12 Helpful Hints

Communicating with someone who has dementia

What can someone with dementia feel?

Imagine if you were to lose the ability to say the right word or understand what was being said, eg when on holiday in a foreign country where you don’t speak the language. You may feel frustrated, angry and look for help, perhaps to someone to interpret for you. You might respond by not speaking at all and withdrawing into yourself of avoiding situations where you have to communicate with people.

Here are 12 Helpful Hints for communicating with someone living with dementia.

1. Be calm and patient.
2. Face the person, speak clearly and slowly.
3. Make sure that you have their attention by gently touching their arm and saying their name.
4. Use short, simple sentences and say exactly what you mean.
5. Try to get one idea across at a time.
6. Allow plenty of time for the person to take in what you say and try not to reply.
7. Try not to confuse or embarrass the person by correcting them bluntly.
8. Use questions which ask for a simple answer.
9. Don’t ask questions which test their memory, e.g. ‘Who am I?’ or ‘What did you do yesterday?’.
10. Talk about familiar people, places and ideas.
11. Use the names of the people you are talking about instead of ‘he’ or ‘she’. It will remind the person of who you are talking about.
12. Use facial expressions and hand gestures to make yourself understood.

A Person with Dementia May Also:

• Feel under pressure because they can’t cope as well as they used to.
• Feel that their independence and privacy are being take away.
• Think that they are being judged for making a mistake.
• Be frightened by too much noise, too many people or a change to their routine.
• May already have poor hearing and eyesight which can be made worse by their dementia.

Don’t forget – Actions speak louder than words!

A smile, touch or gesture can be just as important in getting the message across and showing that you care. Sometimes holding the person’s hand when you talk can be very reassuring.

The leaflet this post is based on was originally compiled by Nicky Thomson, Good Morning Project Ltd and the North Dementia Forum, 2009.

Five ideas & tips to enhance communication (part 2)

Tell me and I will forget, Show me and I might remember, Involve me and I will understand.

Benjamin Franklin

Five more ideas to keep communicating

1. Prior knowledge is everything.

Ensure you know as much as possible about the person and their ‘back story’. It is far better to say ‘oh you have two sons, don’t you?’ than to ask the open question ‘do you have any children?’  Life story work is vital in maintaining communication and either encourage its development or where one has been produced promote its use

2. Set the context.

Back up what you say with reference to an object or pictures/photos. This helps to focus the person’s attention and also by putting the focus ‘out there’, it takes pressure off the person to communicate verbally and generally results in better interactions.

3. It’s about the message not the means!

Accept and encourage any form of communication that gets the message across – gesture, drawing, getting an object.

4. Strategies, strategies, strategies!

When a person with dementia has difficulty finding a word, encourage them to:

• Use gestures or drawing to get the meaning across
• Ask them questions e.g. is it X or Y
• Encourage the person to circumlocute (talking around the target word) so that the person can describe the object/place that cannot be named
• If you think you know the word, ask the person if they would like you to supply it. Always allow plenty of time for the person to respond but when you sense frustration, find a way to move on.
• Encourage the person to develop lists as aids such as shopping lists, regular places they visit, family names and birthdays etc. and then the persons conversational partner can check through these with them to get the target word.

Remember that a strategy may work some of the time but not all of the time. It is important to alternate strategies.

5. It is their decision!

Giving people the opportunity to be part of the decision process about care is vitally important. Talking Mats is a communication framework that facilitates people to express their views. It provides a method of helping people to organise their thoughts and express them using visual symbols, a scale and a mat for presentation.

Finally

In these two blog posts I have been able to share with you some of my specific techniques that can enhance the communication process with people with dementia. However, we must never lose sight of the fact that everyone is an individual who will have had different styles and skills at communicating prior to the onset of dementia.

There may be a time when, if you have dementia or are caring for someone with dementia, you consider that the dementia is impacting on communication. If this is the case it may be important to get an accurate assessment of the person’s communication strengths and challenges, from a speech and language therapist. This enables strategies to be specifically tailored to the individual.

The Standards of Care in Dementia (2011) states:

‘That staff use a variety of communication aids to help communication, including the use of life story books, talking mats, digital stories, interpreters as appropriate and referral to speech and language therapy.’ (page 15)

If you are concerned speak to your GP or team that are working with you just now to find out how to refer to a speech and language therapist in your local area.

As in my previous blog post I am going to invite you to offer

• suggestions and comments to my final 5 ideas and tips?
• share your own ideas and tips that you use to enable people with dementia to communicate their hopes, desires and wishes?

 

 References

Standards of Care in Dementia 2011 www.scotland.gov.uk/Publications/2011/05/31085414/0

Talking Mats  www.talkingmats.com

 

Supporting links

www.rcslt.org

www.nes.scot.nhs.uk/making-communication-even-better/

 

Joy Harris
SLT,Clinical Lead for Dementia, Lothian
@joysltdem

I work in East and Midlothian Psychiatry of Old Age teams seeing people with communication and/ or swallowing problems from the point of diagnosis of Dementia, and at any stage throughout the patient journey as the need arises.

Five ideas & tips to enhance communication

Communication is central to our wellbeing: Five ideas & tips to enhance communication

“The single biggest problem in communication is the illusion it has taken place.”

George Bernard Shaw

 

We are all communicators, however working as a speech and language therapist  means that I have an enhanced level of interest in the process of communication.

Most of us are fortunate to be around people for at least some part of our day.  Imagine what it must be like to not have anyone to communicate with, or possibly worse, not have the ability to make yourself understood or understand what is being said?

In my work as a speech and language therapist when working with people with dementia, I often wonder if their struggles to communicate can be likened to my struggles to construct sentences in French.  I can sometimes produce meaningful utterances if you give me lots of time to respond but rarely quickly enough as part of a fluent conversation. This leaves me feeling frustrated, stupid, sad all at once.

Communication is central to our well being.

Communication plays a fundamental role in maintaining and developing relationships. It is a two way process. It generally involves a minimum of two people interacting in turn taking.  Each person has to be both an attentive listener as well as a talker. We have to check out or monitor that what we are saying is being registered and understood.

If one person finds communication difficult, the other person has to attempt to bridge the gap and do more of the work. We have learnt over the years that there are some specific techniques that improve the communication process with people with dementia.

However, we must never lose sight of the fact that everyone is an individual who would have had different styles and skills at communicating prior to the onset of dementia and communication techniques are aimed at generalities rather than specifics.

In this the first of two blogs I am sharing with you some of my ideas and tips to enhance communication with five more to be shared in next weeks blog in “lets talk about dementia”

 

Five ideas & tips to enhance communication

1. It is not just about words.

Non verbal communication is understood more easily than verbal. Pay attention to your non verbal communication (tone of voice, facial expression, gesture etc) and monitor your conversational partners non verbal messages closely.

2. Location, location, location.

Ensure the environment is conducive to good communication. This means good lighting, reduction of noise and other distractions. Is the person wearing their hearing aids, glasses? Make sure you have their attention when speaking to them.

3. Get to the point.

Keep sentences short and simple. Make one point or statement, allow time for that to be digested before speaking again. Avoid chattering to fill the gaps.

4. Message understood?

Check that the person has understood and re phrase if they have not. Write down for them what they have been told if they are still able to read. People often think that a person is understanding more than is the case. This is because they maybe latching onto some key words and non verbal cues not the language.

5.  Less is often more.

As a conversational partner, accept you need to do more of the work but do not try to over compensate by chattering, even if you think it is about a topic they would have previously enjoyed. One or two words backed up by visual content, for example, and allowing plenty of time for a response will be of more benefit

We would love to hear from you.

• What suggestions and comments can you add to my initial 5 ideas?
• What ideas do you have to enable you keep talking to someone who wants to keep communicating?

 

 

Joy Harris
SLT,Clinical Lead for Dementia, Lothian
@joysltdem

I work in East and Midlothian Psychiatry of Old Age teams seeing people with communication and/ or swallowing problems from the point of diagnosis of Dementia, and at any stage throughout the patient journey as the need arises.