Communication does gradually change when a person is living with dementia, but as Stephen Miller puts it , “there is nothing they can do about it”. We are the ones who have to change. His book Communicating across Dementia1 is well worth a read.
We already have the skills we need to adapt to a different way of communicating. We all use facial expression and body language, tone of voice, and behaviour in every face to face interaction, and in fact we are quite dependent on them. Where words are used on their own, in written messages, texts, emails etc, it is easy to misinterpret the tone, so we’ve developed “emoticons” which add a non-verbal overlay.
We each have our own repertoire of behavioural emoticons.
A baby is completely reliant on non-verbal communication and we can understand and meet their needs. A person who is losing the power of language has more sophisticated social skills and knowledge of the world, and we must respond to their behaviours to understand their more complex messages.
Just as we learn what the different cries of our own baby mean, we also have to learn the significance of a person’s different behaviours. The better we know the person, the joys and sorrows of their life, their pre-occupations, their everyday likes and dislikes, their interests and habits, their spiritual needs, the better we can communicate with them.
Here’s an example:
A man living at home with his wife used to get up from the table after breakfast every day and start emptying the cupboard under the stairs. It made a terrible mess and she was desperate to stop this disruptive habit. He couldn’t explain what he was doing or why, and she didn’t understand. It was another family member who made the link between the behaviour and what it was telling them, reminding her that in their first house, when the children were young, all the shoes lived in the cupboard under the stairs and he used to clean and polish them after breakfast on a Sunday. Now he was reliving those days and trying to be useful. Once his wife understood, she found some shoes to keep there and he was happy getting them out and giving them a brush every day and then putting them away.
It is not always possible to understand what a person is trying to communicate, but they may resort to more extreme behaviour if we ignore the clues. In these circumstances, it usually helps to acknowledge the emotions even if the cause is still a puzzle. The important thing is to recognise that the behaviour is communication.
Communication is two way. It is not just about watching and listening. We have to adapt our own messages so that our meaning is not just conveyed in words. It is still important to use speech – some words will be understood, and the person will recognise they are being included in a conversation. But this isn’t enough.
All the senses can be used to communicate – smell, taste, touch, sight, hearing, being aware of movement, temperature. Words are gone in an instant, but using other modalities can give the person much more time to process the message. Simple things like the cornflakes packet to show it is breakfast time, a warmed blanket to communicate comfort and love, need I say it, smiling, can make a huge difference.
Speech and Language Therapists work with families and carers to help find the best ways to communicate. It is different for everybody, but in Stephen Miller’s words, communication
“goes to the heart of what it is to be human”.
It is vital to our psychological well-being.
1..Stephen Miller Communicating across dementia Robinson 2015
exploring occupational therapist’s professional knowledge of alcohol misuse in physical health care settings.
Speech and Language Therapy Clinical Lead for Dementia in NHS Lothian
I work in the community with adults with acquired neurological problems, including dementia, and I’m a member of the Alzheimer Scotland AHP dementia expert group. I’m starting a new job with a specialist speech and language therapy team in Lothian working with people with dementia.