How to support changing vision in dementia care

When we think about supporting people with dementia at home, memory is usually the first thing that comes to mind. But changes to how a person visually perceives the world is often overlooked.

Our recent webinar with the brilliant Florence Tyloo, a dementia engagement specialist and founder of Dementia Partnered Care, showed how tiny adjustments to our body language and micro-cues can completely transform a home visit.

Watch the full webinar

Seeing the world differently

Dementia has the ability to completely rewire how the brain processes what the eyes see. For the person living with dementia, it is a total shift in perception.

Our clients living in their own homes often face silent daily challenges because of this:

• Fading contrast: It becomes incredibly tricky to separate objects from backgrounds. Imagine trying to eat white rice off a white plate sitting on a white tablecloth. We might presume they aren't hungry, when they actually just can't see the food!
• Colour confusion: Changes in colour perception mean dark items, like a black doormat, can suddenly look like a scary, gaping hole in the floor.
• Muddled depth: Diminished depth perception can make a flat transition from carpet to hard flooring look like a steep cliff edge.

One of the most profound things that happens is the physical narrowing of a person's visual field. It can cut off their sight from the top, bottom, or sides, meaning they can only see through a limited window, which can differ from person to person.

If we fail to account for this, we can accidentally create a lot of stress. For example, if you try to guide a client to sit on an armchair that has been placed completely outside their narrow line of sight, they are going to feel unsafe and panicked. They simply can’t see what you’re asking them to do!

Practical micro-cues

Think about how we usually help someone to a chair. If we just stand across the room and give verbal orders without any visual guidance, our interactions feel one-sided. They lack real warmth and encouragement.

But when we swap those cold commands for clever micro-cues, everything changes! Try stepping directly into your client’s line of vision, pointing clearly to the chair, and providing gentle, physical support. The action instantly makes sense to them, and it completely removes the guesswork.

If simple visual pointers are not quite enough to spark engagement, try using these practical micro-cues on your next domiciliary visit:

1. The hand-on-wrist guide: Place your hand gently on the item or over your client's wrist to subtly guide their movement and reassure them in what you’re asking them to do.
2. The power of mirroring: Human brains are hardwired to copy actions. Want to encourage a client to take a sip of their drink? Try sitting with them and take a sip of your own drink first.
3. Lower and closer: If you are playing a game or doing an activity, always bring the items much closer and lower them down so they sit squarely within their active field of vision.

Unfortunately, things don’t always go to plan and that’s ok! If a client gets upset or refuses an activity, please respect their choice.

Take a breath, pivot to a friendly 'Plan B', and gently apologise for the miscommunication to instantly restore their feeling of safety and control. Our goal is always our client’s ultimate comfort, not just ticking a task off a care checklist.

Quick wins for busy shifts

You don't always have time for long, complex checklists before you enter a home! Instead, try keeping these three simple, active adjustments in mind while you're delivering care:

• Check the glasses: Older people living with dementia often simply forget they need them. A quick look to see if their glasses are clean and on can change their whole day.
• Keep aids close: Pop magnifying glasses or visual aids within their arm's reach so they can stay independent.
• Find the line of sight: Before you speak or hand them an item, take a second to stand directly in their narrow field of vision.

Nursebuddy tip: At Nursebuddy, person-centered care is at the heart of everything. A fantastic way to implement this is by using our "About Me" profiles to note down each client's specific visual changes, ensuring every carer on the rota is on the same page.

Transforming our domiciliary care habits isn't about learning rigid rules or changing who you are as a carer. It's about looking forward, remaining curious, and making life a little bit simpler for the people we support. By understanding these visual changes and shifting our bodies just a few inches into their line of sight, we can remove the fear and bring the comfort back into homecare.

Watch on demand

For more tips, catch up on Florence's webinar about how to adapt your care to visual changes for people living with dementia. 

Further reading

Armstrong, R., & Kergoat, H. (2015). Oculo-visual changes and clinical considerations affecting older patients with dementia. Ophthalmic and Physiological Optics, 35(4), 352–376. https://doi.org/10.1111/opo.12220

Cronin-Golomb, A. (1995). Vision in Alzheimer’s Disease1. The Gerontologist, 35(3), 370–376. https://doi.org/10.1093/geront/35.3.370

Lakshminarayanan, V., Lagrave, J., Louise Kean, M., Dick, M., & Shankle, R. (1996). Vision in dementia: Contrast effects. Neurological Research, 18(1), 9–15. https://doi.org/10.1080/01616412.1996.11740369

Steffes, R., & Thralow, J. (1987). Visual Field Limitation in the Patient with Dementia of the Alzheimer’s Type. Journal of the American Geriatrics Society, 35(3), 198–204. https://doi.org/10.1111/j.1532-5415.1987.tb02309.x

Trick, G. L., Trick, L. R., Morris, P., & Wolf, M. (1995). Visual field loss in senile dementia of the Alzheimer’s type. Neurology, 45(1), 68–74. https://doi.org/10.1212/WNL.45.1.68