Communication with People with Dementia

Original Editor - Akano Oluwadara Tomisin

Top Contributors - Akano Oluwadara Tomisin and Kim Jackson  

Introduction

Dementia 1.jpg

Dementia is a progressive illness that, over time, will affect a person's ability to remember and understand basic everyday facts, such as names, dates and places. Losing the ability to communicate can be one of the most frustrating and difficult problems for people with dementia, their families and caregivers. As the illness progresses, the person with dementia gradually lose their ability to communicate. They find it more and more difficult to express themselves clearly and to understand what others say. Their ability to process information gets progressively weaker and their responses can become delayed. Therefore, communication with people with dementia requires patience, understanding and good listening skills.

Communication changes in people with dementia

Some of the communication changes may include:

  • Difficulty finding the right words
  • Using familiar words repeatedly
  • Describing familiar objects rather than calling them by name
  • Easily losing a train of thought
  • Difficulty organizing words logically
  • Reverting to speaking a native language
  • Speaking less often
  • Relying on gestures more than speaking
  • The use of speech that does not make sense
  • An inability to understand what you are saying or the ability to only grasp a part of what you are saying
  • Writing and reading skills that have deteriorated
  • Loss of the normal social conventions of conversation – an increasing tendency to interrupt, ignore a speaker or fail to respond when spoken to
  • Difficulty in expressing emotions appropriately.

Communicating with people with dementia

Caregivers need to pay attention to how they present themselves to the person with dementia. The three factors that make up the messages we communicate are:

  • body language (the message we give out with our facial expressions, posture and gestures), which accounts for 55% of communication
  • the tone and pitch of our voice, which accounts for 38% of communication
  • the words we use, which account for 7% of communication.How we communicate is very important in having an effective communication with people with dementia. Negative body language, such as sighs and raised eyebrows, can be easily picked up.

WAYS OF COMMUNICATING EFFECTIVELY WITH PEOPLE WITH DEMENTIA:

  • Remain calm and talk in a gentle, matter-of-fact way
  • Keep sentences short and simple, focusing on one idea at a time
  • Always allow plenty of time for what you have said to be understood
  • Use orienting names or labels whenever you can,
  • Be flexible and always allow plenty of time for a response.
  • Where appropriate, use touch to keep the person’s attention and to communicate feelings of warmth and affection.
  • Keep your tone of voice positive and friendly, where possible
  • Talk to them at a respectful distance to avoid intimidating them – being at the same level or lower than they are (for example, if they are sitting) can also help
  • Don’t exclude the person with the disease from conversations.
  • Speak directly to the person rather than to his or her caregiver or companion.

WAYS TO ENCOURAGE PEOPLE WITH DEMENTIA TO COMMUNICATE

  • Try to start conversations with the person you're looking after, especially if you notice that they're starting fewer conversations themselves
  • Speak clearly and slowly, using short sentences
  • Make eye contact with the person when they're talking or asking questions
  • Give them time to respond, because they may feel pressured if you try to speed up their answers
  • Encourage them to join in conversations with others, where possible
  • Let them speak for themselves during discussions about their welfare or health issues
  • Try not to patronize them, or ridicule what they say
  • Acknowledge what they have said, even if they don't answer your question, or what they say seems out of context – show that you've heard them and encourage them to say more about their answer
  • Give them simple choices – avoid creating complicated choices or options for them
  • Use other ways to communicate – such as rephrasing questions because they can't answer in the way they used to
  • Avoid arguing. If the person says something you don’t agree with, let it be
  • Offer clear, step-by-step instructions for tasks. Lengthy requests may be overwhelming.
  • Give visual cues. Demonstrate a task to encourage participation.
  • Written notes can be helpful when spoken words seem confusing

LISTENING AND UNDERSTANDING PEOPLE WITH DEMENTIA

Its not just about communicating, listening effectively when communicating with a person with dementia goes a long way. Practice active listening not passive listening. Give the person your full and undivided attention while communicating. You can practice active listening by

  • Use eye contact to look at the person, and encourage them to look at you when either of you are talking
  • Try not to interrupt them, even if you think you know what they're saying
  • Stop what you're doing so you can give the person your full attention while they speak
  • Minimize distractions that may get in the way of communication, such as the television or the radio playing too loudly, but always check if it's OK to do so
  • Repeat what you heard back to the person and ask if it's accurate, or ask them to repeat what they said

Therapies and communication strategies

  1. Validation Therapy: Validation therapy teaches that, rather than trying to bring the person with dementia back to our reality, it is more positive to enter their reality. In this way, you can develop empathy with the person, and build trust and a sense of security. This, in turn, reduces anxiety.[1]
  2. Dementia 2.jpg
    Music therapy: Activities that involve music are another effective way of communicating with a person who has dementia. Often when other skills have gone, the person can still enjoy old familiar songs and tunes. A certain piece of music can unlock memories and feelings. It is important to be prepared to respond to the release of these feelings. A study showed that the playing of classical music or therapeutic singing resulted in: enjoyment, awareness, and engagement. Providing a source of music in hospitals or care centers are valuable methods for contributing to the care of the patients, while also relieving stress placed on the caregiver and forming a bond between the patient and the caretaker.[2] Another meta-study examined the proposed neurological mechanisms behind music therapy's effects on these patients. Many authors suspect that music has a soothing effect on the patient by affecting how noise is perceived: music renders noise familiar, or buffers the patient from overwhelming or extraneous noise in their environment. Others suggest that music serves as a sort of mediator for social interactions, providing a vessel through which to interact with others without requiring much cognitive load.[3]
  3. Dementia 3.jpg
    Reminiscence Therapy: reminiscence is a way of reviewing past events. This is usually a very positive and rewarding activity. Even if the person with dementia cannot participate verbally, reminiscing and reflecting on the past can still give them pleasure. It can also be a means of distraction if the person becomes upset. While reviewing past events can provide a sense of peace and happiness, it can also stir up painful and sad memories. It is important to be sensitive to the person’s reactions if this happens. If their distress seems overwhelming, then it is better to use another form of distraction to reduce anxiety. Studies have focused on two main benefits of reminiscence therapy for people with dementia: improved cognitive function and an improvement in quality of life (with a focus on improved emotions and overall happiness/mood).[4][5]

Resources

References

  1. Neal M, Barton W. Validation therapy for dementia. The Cochrane Database of Systematic Reviews 2003; 3:CDOO1394
  2. Levitin J, Daniel. This is your brain on music: the science of human obsession 2007
  3. Keough Laurie. Assessment-Based Small Group Music Therapy Programming for individuals with Dementia and Alzheimer's Disease- Amulti year clinical project. Music Therapy Perspectives 2017; 181-189
  4. Wang J. Group Reminiscence Therapy for cognitive and affective function of demented elderly in Taiwan. Int J Psychiatry 2007; 22(12):1235-40
  5. Okumura Y. Tanimukai S and Asada T. Effects of short term reminiscence therapy on elderly with dementia: A comparison with everyday conversation approches. Psychogeriatrics 2008; 8(3):124-133