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Practice Educator

Tackling communication challenges in dementia

Meaningful communication with people who have dementia can be difficult and challenging, yet continued interaction is important and rewarding

In this article…

  • What constitutes a diagnosis of dementia
  • The four stages of dementia
  • Strategies for communication

Author

Graham Stokes is director of dementia care at Bupa.

Abstract

Stokes G (2013) Tackling communication challenges in dementia care. Nursing Times; 109: 8, 14-15.


Nurses and other healthcare workers are often anxious about communicating with people who are living with dementia. This article discusses the issues involved and describes communication techniques taken from the Talking Toolkit, which was developed by Bupa to provide strategies for communicating in a meaningful way with people who have dementia.


Since we live in an ageing society where increasing numbers of people are being diagnosed with Alzheimer’s disease and other forms of dementia, such strategies for communication are
increasingly relevant for all nurses and health workers.

  • This article has been double-blind peer reviewed
  • Figures and tables can be seen in the attached print-friendly PDF file of the complete article in the ‘Files’ section of this page

 

5 key points

  1. Dementia is progressive and the numbers diagnosed are increasing
  2. Difficulty in communicating becomes most acute when people begin to lose their grip on the present
  3. Speak slowly and clearly, keeping things simple
  4. Do not antagonise - it is better to agree with their version of reality
  5. Be patient and lead the conversation to meaningful subjects such as memories

 

The prejudice and fear associated with dementia often lead to anxiety about communicating with those who are living with the condition. A recent Bupa Health Pulse poll of more than 2,000 people in the UK found that one in three felt apprehensive about talking to someone with the condition. Participants said that they did not know what to say, or how to respond to what is often perceived as unusual and unsettling behaviour.

Around 800,000 people in the UK have dementia, and this number is expected to double over the next 40 years (Alzheimer’s Society, 2009). This means nurses and other health professionals will increasingly come into contact with older people who have dementia, even if they do not work in dementia-specific services, particularly since many cases go undiagnosed.

Bupa has created a Talking Toolkit to equip both professionals and non-professionals, such as family and friends, with strategies to talk to people with dementia in a meaningful way, without apprehension or anxiety. It aims to help people to hone their communication skills, to enable them to see beyond the condition to the person living with it. This will mean professionals are not only better placed to care for people with dementia but also will be able to help the person retain their connection to the people around them.

What is dementia?

Dementia is a broad term used to describe a set of symptoms that develop as a result of damage to the brain, the most common of which are memory loss, mood changes and difficulty in communicating.

There are many forms of dementia, including Alzheimer’s disease, vascular dementia and Pick’s disease; it is more likely to affect people over the age of 65, although it can affect younger people.

The condition is progressive and worsens over time; in the later stages, people with dementia become unable to carry out everyday activities and find it difficult to convey their thoughts and feelings. As the symptoms become more profound, they will need increasing amounts of support from their friends, family and carers. To help navigate the dementia journey, we have divided the condition in to four stages (Box 1).

The challenge of communication

Communicating with people who have dementia presents a number of challenges, and the difficulties become most acute when they begin to lose their grip on the present. Their ability to convey thoughts and feelings significantly deteriorates and they become increasingly confused. They may not recognise close friends or family, and may think they are in another place or time.

Experiencing this uncertainty and confusion often causes people to retreat to the safety of established memories, and they begin to lose awareness of the world around them. Nurses and carers who have never encountered these behaviours before often do not know how to respond when a person with dementia asks difficult questions, such as requesting to see a mother who has passed away. It can also be difficult to know how to reply if they believe they need to go to work or collect children from school.

Below are some techniques that can help in dealing with such situations. It is important to remember, at this stage when communication is most challenging, that continuing to interact with the person who has dementia is more important than ever.

Keep it simple

The first thing to remember when talking to people with dementia is to keep things simple:

  • Speak slowly and distinctly, using clear and simple words;
  • Keep statements brief - the person may lose the thread of the conversation if you talk for too long, which can lead to irritation and frustration for both of you;
  • Avoid asking open questions, which can cause confusion - all questions should have a direct “yes” or “no” answer. For example, instead of asking “What would you like for lunch?” ask “Would you like a cheese sandwich?”
  • Use real names for people and objects, rather than words like “she”, “it” or “them”, as this makes conversations easier to follow. For example, instead of asking “Do you like it?” ask “Do you like the cake?”

Do not contradict

Being contradicted can increase anxiety and confusion in people with dementia, because what they are saying is what they “know” to be true. Rather than contradict them, focus on what you can do to put them at ease and reduce their anxiety.

For example:

  • If they repeatedly ask for a deceased mother, rather than correcting them, you could say: “Tell me about your mum - what was she like?”
  • Validating something you know to be untrue is often the best approach in communicating with people with dementia, as it makes them feel content and at ease, rather than anxious, sad or distressed. Colluding with them in their vision of the world can help them to regain peace of mind.

Be patient

  • Try not to finish their sentences; if you sense they are struggling to find the right word, ask a question that provides a helpful prompt;
  • If they repeat questions, it is likely they have forgotten that they have asked you before. Never say “I’ve told you this before” because, to them, you never have;
  • Give them plenty of time to respond to questions and try not to show frustration if they do not understand you;
  • We all have days when we do not feel like talking, and people with dementia are no different. If your attempts to communicate with someone are unsuccessful, try again later.

Look for the meaning behind behaviours

Understanding the meaning behind certain behaviours will enable you to find solutions to help people with dementia cope with what they are feeling.

For example, if they insist they need to go to work, this could be because they are remembering a time when they felt useful. If so, try to find tasks and activities that could help them feel valuable; this could be something as simple as helping to make a cup of tea or bringing in the newspaper in the morning.

Make a meaningful connection

The most successful connections with people who have dementia are the ones that carry deep-seated meaning for them. Flippant conversations and statements can make them confused, which will increase their anxiety, so try the following:

  • Talk about things they enjoy discussing and which have meaning to them - this could be their family, a sport or another favourite pastime;
  • Use happy memories to connect, as this can create a sense of wellbeing - looking through a box of photographs, keepsakes and other special objects can be a way to tap in to their memory and trigger a conversation.

These meaningful moments may be brief, but they are emotionally rich for the individual with dementia. If you can make that person smile, even for a moment, the contact will have been worthwhile.

Conclusion

While there is no cure for dementia, the condition can be managed with sensitivity and compassion.

You may feel anxious about engaging with people who have dementia, but it is important to recognise the value of interacting with them, even if it seems they are no longer “in the present”. You can learn skills and techniques to overcome the communication challenges, putting you in the best possible position to care for this vulnerable group.

You will also be able to help friends and family members to enjoy moments of meaningful communication with their loved one, which can be extremely rewarding for everyone involved.

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