Dementia Gateway: Getting to know the person with dementia

Getting the communication going

When one person has communication problems, if we just make our usual effort then the communication will not connect.

Explore the links below now to read more about this topic:

• 1. Introduction Open

  This feature gives some tips for communicating with those people with dementia who have words, but who find themselves in need of quite a lot of assistance with communication.

  Once we understand some of the underlying problems the person with dementia is struggling with, it becomes obvious that we need to adapt our communication style to help the person feel supported by us, rather than intimidated or out-paced.

  When we are having a conversation with another person who does not have a communication problem, we chat easily and neither has to make a particular effort to be understood. Their conversation meets in the middle as illustrated below.

  

  However, when one person has communication problems (as is the case in dementia), if we just make our usual effort then the communication will not connect. The person with dementia remains disengaged with the world.

  

  If we want to have a connected communication with a person with communication problems then we need to make the extra effort to ensure that this occurs. We have to go that extra distance as illustrated below.

  

  Another way of looking at this is to compare the communication to a game of tennis. If you are playing tennis with someone of equal ability then you play to just have fun or to win. If you are playing with someone who is much less skilled then usually you try to get a rally going by just getting that ball over the net and returned again. A good tennis coach will build confidence effortlessly by helping the unskilled player to succeed and slowly stretching skills. As good dementia communicators we have to adopt the coach position. Some of us are naturally better coaches that others but these skills can be learned.

• 2. Pre-match preparation/prior to communication Open

  Minimise background noise: You want to maximise the chances of concentration. If there is a lot of background noise, TV, music, vacuuming, clattering, chatting then your chances of good communication are less. If you work in a noisy environment you are probably immune to how noisy it actually is. Close your eyes for a few minutes and listen and name every sound you can hear. Can you lessen any of them?

  Consciously relax: You are likely to be moving at a much faster pace than the person with dementia. In order to fully attend to your job as coach you need to be relaxed and slowing your pace. Become aware of your breathing. Exhale fully and then slow down your respiration rate. Relax any bodily tension that you are carrying, drop your shoulders, unclench your jaws, stretch out.

  Think how the person may be feeling: Try to put yourself in their shoes or seat. What is their emotional state likely to be? Are they relaxed and happy or anxious and distressed? Are they calm or frightened? Are they likely to respond to humour or are they angry and frustrated?

  It may feel like a first for the other person: Because of problems with laying down new memories, even though you may have had a number of interactions already with that person today, to them it may feel like the first time they have seen you. Think whether this is likely to be the case. How will this impact on your conversation?

• 3. The serve/opening the communication Open

  Greetings: Think beforehand about how you are going to greet the person. Do they know who you are? They may not know you even though you know them well. Think about whether you need to say your name or whether a warm hello will suffice. Warmth and friendliness in your initial greeting is usually important.

  Physical approach: Think about where the person is sitting. What can they see from there? Are there any sight or hearing problems that will have a bearing on how you should approach them? Generally make sure that the light is on your face rather than behind you.

  Coming in low at eye-level if the person is seated will be less intimidating. If the person is quite withdrawn, sitting alongside them making some minimal movement and sound may be a gentler way of getting their attention rather than trying to strike up a conversation straight away.

  Touch aware: Does the person respond to touch in a positive way? A light touch on the back of the hand can often feel reassuring and non-threatening. If the person moves their hand away from you, take your cue from them and be careful how you use touch. If the person takes the opportunity to clasp your hand this may be an indication that they need more physical reassurance and support. With people who are quite withdrawn, a gentle touch on the cheek can be a way of getting them to look at you. Again be sensitive to their reaction to the touch and take your lead from them.

• 4. Reaching the serve to return it/achieving understanding Open

  Identify the emotional state of the response: How is this person feeling? If they have been able to speak, what do the words convey? What does the tone of voice convey? What does their facial expression tell you? What does their body position tell you? What does their respiration rate tell you? Is there any indication that the person is in physical discomfort or pain?

  In dementia care you need to listen with your eyes and your ears.

  Be open to a range of possibilities: We often go into situations with set ideas of what we want to speak about or what we expect to hear and we try to switch the conversation quickly to the topic we have in mind. At the beginning of a communication take your lead from the person with dementia. Don't try to switch topic too soon or your serve won't get that back over the net. Work on what is in the foreground for them.

  When the person says x they mean y (or z or t): Be aware that as word finding becomes more difficult for the person with dementia the content of speech becomes more limited. So for example a female name such as Julie may come to represent every female helper rather than referring to Julie in person. A reference to 'needing my mum' may mean that the person is feeling scared and unattached rather than a literal question needing a literal answer about the whereabouts of the person's mother.

  Put present and past together to understand the other's reality: The more that you know about the key stories, people and themes of a person's life the better you become at interpreting meaning. If you are puzzled by a response, think what the person has just been experiencing before your conversation, think about what you know about the person's past and see if you can make a connection.

• 5. Ensure your ball gets returned/keeping the conversation going Open

  Say what you think the other feels: You have listened with your eyes and your ears to how the person is feeling. A simple statement of what you have observed will let the person know that you care how they feel. For example, 'You sound sad right now' or 'You look really relaxed sitting there'. Keep it simple.

  Say what you think the other person wants to say: If the personhas said words, summarise back the meaning of what you think they have said. If you are not sure then just feed back the key words to see if any more are forthcoming.

  Don't correct 'mistakes': It is often tricky to know whether to correct errors, for example when someone has got the wrong time of day or got muddled up. Be wary of your tone if you feel you need to correct the person. Consider offering a tentative alternative such as 'I wonder if you think its morning already? I think it's about 11 at night now – look everyone else is in their beds?'

  Confrontation is usually pointless: Sometimes people will accept your point of view or explanation, other times they won't. If they won't, then graciously agree to disagree and move the topic of conversation on to something less troubling.

  Use visual aids: Having some key words or pictures on cards in front of you can really help people with dementia stay focused. They will often struggle to keep the topic of the conversation in mind as the conversation progresses. Having pictures or objects in front of you will help. For example, if the conversation is about medication, have the medication on the table or use a picture of someone receiving medication there.

  Don't shy away from tears or laughter: People with dementia often lead very emotional lives. Anxiety and grief may be quite near to the surface. Don't shy away from tears. Stay with the person and offer them natural support.

  You may not be able to fix the cause of the anxiety or grief but seeing this through with them and not being afraid will help them enormously. Never underestimate this. Likewise, having a belly laugh together over something silly is a great way of getting to know each other.

  Little and often is usually better: Sometimes you can bat the ball back and forth for a long time. Be vigilant for signs of fatigue. Finding words for things and communicating at length can be particularly tiring for some people with dementia. Take a break but come back again soon.

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What are these? DEJI