A resident's legs were never the problem. His sensory system was.
A resident in the long-term care community where I worked kept ending up on the floor, and it didn't add up. His strength checked out fine. His balance checked out fine. His gait checked out fine. Nothing in a standard fall evaluation explained why this man kept sitting down before he ever reached his bed.
So I started asking different questions. Not just how he was falling, but where and when. Most of his falls happened in his own room, in the morning after he got up, or in the afternoon on his way to nap. When I finally looked closely at that room, I found the answer. His curtains were dark maroon. His bedspread was maroon. The floor mat beside his bed, the one placed there because he kept falling, was maroon too. Everything around that bed was nearly the same color, and his brain could no longer tell where one surface ended and the next one began. He wasn't losing his balance. He was sitting down two feet too soon, aiming for a bed his brain could no longer clearly see.
His legs were never the problem. His sensory system was.
What Sensory Function Actually Means in Dementia Care
Most of us think of the senses as sight, hearing, smell, taste, and touch, the five things you learned about as a kid. That's true, but it's incomplete. Your senses aren't just collecting information, your brain is constantly interpreting it: sorting what matters from what doesn't, judging distance and depth, deciding what's safe to touch and what isn't. Most of that happens without you noticing, until something changes.
Dementia is a disease of the brain, and the brain doesn't just store memories, it makes sense of everything coming in from the world. When that processing changes, a person's experience of their own bedroom, their own shower, even their own family, can change with it. This is the sensory spoke of the Wheel of Function Framework™, the model I use to connect the different pieces of dementia care so a behavior becomes a clue instead of a mystery.
Why a Behavior That Makes No Sense Might Be a Sensory Signal
Take something as ordinary as a shower. The person you care for has taken thousands of them. Now they resist, pull away, maybe even yell, and it seems to come out of nowhere. But think about what's actually happening in that room: an echo off hard surfaces, water that can feel like needles on thinning skin, a sudden change in temperature, a wet floor with a glare that might look like something else entirely, a wall and a grab bar and a toilet all the same shade of white with no visible edges between them. That's a lot of sensory information landing all at once, and for a brain that can no longer sort and filter it the way it used to, it can stop feeling like a shower and start feeling unsafe.
Sound works the same way. A television on, dishes running, a second conversation nearby, and a brain that used to filter all of that automatically may no longer be able to. When someone doesn't answer you right away, or answers something unrelated, or walks away, it's easy to assume they weren't listening. They might actually be trying to process six sounds at once and unable to tell which one matters most.
Touch, too. Reaching over to help someone into a sleeve makes perfect sense to you, because you know what's coming next. They may not. From their side, it can feel like someone grabbed their arm without warning, and a pulled-away hand or a swat isn't defiance, it's a startled response to touch they didn't see coming.
This is the core idea behind the Wheel of Function Framework™: behavior is never the problem, it is always the signal.
What to Watch For
- Hesitating, stopping, or misjudging distance near beds, chairs, or floor transitions
- Resisting bathing, dressing, or anything involving touch and temperature change
- Not responding, or responding to the wrong thing, in a noisy or busy room
- Pulling away, flinching, or swatting when touched without warning
- Losing interest in favorite foods, or seeming withdrawn and disengaged for long stretches
What Helps
- Build in real contrast. A dark rug on a dark floor, a white plate on a white tablecloth, a bedspread that matches the wall behind it, all of these can disappear to a brain that's lost the ability to separate them. Contrasting colors and textures give the eye something to actually find.
- Lower the noise before you speak. Turn off the television, move to a quieter spot, and get their attention before you start talking, rather than adding your voice to everything else already competing for attention.
- Narrate touch before it happens. A simple "I'm going to help with your sleeve now" gives the brain a half second to prepare for what's coming.
- Don't assume less engagement always means the disease is progressing. Ask what they're actually taking in during a normal day. Sunlight on skin, familiar music, a favorite scent from the kitchen, something soft and familiar to hold, these are real sensory needs, not extras, and they can be some of the last ways you're still able to connect once words become harder to reach.
Reading the Senses Before You Read the Behavior
The goal isn't to explain away every hard moment as sensory, sometimes it is, sometimes it isn't. The goal is to ask the question before reaching for a response. What is this person's brain actually seeing, hearing, and feeling right now? That single shift turns a confusing behavior into a clue you can actually work with, and it's often the difference between fighting the same battle every day and finally understanding what's underneath it.
Want to hear the whole story, including what actually changed once that room was rearranged? Navigating Dementia is up now. Search for it wherever you listen to podcasts, or press play right here: PODCAST EPISODE 4 LINK
If you want the fuller breakdown of all five senses and how they show up across dementia care day to day, that's covered in What Your Senses Are Telling You: The Sensory Spoke and Dementia Activities. And if you're curious how the Wheel of Function Framework™ itself came together, that story is in Why It Took Me Ten Years to Build the Wheel of Function Framework™.
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ABOUT THE AUTHOR
Carlyn Lenfestey, PT, MPT, CDP, CADDCT, is a licensed physical therapist with 25 years of clinical experience and 15 years specializing in dementia care. She is the founder of A Better Way: Dementia Care Solutions, LLC, the creator of the Wheel of Function Framework™, and the host of the podcast, Navigating Dementia.
DISCLAIMER
The information provided in this blog is for educational purposes only and should not be considered medical advice. Always consult with a doctor or a licensed physical therapist before starting any new exercise routine, using assistive devices, or following the recommendations mentioned. Every individual's needs are different, and professional guidance is essential to ensure safety and appropriateness of care.
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