Mental health articles

Communication with people with dementia is often considered to be a challenge. Indeed, some people talk as though it is not possible for those in the later stages to communicate at all and that those in the earlier stages are unable to communicate meaningfully. It depends on what is considered to be communication. Verbal and non-verbal communications are crucial links between people and continue throughout life, even the apparent absence of communication tells a story – that of being ignored, neglected or unimportant.

Communication with people with dementia .Goldsmith  has written a lot about communication and asserts that not only is communication possible with people with dementia but it must be encouraged and facilitated. The first step in the process is to believe it is possible. It is necessary to engage with the person and interpret the meaning behind the words. To do so requires highly developed sensory acuity, the ability to engage with people using all our senses and to use our senses to express communication. Touch, tone, pitch and pace should be appropriate to the needs of the individual. To be unhurried and connect with the emotions being expressed will validate the person and their experience.

Attention to the environment is also necessary, trying to talk to someone in a noisy environment where there are many distractions may lead to confusion and anxiety. Good lighting will reduce

the likelihood of misinterpreting visual images, and having space to walk around may make people feel less hemmed in. Other considerations include ensuring your posture and facial expressions are relaxed, allowing time for the person to process the information. It can take five times longer for a person with moderate dementia to process information, and even then they may have difficulty responding. Use short sentences with only one message and give time for a response before moving

on. The use of visual images or objects can aid communication, for example when telling someone with dementia that they are being taken to the bathroom a picture of a bathroom may aid understanding and reduce anxiety.

Underpinning all communication should be respect, genuineness, a desire to communicate effectively and a belief that it is possible. Aggression often results because of poor or negative communication leading to confusion and even fear for staff and service users. Being sure that communication is carried out to meet the needs of the person with dementia reduces the incidence of aggressive outbursts considerably. Staff attitudes to aggressive behaviour reframe the experience, understanding it as a response to a frightening situation, frustration or panic, and may encourage staff to consider their own behaviour and approach, and to adapt it in order to meet the needs of the person with dementia.

Communication with people with dementia.‘Wandering’ is a term used to describe the apparent aimless walking observed in some people with dementia. This type of activity is rarely aimless. It may be an expression of frustration, boredom or restlessness and close observation may well give some insight into the cause of the behaviour. Staff need to have the capacity to cope with the behaviour and the skill to interpret the reason behind it to enable their response to be reassuring and meaningful to the person with dementia. Hussain found that 93% of all ‘wandering’ seemed to have a logical destination, with 53% of stops being within 1 foot of another person, and 29% being by an external view – both providing clear communication if only someone was listening. Aggressive outbursts are distressing, and every effort to address the cause should be explored; however, it should be recognised that anger is a natural response to fear, frustration and confinement.

Tags: communication, dementia