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Confused and frightened by sounds

28 April 2020
Janouk Kosters (Photo: Nienke Maat)
Janouk Kosters (Photo: Nienke Maat)

Deaf or blind? Which would you rather be? Everyone thinks about this at some point as a child. And even then, you probably realized that this question was about the feeling of security. A feeling that people with dementia will have started to miss earlier on, because they don’t have a grip on the world around them. Unexpected sounds can be threatening and cause problematic behaviour or depression. But this can be quickly avoided with a few simple interventions, says PhD student Janouk Kosters.

Text: Eelco Salverda, Communication UG

Someone is unloading a dishwasher. Glass hits glass, cutlery falls on the ground, cupboards squeak open and close with a bang. When you are the one unloading the dishwasher, you hardly notice it. But if you are suffering from dementia, you may hear incomprehensible sounds that give you a feeling of insecurity. Janouk Kosters, a PhD student at the UMCG, is conducting research in five nursing homes, studying the influence of sounds on people with dementia. It is a minor problem with sometimes major consequences, because sounds can evoke or strengthen apathy, depression, unsettled behaviour and eating and sleeping problems in this subject group.

A construction site: loud, penetrating sounds which are often difficult to place. (Photo: ErixPhotobook/Nationale Beeldbank)
A construction site: loud, penetrating sounds which are often difficult to place. (Photo: ErixPhotobook/Nationale Beeldbank)

The influence of music

Kosters, a psychologist, came into contact with people with dementia through her mother’s work. ‘I had read about the influence of music on this group of people. I found it fascinating how they remembered things from the past and seemed to liven up when hearing certain music. When I saw that this PhD position was vacant, I thought that there might be other ways to apply the use of sound and to help them.’

Awareness

At first, Kosters focused primarily on awareness among care providers. These care providers use questionnaires at six identified moments to rate the problem behaviour and quality of life of people with dementia. ‘In every nursing home, we also have two or three trained ambassadors. They are the point of contact and lead meetings that focus on the topic of sound. They use the MoSART app to measure the sounds. The next step is to devise improvements,’ says Kosters, when explaining the approach. These adjustments are often very simple, if you just know what to look for.

War memories

Unexpected sounds can even be frightening for people with dementia. Kosters cites the example of a door in a department that made a clicking sound when opening and slammed hard when closing. ‘For the residents, the combination of the click and the bang reminded them of the war. They thought that the enemy was shooting at them.’

In a world that revolves around safety and security, explanations are crucial. (Photo: Tom Elst Fotografie / Nationale Beeldbank)
In a world that revolves around safety and security, explanations are crucial. (Photo: Tom Elst Fotografie / Nationale Beeldbank)

Explanation is important

All animals, including humans, use sound to determine whether an environment is safe, Kosters explains. ‘The biggest difference between healthy people and those suffering from dementia is their ability to understand the sounds around them. You can ease their anxiety by making it clear to them where a sound is coming from and what it means. This can be something simple, such as announcing that you are going to unload the dishwasher and that this might make some noise.’

Hearing, smelling and tasting coffee

Is there such a thing as a ranking of the senses? Does sound have more of an impact than visual, taste or smell-based stimuli? Kosters thinks that the senses reinforce each other. ‘A simmering pot of coffee can create structure and indicate that it will soon be time for coffee. Add to that the smell, the sight of pouring the coffee and the taste that it gives off in the mouth, and it reinforces that idea. After all, you did hear the coffee machine simmer, didn’t you? On the other hand, I think that when the environment doesn’t feel safe due to unknown sounds, you cannot enjoy the smell and taste of the coffee. Sound prevails, in a sense, because it is always around us and is very important to determine whether we are safe.’

Kosters: ‘I am now much more aware of what I hear. I can enjoy the wind rustling through the leaves or birds that react to each other.’
Kosters: ‘I am now much more aware of what I hear. I can enjoy the wind rustling through the leaves or birds that react to each other.’

Sensitive to what we hear

We can close our eyes to visual stimuli, but closing our ears is impossible. Not even with earplugs. What is pleasant for one person can be perceived as unpleasant or disturbing for the other – think of loud music being played by your neighbours, which does not match what you are doing at the time. Age, fatigue, concentration; it all plays a role in the degree of acceptance of unpleasant sounds. Kosters’ research has also had its impact on her own life. ‘I am now much more aware of what I hear. I can listen more closely and enjoy things such as the wind rustling through the leaves or birds that react to each other. But the opposite is also the case. Smacking when eating, tapping, loud breathing; when others make these sounds, I find it very disruptive. But when I explore why I am annoyed, the annoyance disappears.’

The workload in healthcare

The workload in healthcare is very high. Creating and implementing sound policies means yet another element to take into account. What do staff think about that? Kosters points out that in her project, she uses existing knowledge. ‘Healthy people are very good at ignoring what they hear. By making care providers listen to the environment, they start noticing all the sounds again. They are often startled by the number of sounds and realize that they also wouldn’t to hear them all at home, either.’ An important point, because the nursing home is indeed home for the residents – but for the care providers, it is their place of work. ‘Studies have shown that you accept different and more sounds at work than at home.’ Listening through the ears of the residents should be the motto.

A more pleasant atmosphere

Although Kosters is only halfway through her research, she can already say that the first phase has been successful. ‘Employees are more aware of sounds and are coming up with solutions. I myself have also noticed a more pleasant atmosphere in the nursing homes that I have been visiting. There is less disturbing noise and, for example, the TV and radio are turned on less often. It was amazing to notice that.’

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Janouk Kosters

Last modified:28 April 2020 08.45 a.m.
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