When we talk about person-centred care in dementia, we often mean well. The intention is to move away from a one-size-fits-all institutional model and towards something more human, more individual. Yet in practice, the interventions we reach for (aromatherapy, tactile memory boxes, group singing sessions) are themselves built on a set of assumptions about what people find comforting, connecting, and meaningful.
Those assumptions are largely neurotypical ones.
The Problem with Sensory-First Approaches
The dominant paradigm in dementia care interventions leans heavily on sensory stimulation. The logic is sound: as cognitive capacity changes, sensory experience remains a powerful pathway to emotion, memory, and connection. Lavender oil to calm anxiety. A soft toy to hold. The familiar smell of baking bread.
For many people living with dementia, these approaches are genuinely helpful. But for people who are also neurodivergent (whether that means autistic, ADHD, sensory processing differences, or other profiles) these same interventions can be actively distressing.
"What soothes one person can overwhelm another. The care environment that feels like home to a neurotypical resident may feel like a sensory assault to someone with different processing needs."
This is not a niche concern. Estimates suggest that neurodivergent conditions are significantly underdiagnosed in older populations, particularly in people who grew up before these frameworks existed. Many people living in care homes today spent their entire lives adapting to a neurotypical world without ever having a name for why it was so difficult.
What My Dissertation Is Exploring
My master's dissertation is examining what the evidence says, and what it doesn't say, about care interventions for people who are both living with dementia and neurodivergent. The research questions are:
- What assumptions about sensory processing underpin current dementia care intervention frameworks?
- What adaptations, if any, are being made for neurodivergent residents in care settings?
- What does the emerging literature on neurodivergent-affirming care suggest for this population?
The honest answer, at this early stage, is that the literature is sparse. This is a gap. And gaps are where the most important work happens.
Why This Blog Exists
I'm writing this blog to think out loud, to share what I'm finding, to invite conversation, and to connect with others in the care community who are grappling with the same questions. If you're a carer, a researcher, a family member, or someone living with dementia yourself, I want to hear from you.
The title, A Square Peg in a Round Home, felt right. Because that's exactly what we're talking about: people who have always been square pegs, now living in care environments that were designed for round holes.
It's time to start making different shapes.