The Importance of Personalization in Long Term Care Communities

The Importance of Personalization in Long Term Care Communities

By Jennifer Brush, MA, CCC/SLP

An individual's possessions represent a lifetime of memories, achievements and activities. It is vital that new residents be allowed to bring some of their favorite and special items of furniture and belongings with them when moving into a residential setting. Care communities can recognize the importance of these belongings by not treating them as objects we allow residents to bring with them, but as part of the right to continue to create an environment that they find suitable and worth living in (Calkins, 1997). More and more care communities are implementing policies that not only allow, but encourage possessions to be moved in with residents including beds, furniture, art, and memorabilia. Personal items and decorations should be able to be stored and displayed both in bedrooms and common areas that are shared with other residents.



Personal possessions also aid staff on their journey of getting to know the residents, their tastes, family, and special memories of travel and a well lived life. This is even more important in the case of those suffering from communication difficulties such as dementia and expressive aphasia.  Often persons with communication impairment cannot tell their own life story, travel memorabilia and family photos can communicate, to some extent, about the past.



One of the key reasons for personalization of a person’s environment is to help them remember people, places and objects by compensating for deficits in declarative memory. Having familiar items around makes it feel like home and provides more distinctive spaces, providing orientation cues for all individuals. For example, one will recognize a favorite chair and be able to experience the joy of leaning against the much loved cushions in the sitting room, or sipping tea out of one’s own china cup can make a huge difference to someone’s feeling of well-being.



Displaying personal items in a lit glass display case next to the bedroom door can help residents find their room. The more significant the objects or the stronger the memory associated with the objects, the better these objects assist people with locating their room (Namazi, Rosner, and Rechlin 1991).  Some researchers have found that using a large photograph (8 by 10) of the person helped in locating their rooms (Nolan et al, 2002).



One option is to ask the resident’s family to bring a picture from home to hang on the bedroom door. It can be an earlier picture of the resident or a photo from a special occasion like a wedding. Often, a person will not recognize a current picture, but will recognize a favorite pet, childhood home, or other object such as a trophy or favorite knick-knack from home. Whatever items you decide to use for personalization and orientation, make sure you test for recognition by the resident.  Ask the person if he knows who or what is in the picture, if he likes the item, or if he would like to have it on his door. The person should always have a choice in how his room is decorated and what pictures are displayed.




So, take a walk down memory lane and gather some favorite bits of the past, personalization is a wonderful way for an individual to feel more connected with their new home and have better orientation in a different environment.  



(c) 2014 Jennifer A Brush.  May not reprint or distribute without permission

Caring for Your Loved One with GRACE

I am pleased to welcome Melissa Cohn Bernstein, one of our guest bloggers this month.  Melissa and I have collaborated on online learning projects together for a number of years.  Melissa owns Dynamic Learning Online, an excellent source of continuing education for health care professionals.

 Thank you Jennifer for inviting us to Guest Blog for you!

As an Occupational Therapist, married to a Geriatrician, many of our discussion revolve around the care and needs of the senior population.  My husband’s book, I’ve Got Some Good News and Some Bad News YOU’RE OLD, Tales of a Geriatrician, provides many “lessons learned” from the thousands of patients he has treated in his 30 years of practice. He developed the acronym  G.R.A.C.E. leads to a happier healthier life.

What does G.R.A.C.E. stand for?

G stand for Goals, R for Roots or DNA, A for Attitude, C for Companionship and E for Environment.
He observed from his patients who have lived happy, healthy, and long lives, that the traits of GRACE had been incorporated into their lives.
G-having Goals or a purpose in life leads to greater satisfaction and fulfillment.
R-knowing your Roots or DNA is critical to understanding your genetic makeup and what risks or benefit you can derive from your heredity.
A-having a positive Attitude and being grateful, showing gratitude for what you have leads to greater enjoyment and experiences in life.
C- Companionship and connections to others is a critical factor in forming supportive and loving relationships.
E- Environment is what you do to live a healthier life, such as eating, exercising, sleeping and listening to your physician’s advice.

GRACE plays an important role in caring for loved ones, especially someone who has memory impairment or Dementia.  Having clearly defined Goals or a purpose for each day provides much needed structure, an essential component for an individual who is bombarded with distractions daily.  Roots, in this case family structure or family tree, denotes  knowing who your family is,  and that you can count on them to assist and provide much needed respite and support.  Family can also be loosely interpreted to include local friends and your support system as well.   Having a positive Attitude is essential in surviving the marathon of living and sustaining a loved one with Dementia.  Included within the trait of attitude is gratitude since without it we become less human.  Companionship and Connection with our loved one brings us back to the depth of our love within the relationship, and it becomes the glue that holds us together through difficult times.  Connections within our community enable us to seek and obtain much needed physical and emotional support.  Keeping the Environment safe and uncluttered helps prevent injuries and reduces distractions both of which are detrimental to the individual with dementia.  Providing a healthy environment includes a healthy lower carbohydrate diet, physical activity/exercise, and good sleep habits.

It is important to remember the 5 characteristics of GRACE when caring for a loved one with memory impairment or dementia.   Whether it is in the early stages and in a home environment, or in the later stages where the loved one resides in an assisted living facility or nursing home, they all need a little GRACE.

How are you applying GRACE in your life and the lives of your loved ones?
We are happy to hear from you!

Here’s to aging GRACEfully!
© 2014, Melissa Cohn Bernstein, OTR/L, FAOTA
Dynamic Learning Online, Inc.
melissa@dynamicgrp.com

David Bernstein, MD, FACP
Physician-Author-Public Speaker
david@davidbernsteinmd.com

Facing the Challenge of Good Nutrition as We Age

I am very pleased to introduce you to our guest blogger this week, Kathy Birkett, RDN.   Kathy is a registered and licensed dietitian nutritionist with over thirty years of experience helping patients, clients and their family members achieve healthy lives through nutrition. She has provided nutrition advice to people in a variety of settings, including hospitals, rehabilitation and skilled long term care nursing facilities, home-based care, hospice, education, wellness centers and fitness facilities, touching thousands of lives with her knowledge and caring approach.  Kathy has a wonderful website full of information that will help all of us, at any age.  Please visit http://www.nutritionforthehealthofit.com to learn more.

Facing the Challenge of Good Nutrition as We Age

By Kathy Birkett, RDN

As a dietitian, I know the value of good nutrition from beginning to the end of our lives. There is no point in our lives that we can stop and rest on our laurels when it comes to eating well and being well nutritionally.

What I also know from experience working with many clients of all ages is that the physical results of poor eating habits will haunt us throughout our lives.
Research shows us clearly that when we are not making wise food choices it will impact our heart health leading to stroke and heart disease as well as contribute to several forms of cancer, diabetes and obesity. Chronic disease in our nation and actually globally has recently been defined by the World Health Organization as causing 6 out of 10 deaths around the world. The very sad reality of that statistic is that good nutrition is not that difficult and death from nutrition related chronic disease is preventable.

Aging Impacts on Nutrition

It is true that as we age, our bodies’ age too and our nutritional health can be affected.
Unfortunately, our bodies’ do not need any fewer nutrients as we age at a time when our intake tends to decline due to a number of factors.

• Difficulty chewing. Often our teeth become an issue that leads to food choices that are not the most nutritious. We may have missing teeth, dental caries or ill-fitting dentures which might be causing mouth sores that mean older adults begin restricting harder to chew items including protein foods and fresh fruits and vegetables. These foods are key nutrient sources that are hard to match when eliminated. There are many texture changes that can be made while still eating the healthy foods their bodies require.

• Perceived out of budget cost of nutritious foods. When older adults feel the pinch of a fixed income that may cause them to choose between medications, housing, electricity and food, they often tend to buy ‘cheaper’ food items like canned soup and ignore the fresh fruit and vegetables and meats that seem costly. Unfortunately they may be costing themselves poor health and more healthcare costs in the long term.

• Taste changes. Many older adults experience taste changes perhaps due to the many medications they take or dry mouth. They become disinterested in eating because it doesn’t taste like they remember or doesn’t bring them satisfaction.

• Lack of energy. Many older adults tell me that they tire quickly so don’t enjoy grocery shopping, food preparation or clean up so they look for ways to avoid it. They buy standard items like coffee, milk, bread and canned foods they can carry and then go home. They don’t want to cook for themselves and don’t enjoy eating by themselves. They don’t want to bother with the trouble. Many also tell me that they didn’t do anything during the day to work up an appetite which leads to further decreased intake. The result is a vicious cycle of weight loss, lack of energy, loose dentures and frailty leading to poor health outcomes.

• Restrictions of a medical condition. Many seniors have told me that over the years in order to follow different health messages they have become very restrictive in their food choices. They actually become afraid to eat food with fat or sugar or other “bad” foods. Unfortunately, many get to the point that they now are eating only a dozen items which limits the nutritional content of their diet resulting in poor nutrition and worsening of their medical condition. Often I end up telling them to forget following a diet and start eating to get calories, protein and nutrients that they are sorely missing.
• Dementia. Cognitive impairment that is progressive can lead to poor nutritional intake. As the memory loss worsens many older adults fight against meal time; become easily distracted by noise, patterns, smells, or other people nearby; forget how to use utensils or even how to chew and swallow; think they have already eaten; are unable to express desires of hunger and thirst and even to recognize them; allow agitation to inhibit intake; and eventually are not alert enough to eat. There are numerous strategies that a caregiver can employ to overcome food-related issues created by dementia. Many are quick fixes that can be accomplished easily.

Nutrient Needs for Aging

Seniors (all of us over 50) need calories to fuel our bodies to keep them functioning properly as well as give us plenty of steam to keep the machine working for all the activities we plan for the day.
Most seniors begin cutting down on portion sizes and even skip meals altogether at a time when calories are still needed and more importantly protein is needed to maintain strong muscles. Muscle wasting or sarcopenia in our seniors has become all too common resulting in falls and injuries from those falls.

Not eating enough or avoiding some foods could mean that an older person misses out on necessary vitamins, minerals and fiber too. Older adults need calcium and vitamin D for strong bones that could help prevent fractures. They need B vitamins especially B12 since it becomes more difficult to absorb as we age. Even with a diet rich in B12 your senior may need to talk with the doctor about a supplement. Potassium is also an important part of a healthy diet for seniors combined with reducing sodium will help manage proper blood pressure. Fiber is essential for good bowel health, relieve constipation in addition to benefiting many chronic diseases such as heart disease and diabetes. Let’s not forget water. Many older adults who are not fans of drinking plain water, who don’t want to go to the bathroom often or who don’t feel thirst simply don’t drink enough each day. Medications can also contribute to dehydration.

Eating more nutrient dense foods making every bite seniors eat count should be a focus of our overall health and treatment plan. It takes some thought and planning to find foods that are nutritious and delicious that provide a powerful punch of nutrients every day.
Ways to Get a Nutrition Punch!

• Drink water every time you use the restroom. Drink throughout the day especially if you are out in the heat or taking a medication that causes water loss.

• Add protein sources that are easy to eat such as scrambled eggs, egg salad, chick peas, beans, hummus, peanut butter, cottage cheese, Greek yogurt, protein fortified water, low fat milk, gelatin, smoothies, boiled meats, canned salmon or tuna, custard and puddings.
• Talk with your doctor about the potential need for B12, vitamin D or calcium supplements in case you can’t get enough in your diet.

• Add calorie sources if you are having trouble losing weight that will not increase the volume of food you need by using spreads, mayonnaise, sour cream, gravy, syrup, jelly, nut spreads as part of your recipes and on top of what you eat now.

• Consider a nutritional supplement in addition to your current meal plan NOT as a replacement of what you now eat. You may want to consider having a meal delivered each day if cooking is a problem. Not only will congregate senior programs deliver but local restaurants will too!

• Skip the ‘junk’ food like chips and Danish in favor of whole, healthy foods. You will see that they are not going to break your budget.

• Look for fortified foods that will give you more nutrition with each serving such as fortified orange juice, cereals, breads and other products with added calcium, vitamins and protein.

Eating should be a pleasurable experience not a battle ground. Caregivers can help their senior loved ones make a few changes and perhaps some wiser choices. Investigate reasons why they may not be eating as well as they could because there may be a way to correct it and get them back on the road to health so that they can enjoy each day to the fullest!

© 2014 By Kathy Birkett, RDN, this may not be preprinted without permission

Living with Purpose

Living with Purpose

By Jennifer Brush, MA, CCC/SLP

Each and every one of us likes to feel that we are needed.  We like to help out, make a difference and be useful.  Helping others adds purpose and meaning to our life.  Completing a job-well-done gives a boost to our self-esteem.  People with dementia have the same desire to contribute to their household or the community; the need to be productive doesn’t end once someone has a diagnosis of dementia.  In fact, people in the early stages of dementia who are aware that they are having difficulties with word finding, memory, have an incredibly strong desire to be needed by others.  As they struggle to communicate and remember daily information they need to have tasks at which they succeed.  They require positive reinforcement that they are valued.  Although people with dementia may not be able to contribute in exactly the ways they could before, there are still so many things they can do.
My friends Angela and Jeff come to mind.  Jeff has moderately advanced dementia and his speech is very limited.  He has great difficulty communicating his needs to his wife Angela.  However, he still has a desire to do things for her.  He enjoys clearing the table and washing the dishes after meals.

Because this has always been part of their routine-she cooks and he cleans up-it’s familiar and comfortable to him.  One daily ritual they’ve had for years is a 10:00 AM coffee break and snack in the living room.  Jeff will put placemats on the coffee table, get out the cream and sugar, and fold the napkins.  Angela makes and serves the coffee and then Jeff cleans up.  In a life filled with daily challenges to communicate, being able to helpful and complete these tasks for his wife truly makes Jeff feel good.

If you care for someone who has dementia, try to think of small ways throughout the day that they can help you or others and make that part of the daily routine.  People with dementia will have less anxiety and confusion throughout the day if their daily routine is consistent.  Look for opportunities to involve others outside of the family unit so as friends, colleagues, or church members.  Being able to socialize has significant implications for quality of life.  Maintaining meaningful relationships with staff, family, friends, and visitors, in large part, is based on being able to communicate.  People with dementia who experience language impairment are more likely to become socially withdrawn unless caregivers help them to remain active.

Here are some ideas of helpful tasks you may want to incorporate into the daily routine of someone with dementia:
• Set and clear the table
• Wipe the table and wash the dishes
• Help prepare meal by washing fruits and vegetables or mixing ingredients
• Read to a child
• Read the mail to a spouse
• Teach child to play a game
• Walk or feed a dog
• Brush a dog
• Sweep, dust, vacuum
• Rake leaves
• Plant flowers
• Weed garden
• Fold laundry
• Take a meal to a friend
• Visit someone who is home bound

Make sure to say “thank you” for the help you do receive.  A hug, pat on the back, or praise for a job well done are all great way to acknowledge someone’s contributions.  Ralph Waldo Emerson wrote, “The purpose of life is not to be happy. It is to be useful, to be honorable, to be compassionate, to have it make some difference that you have lived and lived well.”

The Joy of Discovering Preserved Abilities

In honor of Better Hearing and Speech month, I’d like to say a few words about communication and the relationships we have with our loved ones with dementia.   I’d like to share a story with you.  Last year I worked with a client who lived with frontotemporal degeneration.  I made a once weekly home speech therapy visit to help her with communication skills and to find ways for her to become engaged again with her family and friends.

Frontotemporal degeneration is a progressive deterioration of the temporal and frontal lobes of the brain. These areas of the brain play a significant role in decision-making, behavioral control, emotions and language. This degeneration of the brain can cause a language disorder called semantic Primary Progressive Aphasia (PPA).   The distinguishing feature of semantic PPA is difficulty generating or recognizing familiar words. Some individuals have difficulty recognizing familiar objects and faces as well.  Fluent, spontaneous speech is preserved, especially in early stages of the disease.  Word-finding and naming deficits are common.  Neuroimaging studies reveal loss of brain volume, blood flow, and/or neural activity in the left temporal lobe of individuals living with semantic PPA.

My client, Gina (name changed) had been living with PPA for several years and by the time I met her, she was speaking only automatic greetings and phrases such as “That’s okay.”  Gina was unable to answer even the simple yes or no questions that I asked.  Because Gina could not communicate her thoughts and needs to her family she became withdrawn and depressed.  She sat in her favorite chair for hours every day and her family took over all of the cooking and household chores that she used to complete on her own.

When I first met with Gina and her family, I asked them a few questions:
“What are some things that have always been important to Gina?”
“What did Gina enjoy doing most during the day?”
“How do you think Gina would like to spend her time now?”
I learned that Gina’s religious practices were central to her sense of wellbeing.  Her son indicated that each night the family took turns sharing their blessings of the day with each other and saying a meal time prayer of thanks.  Gina had not been able to participate for many months.
Next, I spent time with Gina to discover her preserved abilities.  During the speech-language evaluation, I learned that Gina could read and sing, and that she loved to do both!  When I work with clients, I learn about their skills, interests, and abilities and use those to compensate for their deficits.  I collaborated with the family to write blessings, prayers and favorite hymns in large print so that Gina could read them.  Through practice, repetition, and encouragement, Gina began participating in the dinnertime sharing of daily blessings by reading a preprinted note card of her choice.  She began singing with music the family played throughout the day and the expression of sadness gradually began to fade from her face.

As a result, the whole family dynamic changed.  After several weeks of educating the family about what Gina could do, rather than focusing on what she couldn’t do, Gina was participating in chores, singing throughout the day, and reading labels we made for common household items to express her choices and needs.

Communication takes many shapes and forms, just like us.  Throughout life, all the little things accumulate and make a relationship with our loved ones what it is. Don’t forget those little things; savor them. Find joy in the little things and your relationship will prosper.  Look for the person within, not the dementia.

© 2014 Jennifer A Brush, do not copy or distribute without permission

Spring is finally here!

Spring is finally here!  Those of us who live in colder climates have been anxiously awaiting the arrival of spring.  Although it snowed here is Ohio just a few days ago, it looks like we will be seeing green grass and a few buds on the trees for Easter.  In fact, my daffodils are beginning to show their heads.  This is a wonderful time to get outside with a loved one who has dementia and enjoy the sights and sounds that spring has to offer.  Many of us are more sedentary in the winter and welcome the opportunity to stretch our stiff muscles.  Now is the perfect opportunity to being a daily walking program.  With your doctor’s permission of course, begin by walking 10-15 minutes a day for the first week and gradually increase that to 30 minutes each day.

Exercise helps the body release hormones that make us feel great and aid in providing a nourishing environment for the growth of brain cells.  We know that physical exercise is crucial for maintaining good blood flow to the brain, reducing the risk of heart attack, stroke and diabetes, but it also helps protect against the risk factors for Alzheimer's disease and other dementias.
What some of the recent research says:
• Recent research from UCLA demonstrated that exercise increased growth factors in the brain- making it easier for the brain to grow new neuronal connections.
• According to a study done by the Department of Exercise Science at the University of Georgia, even briefly exercising for 20 minutes facilitates information processing and memory functions.
• A new study conducted by researchers at the Center for Brain Health at The University of Texas at Dallas found that engaging in a physical exercise program helps healthy aging adults improve their memory, brain health and physical fitness.
• A study published in the British Journal of Sports Medicine Regular found that aerobic exercise seems to boost the size of the hippocampus, which is involved in verbal memory and learning.

Besides keeping our body healthy, walking outside is a great mental stress reliever.  You can use the time to relax, clear your head, and enjoy what nature has to offer.  Walking can be a great social activity too.  Ask friends, neighbors, or other families who are living with dementia to form a walking group with you.  Begin by meeting at the same place and time once a week to enjoy each other’s support and camaraderie.  Often when people come together to exercise, they are more motivated to stick with it because they know other people are counting on them and they enjoy the social aspect of the event.  So get outside, enjoy spring, and get walking-your body and brain will love you for it!

© 2014 Jennifer Brush, do not reprint or distribute without permission.

Create a Memory Center in Your Home

Rather than putting excess demands on the impaired memory of someone with dementia, help the person by compensating for cognitive changes.  Find a spot in your home that is centrally located, or a spot where you often spend time.  Take down wall decor, clear up the clutter and create a memory center in your home that is easily noticed.  With practice, it will be the “go to” place for all important information such as the time, date, list of things to do, daily schedule, visitors for the day, etc.  One thing to keep in mind is that many people have the tendency to make this area very cluttered with post it notes, lists, photos, etc.  The memory center needs to provide just the needed information and that’s it.

Items to place in your memory center:

• Large, easy to read digital clock or a large analog clock with a white face and black numbers.  Look for an analog clock with Arabic numbers as they are easier to read than Roman numerals.  If you aren’t sure which to choose (digital or analog), pick the type of clock that your loved one is used to using.  
• Simple, large wall calendar with minimal designs or pictures.  Make sure to cross off the completed day at bedtime.  Office supply stores have memo boards with dry erase surfaces that already have a place for a calendar and place for notes or the schedule of the day.
• Telephone.  There are many phones available on the market that are designed for older adults.  Phones with large buttons are ideal for people with low vision or limited fine motor abilities. There are also phones with memory buttons that can be preprogrammed and dialed with the touch of just one button. This is ideal for people with mild memory problems. Picture phones have room for a picture of the person next to the memory dial button. This is best for people with significant memory issues or limited literacy.
• Notebook and pens.
• Emergency information.  Ambulance, fire and police station numbers should be posted in large print.  In addition, health information about the person with dementia should be posted in a place for emergency personnel to easily locate it.

The emergency form should contain the following information:
• Name of physician
• Primary health diagnoses (including dementia)
• List of medications
• List of allergies
• Health insurance numbers or copy of insurance card
• Name and phone number of one or two friends or relatives to contact
Make it part of your daily routine to go to the memory center several times a day with your loved one who has cognitive impairment.  Show the person the schedule, notes etc. and ask the person to read them.  Help the person to develop a new habit of checking the memory center whenever he or she would like to know the events for the day.  This will help to reduce anxiety and reassure your loved one.

© 2014 Jennifer Brush, do not reprint or distribute without permission.

Noise Pollution

Individuals with dementia have difficulty filtering out irrelevant noise from the environment and focusing on relevant sounds pertinent to their communication partner. When noise bothers people with dementia it can cause them to become agitated and restless. Background noise hinders communication because it affects the ability of people with dementia to hear and focus on tasks requiring cognitive attention. It is particularly disturbing for those who wear hearing aids since these devices amplify background noise. Pay attention to both people-generated and environmental sources of noise. Some are easier to address than others. Noise common to long term care settings and hospitals includes other people, running water, cell phones, overhead pagers, and appliances such as televisions, radios, icemakers, heating and cooling systems, vacuum cleaners, and floor buffers.  These types of noise should be reduced or eliminated whenever possible to allow people to maximize their hearing.

Background noise can become especially problematic in the dining areas because people often raise the volume of their voices to compensate for high background noise (Lane & Tranel, 1971). The increased sound level from louder conversations adds to the background noise, which can cause conversation with dining companions to be extremely difficult (Lane & Tranel, 1971). Sound reverberates off all hard surfaces on the ceiling, walls, and floor, leading to higher levels of background noise. As a result, older adults, and particularly clients with dementia, will not hear as well in a room filled with hard surfaces.

Reducing noise reverberation will help reduce demands on the already impaired hearing and communication systems.
Here are some environmental modifications to reduce reverberation:

• Incorporate acoustic treatments, such as acoustic ceiling tiles and acoustic panels on walls, can help reduce background sound levels and make the dining experience more pleasant and successful. 
• If there are many windows, which is a hard surface that bounces noise instead of absorbing it, use full drapes or curtains around them. The folds of the fabric will help absorb some noise. Full drapery treatments have better acoustic benefits than just valances or vinyl blinds. If sound in the room is a significant problem, also consider using lined draperies. 
• Furniture and other movable items can reduce sound if they are soft or porous. 
• Introduce small hands-free personal communicators that replace overhead paging and cell phones, the noise generated by overhead pages can be significantly reduced.

Human ears can hear a wide range of sounds from a very quiet whisper to a loud jet engine. Any sound above 85 dB can cause hearing loss; 130 dB sound causes pain. Noise levels between 43 and 80 dB have been found to disrupt math abilities, problem-solving skills, and cause frustration in healthy adults (Hansell, 1984). The decibel (dB) is a logarithmic unit used to measure the relative intensity of sound. On the decibel scale, the smallest audible sound (near total silence) is 0 dB. A sound 10 times more powerful is 10 dB. A sound 100 times more powerful than near total silence is 20 dB. A sound 1,000 times more powerful than near total silence is 30 dB. Distance affects the intensity of sound. If a person is far away from a sound, the intensity or power is greatly diminished.

Here are some common sounds and their decibel ratings taken while standing near the sound source:

• Near total silence: 0 dB
• A whisper: 15–25 dB
• Quiet residence: 35 dB
• Light traffic at 10 feet: 55 dB
• Normal conversation: 60 dB
• Vacuum cleaner: 65 dB
• Lawnmower: 90 dB
• Car horn: 110 dB
• Rock concert or a jet engine: 120 dB
• Gunshot or firecracker: 140 dB

Remember to always consider the potential noise in an environment for people with dementia.  The quieter the environment, the easier it will be for people to communicate.
© 2014 Jennifer Brush, this may not be reprinted or distributed without permission