp sheets, a favourite chair or the sound of birds outside may all carry meaning that goes well beyond the immediate sensory stimulus.
This is another reason why knowing the person matters. We cannot assume that the same sensory experience will have the same meaning for everyone.
One person’s comforting music may be another person’s irritating noise.
One resident may enjoy a busy dining room while another finds it overwhelming.
One person may love being hugged. Another may strongly dislike unexpected touch.
The goal is not simply to provide more stimulation. The goal is to create the right experiences for the individual.
This Question Arises…Is This More Important in Advanced Dementia?
Sensate experience matters throughout the course of dementia, and indeed to people who do not have dementia at all.
We all respond to pleasant food, comfortable surroundings, familiar smells, music, temperature, touch and atmosphere. These things contribute to quality of life regardless of cognitive ability.
What changes as dementia progresses is the relative importance of sensory experience as a way of connecting with and understanding the world.
Earlier in dementia, a person may still be able to tell us:
“I don’t like this room.”
“I always have coffee before breakfast.”
“That music is too loud.”
“I’d rather have a shower tonight.”
“I don’t like that food.”
As dementia becomes more advanced, the person may have greater difficulty explaining those preferences verbally, remembering why something feels familiar or uncomfortable, or understanding complex explanations.
But they can still experience the environment. They can still feel warmth. They can still taste something pleasant.
They can still recoil from an unpleasant smell. They can still relax when familiar music begins.
They can still respond to gentle versus hurried touch. They can still experience comfort, pleasure, irritation, fear, familiarity and connection.
So, it’s not to say that sensate experience suddenly becomes important in advanced dementia.
A better way to put it is:
Sensate experience is important at every stage, but as verbal communication and cognitive processing become more difficult, the person’s sensory experience may become an increasingly important way of understanding what is comfortable, meaningful and supportive for them.
Behaviour Can Also Tell Us About the Sensory Experience
This becomes particularly important when a person can no longer easily tell us what is wrong.
A resident who repeatedly leaves the dining room may not simply be “wandering.”
Is the room too noisy? Is the lighting uncomfortable? Is there an odour they dislike? Are there too many people moving around them? Is the chair uncomfortable? Is the meal unfamiliar? Are they being rushed?
Similarly, resistance during personal care may sometimes tell us something about the experience itself.
Was the person approached unexpectedly? Is the room cold? Is the water uncomfortable? Is someone touching them before explaining what is happening? Are several instructions being given at once? Is the experience happening at a time of day that conflicts with the person’s lifelong routine?
Looking through a sensory lens does not provide an explanation for every response, but it gives staff another useful question to ask: “What might this experience feel like to the resident?”
That is quite different from asking only: “How do we get the resident to cooperate?”
Sensate Does Not Mean “Sensory Activity”
There is also an important distinction.
Thinking about sensate experience does not mean creating a schedule full of “sensory activities.”
It is much broader. These are all sensate experiences:
- Having a meal
- Getting dressed
- Walking outside
- Having hair brushed
- Sitting by a window
- Listening to someone speak
- Holding a warm cup
- Entering a noisy dining room
- Being hurried through morning care
Daily life itself is sensory.
The opportunity for a residence is to become more intentional about the experiences it is already creating.
A Different Question for Staff
Instead of asking only: “Did we complete the task?”
we can also ask: “What was the experience like for the resident?”
Instead of: “Was lunch served?” ask: “Was the meal appealing and enjoyable?”
Instead of: “Did the resident attend the activity?” ask: “Was there something in the experience that was meaningful to this person?”
Instead of: “Was personal care completed?” ask: “Did the resident feel comfortable, respected and involved?”
That small change in perspective can have a significant effect on how we think about care.
Bringing It Back to the Person
The senses provide one of the ways people experience the world throughout their lives. Dementia does not remove that.
A residence therefore has an opportunity to think beyond simply providing safe environments, appropriate meals, scheduled activities and completed care.
It can ask:
What does daily life actually feel like to the person living here?
What do they see when they wake up?
What do they hear throughout their day?
What familiar smells, tastes and textures remain part of their life?
What causes comfort?
What overwhelms them?
What feels familiar?
What still gives pleasure?
And what can we learn about the person by paying attention to their response?
Whether we are talking about beautifully presenting texture-modified food, preserving a familiar morning coffee ritual, choosing music, supporting someone during bathing or simply making a room feel comfortable, the principle is the same:
We are not only providing care. We are creating an experience.
And the more we know about the individual, the better that experience can become.
