Communication Advice
Dementia is the name given to a broad category of diseases of the brain. It is not a mental illness but it may become one if misunderstood.
Understanding the need for effective communication is the key to maintaining good mental health for the person with dementia and their carer. The following broad advice may contribute to a positive support for the person with the disease. However advice for each individual is always preferable because of so many variations in the manifestations of dementia and our individual responses.
- Do not ask direct questions
Direct questions are very unsettling for someone with memory, orientation and logic problems. Introduce a subject in the course of conversation by "gliding" for example -
Replace "Do you want a drink"?
By saying "Ooh I fancy a cup of tea; shall we" and see what their response is.
NB: Fluid intake should be around 2 litres a day otherwise you may be at greater risk of urinary infections, particularly when hygiene may be an issue. It has been shown in studies that using a red cup or beaker can increase fluid uptake by 80% because red, yellow and orange colour perception remains largely intact for most. Also be aware that peripheral vision will be reduced so make sure the drinking vessel is in front of the person with dementia. The same goes for plates; red is best.
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- Limit new information Some recent and new information may not be stored by the person with dementia. This is not through lack of effort or concentration but may be physically impossible.
- Do not challenge memory loss. There is no value at all in reminding someone with dementia that they have either forgotten an event, a name or that they are repeating themselves. They have not stored the information and therefore they cannot remember it. However, their emotional memory is likely to be intact so they may be left feeling anxious or frustrated with a negative encounter where someone else owns their memory for an event, activity or conversation they cannot recall.
- Empathy, Kindness and Respect are all; ultimately it will improve the quality of your relationship and reduce some of the stress. So, for example, every question you are asked must be like the first time you have heard it with your response; this includes your facial expression which must show sincere interest/care. People with dementia often become very good at reading peoples facial expressions, watching out for irritation and frustration. In my experience, people with dementia who are unable to speak fluently are not "somewhere else" but are responsive to the here and now and who they are with; if you are just popping in and are very tired/frustrated/irritated etc, ask yourself "for who's benefit am I visiting" because the person with dementia will sense your mood.
- Soft Eye Technique This is a technique I use. If the person you are visiting is agitated, obviously try to establish what is concerning them but at the same time make eye contact but soften your gaze by going out of focus. Do not move quickly; try to be poised and calm, smiling slightly but you have to mean it/be convincing. Some people are reluctant to join in with looking at images/books/engagment tools so try sitting close, within the persons visual field and look at the item yourself, just commenting and they may well start to join in. No need to force anything and make sure the item you are looking at will not trigger a negative memory.
- Using family photographs is fine early on but if family images stop being familiar you may be triggering anxiety unless you can just enjoy looking at happy images.
- Using reminiscence images/objects is fine if they give a positive response and this must be watched for; some general images may trigger a negative memory so be aware of this. I am currently developing a communication product which will not attempt to own someone`s memory.
- Gliding (as I call it) where you sit next to someone and look at an item like a newspaper, book or postcards, for example, and comment to yourself but allow the other person to join in, should they wish.
The following links takes you to an excellent animation about dementia and communication; this was produced by Alison Wray FAcSS, a Research Professor in Language and Communication at Cardiff University
CLICK ON LINK BELOW TO VIEW VIDEO
Dementia - The "Communication Disease" - YouTube
Helping dementia carers make sense of their experiences - News ...
Excellent Caregiving Tips below from Teepa Snow, Occupational Therapist USA
Positive Approach to Brain Change
It can be difficult, frustrating and confusing to care for a person with dementia. When frustration mounts, these five tips can help caregivers of loved ones with dementia cope:
Step back
When an interaction is not going well, you have a choice—you can push your agenda and watch things get worse, or you can step back and think. What's happening is often more complicated than it appears on the surface. In your effort to be helpful you may have created a problem. The person who is challenging you is doing the very best they can with what they have left. Stop judging them.
Learn to be a good detective. Your brain works better than theirs, so use it! Step back and assess their abilities. Know what you are working with.
Try to figure out what might be driving the person—what are you seeing, what are you hearing? What might be their unmet emotional need? Their unmet physical need?
Why might they be doing what they are doing? What are they trying to communicate? You need to try to see it from their point of view.
Respond (don't react)
What you thought would happen didn't happen. The person did not react the way you wanted (or expected) them to.You're getting frustrated and you're getting angry. What to do?
Stop reacting: Stop your behavior of trying to correct them. Stop pointing out "errors." Stop trying to fix things. Stop raising your voice, and stop pushing your agenda. "Remember, I already told you that" —do you find yourself repeating that sentence? It's time to stop! Don't argue with them.
What will be more helpful is to use the words they have given you. It's called reflective narrative language and it will support their ability to make connections. Repeat back to them what they have said to you— acknowledge and validate what they are feeling. It is not helpful to focus on who is right or wrong. But it is very often helpful to apologize (for whatever happened) and say: "I'm sorry this happened, or I'm sorry I upset you, I was trying to help."
Make plans, but expect them to change
Create a plan, think it through, and get organized. Have a schedule. You know what you want to happen. However, when it doesn't, you have to be flexible.
If your plan isn't working, you can't force it! It's part of your care agenda. Adjust your plans. It was just a plan! Figure out where to go, or what to do, instead. Having alternatives ready is necessary and helpful: Plan B, Plan C or even Plan D.
Figure out what you can (and can't) control
Stop trying to control what you can't control. This is so important to realize. You can't control their dementia or their past (who they've been or their routines and preferences that may now be exaggerated or problematic). And, you can't control/fix/change their behavior.
You do have some control, however, over their environment—the physical and sensory experiences including where they are, the objects they use or have access to, and how you guide or help to direct their time. Consider how you can make a difference for both of you.
Pay attention to what helps them feel valued and important, as well as when they relax and build energy. Try to prioritize the most important things and what needs to get done. Knowyour agenda, but don't show your agenda. And then recognize if/when it doesn't go as you'd have hoped.
You can figure out how to get yourself under control—and you can build your skills and knowledge about how to better live with dementia. Change what you can change and "Let Go" of the rest.
Take care of yourself
When it's not working—when something you tried to do didn't work, when you're getting frustrated or angry—you absolutely need to learn to take a time out. It's critical to step out of the situation. Take at least three deep breaths—breathe in and out, deeply!
When you are frustrated, angry, or in despair, the person you are caring for picks up on—and reacts to—your stress level and intensity. They may not understand what or why you are feeling as you do, but they will be impacted by your tone of voice, body language and emotional state. When you're angry, you're no good to them or to yourself.
Breathing deeply will help you get back to neutral, lower your emotional level, and help you regain perspective about the situation you are trying to problem solve. Also, don't hesitate to ask for help. Putting support systems in place for surprising times when living with dementia is critical. Dementia is hard work
TAD 70: 5th July, 2021
The ‘Ten plus communication options model’:
Option 3 - Reminisce
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