Communication is an expressive or receptive exchange of information which is vital to the functional success and emotional well-being of a person with dementia. Difficulty expressing needs or understanding another person is extremely stressful to both the healthcare professional and the individual with dementia.
The ability to express one’s needs and thought in various forms, such as speech, body language, and facial expressions.
The ability to understand communication from others, including messages sent via words, body language, and facial expressions.
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Steps To Better Communication
Before you attempt to communicate, make sure you have gained the individual’s attention. It is important that the person in your care feels safe with you and the you have his or her agreement and approval to proceed.
When you approach an individual, always try to do so from the front so she/he has an opportunity to recognize you. In the later stages of dementia, range of vision may become more limited, so you need to make further adaptations.
Before delivering your message, make direct eye contact (unless culturally unacceptable) and stand or sit in front of the individual before proceeding. During the conversation, maintaining eye contact shows that you are listening, builds trust, promotes respect, and indicates that you care for them.
A key aspect of communication is nonverbal. In addition to words you use, your tone of voice, body language, and facial expressions also send a message every time you speak. So be careful not to change the meaning of your message with your nonverbal cues.
At any stage of dementia, there is a person behind the name. Let the person know that they have your full attention.
Working in health care may bring you in contact with residents whose chronic confusion or cognitive impairment may cause them to exhibit combative behavior. It is essential to recognize that a resident’s combativeness is a symptom of the need for care, not a sign of dislike or fear of you. Therefore, your ability to assess, understand and work to prevent or modify combative behavior will result in better care for residents and greater work satisfaction for you.
Individuals with dementia are often easily distracted by both sights and sounds. Before communicating, try to eliminate all unnecessary sources of stimulation. If you need to handle the individual’s belongings, ask for permission first.
Calling a person with dementia by name shows respect, and identifying yourself often helps the individual with orientation. Leading with the person’s name will improve the person’s ability to answer your questions or request.
Using pronouns when communicating with an individual with dementia can cause confusion and frustration. Pronouns are words like: it, his, she, her, them, and they. You must speak clearly and simply, and avoid pronouns when at all possible.
Long sentences are filled with a lot of information which will cause increased confusion for an individual with dementia. Keep all sentences short and to the point.
Research shows that the response time for an individual with dementia can be delayed by up to 30 seconds. When communicating with an individual with dementia, allow time for your words to be processed. Be patient and often you will receive the response you seek.
Words alone may not be enough to convey the meaning of a message you are trying to send. Use visual demonstrations or tactile/hands- on cues to accompany your words.
Any physically aggressive act that causes or intends to cause hurt or damage to a person or object. Some types of behavior you may encounter in healthcare include:
Certain types of brain disorders, health condition, psycho-social factors, environmental situation, and care-giving interactions can interfere with the ability of residents to mirror reality. In effect, behavior always occurs within a context of people, places, times, and events.
Dementia is a brain disorder in which both personality and thinking abilities deteriorate. It occurs in organic brain diseases, such as Alzheimer’s, and in other disorders. It worsens over time. As Alzheimer’s residents lose touch with reality, combative behavior may result from an inability to understand what is going on in the care setting.
Other health-related causes may include hearing or visual impairment, acute illness, multiple illnesses and disabilities, hormonal changes, loss of control over bodily function, or disturbances in body image.
Likewise, alcohol or drug-related condition, changes in medication, and lack of sleep may induce episodes of combative behavior.
Psycho-social causes of combative behavior may stem from a resident’s feeling threatened by life changes and frustrated by a perceived loss of control. Unable to communicate adequately, a resident may misunderstand your efforts to provide care. He or she may be unable to control feelings, or may withdraw from interaction.
Environmental causes of combative behavior can be varied. Very bright or dime lights, blaring radios and TV’s, intrusive loud speaker messages, cluttered rooms, or the constant traffic of people coming and going can upset residents. A change of rooms, roommates or routines, as well as a disregard for the way a resident likes their belongings arranges, may also trigger combative behavior.
Unskilled care-giving acts that can contribute to combative behavior include being overly authoritarian, making gestures that startle or frighten, rough or hurried handling during care-giving, and impatient, loud or demeaning conversation.
Managing Combative Behavior
In dealing with disruptive or combative behavior, one must determine what the individual is trying to communicate through their behavior. If we don’t act on the message it could lead to further escalation or if we try to suppress the behavior it may come out in some other way which may ultimately be more problematic. To manage the behavior, you need to assess and understand the reason for it or the purpose it serves, develop a care plan based on realistic goals, use strategies to prevent it, and intervene safely when it occurs. Regardless of the circumstances, you must always treat residents with respect and preserve their dignity.
A thorough assessment begins with a review of the patient’s medical, social and work history, and a search for behavior patterns that may repeat. Visit with family members to better understand the resident’s personality, former occupation, hobbies and life experiences. Keep the family informed and enlist their help in modifying the behavior. Talk with the resident to share a closer, more understanding relationship.
Maintain an ongoing, regularly updated assessment of the type of dementia, its severity and progression.
Work closely with the entire care-giving team to develop a plan for successful management, containment and, where possible, prevention of combative incidents. Make your goals realistic. Begin with the understanding that you’ll probably be unable to stop all behavior problems, and cannot halt the progression of conditions such as dementia. Some realistic goals are:
Our actions should be motivated by the need to protect and teach, not by a desire to punish. Despite a resident’s confusion or cognitive impairment, always try to validate his or her reality and honor the human dignity to which each of us is entitled. Give each resident your respect, shown by words of praise and gestures of support. Encourage a resident’s self-care and functional independence to the full extent of their capabilities. Use the following preventive strategies:
As a result of physiologic changes caused by Alzheimer’s disease, affected people may not communicate well with others. They are not creating these obstacles on purpose, and are probably as frustrated as their friends and family about the communication problems.
People with Alzheimer’s disease may:
You can help the person with Alzheimer’s disease by being a good listener. Let the person with Alzheimer’s know that you are listening and that you are trying to understand them. Maintain eye contact to show them that you care about what they are saying. Encourage them to continue trying to express their thoughts, even though they may have difficulty doing so. Don’t interrupt them, no matter how long it takes them to think about and describe what they want. Avoid criticizing or correcting their speech or actions. Don’t argue with them.
Follow these tips for improving communication with a person affected by Alzheimer’s disease: