Download Connecting in every way possible: communication with people living

Connecting in every way possible:
communication with people living
with dementia
Maria Parsons
Director Creative Dementia Arts Network
A person centred approach
Need to understand the
neurobiology of dementia
(clinical model)
●Pharmacological
approaches – drug
treatments
BUT only partial
Understanding SO we need
to
●
SEE the PERSON first
Person with Dementia
●PERSON with
dementia
And act in the social
model practising a
person centred
approach
●
Key questions
How does dementia affect communication?
●
What is communication?
●
Barriers to communication
●
Improving practice
●
Brain: regions affected by dementia
Parietal
Lobe
Frontal
Lobe
Temporal
Lobe
Occipital
Lobe
Amygdal
a
Hippocampu
s
Effects of dementia on communication
Early signs
●Repetitive speech
●Slow to find a word
●Difficulty finding the correct word, particularly the names
of objects, places, people
●May substitute an incorrect word
Later signs
●Great difficulty using verbal language to communicate
●Unable to find the words of objects, places and people
●Misinterpret visual signals so that a man’s daughter may
be called ‘wife’
●Constantly repeat one or more phrase or sound
●Speech is lost
The Brain in Action
DIF Hearing Words Speaking Words Seeing Words Thinking about Words FERENT MENTAL ACTIVITIES TAKE PLACE IN DIFFERENT PARTS OF THE
BRAIN. POSITRON EMISSION TOMOGRAPHY (PET) SCANS CAN MEASURE THIS ACTIVITY. CHEMICALS TAGGED WITH A TRACER “LIGHT UP” ACTIVATED
REGIONS SHOWN IN RED AND YELLOW
Hearing Words
Speaking Words
Seeing Words
Thinking about Words
Different mental activities take place in different parts of the brain.
Positron emission tomography (PET) scans can measure this activity.
Chemicals tagged with a tracer “light up” activated regions shown in red
and yellow measure this activity.
Aphasia
Disorder of language affecting the content of speech and how it is
created and its understanding.’ Literally speechlessness
●Progressive forms of aphasia develop slowly as a result of damage to
the brain including Alzheimer’s disease or stroke or both
●
Aphasia (also known as dysphasia) is commonly accompanied by
difficulties in:
●Reading and writing.
●With general conversation
●Answering the telephone
●Watching TV
●Listening to the radio
Communication is pivotal to personal relationships. Person who
becomes aphasic may become increasingly frustrated and socially
isolated exacerbating disabilities associated with dementia.
William Utermohlen: self portraits
How do we communicate?
Spoken word
●Written word
●Signs/sign language
●Body & facial language
●Touch
●Singing
●Using objects
●Social media
●Braille
●
Understanding non verbal communication
The act of communication
Tell me that you are going out in two distinct ways using
different
●
Facial expression
●
Eye contact
●
Body language
●
Tone of voice
The ABC of Communication
Write a word associated with communication for each letter of the alphabet
A
N
B
O
C
P
D
Q
E
R
F
S
G
T
H
U
I
V
J
W
K
X
L
Y
M
Z
Most communication difficulties are ours
Not taking account of impact of dementia
●Not knowing the individual, not knowing if they are having a
bad day, are in pain, overmedicated or ready for a nap.
●Some staff find ‘beginning a conversation’ difficult
●Outpacing the person with dementia
●Asking too many questions and not waiting for answers
●Does he take sugar? – conversations with carers
●Cross cultural – language and accent as barriers
●Cultural dissonance between staff and people with dementia
●Beard!
●
Person with a dementia
Difficulty in word finding
●Perseveration- stuck record
●Understanding sequenced information
●Starting to say something and then forgetting what they were
talking about
●Hallucinations
●Saying things that are not true
●Sight problems
●Hearing impairment
●Behavioural and Psychological Symptoms of Dementia
(BPSD): anxiety, agitation and apathy
●Depression
●
Overcoming barriers to communication
Ask why someone has the problem, then:
Avoid confrontation – don’t confront the person with their
mistakes, this could make the problem worse
●
Be practical – try doing something practical to ease a
situation
●
Clarify the feelings and give comfort – acknowledge
someone’s feelings and provide support
●
Practice example and suggested response
●
Problem: Asking the same question a number of times
Why? Because the person forgets he/she has just asked the
question
●Avoid confrontation – don’t say “You’ve just asked me that”
●Be practical – try a short simple answer each time
●Clarify feelings – For example ‘ You seem worried that you
can’t remember the time of the appointment
●
Practice example and suggested response
Problem: Saying things that aren’t true e.g. that husband is
coming to visit when he died some years ago
●
●
Why is the person doing this?
●
Avoid confrontation
Be practical – Try saying something that incorporates the
truth but does not criticise or distract
●
●
Clarify feelings of the person with dementia
Effective communication
Wear something that can provide continuity if getting to
know the person with dementia
●Reduce as far as possible any ambient noise
●Ensure the person is comfortable
●Approach the person in their full view
●Get their person’s attention before speaking to them
●Use the person’s preferred name and say the same
phrase every time you meet
●Speak clearly and calmly. Avoid speaking sharply or
raising your voice as this may distress the person, even if
they can’t follow the sense of your words
●
Good Practice
Maximising success
●Attend fully throughout the encounter
●Allow enough time for the person to process information
●Judge whether the person is ready to speak to you? Have
they just woken up, do they need time to adjust?
●If wearing glasses –that they are clean
●Check hearing aids are working properly
Environmental
●Reduce environmental stressors and try to ensure
conversation can place privately
●Make sure that lighting is good - if possible sit in natural
light so the person can see you
Good Practice (2)
Avoid asking what/where/why/how/who questions
●Break down ideas and ask short direct and closed
questions
●Try not to ask the person to make complicated decisions
●If the person doesn’t understand what you are saying, try
getting the message across in a different way
●As the dementia progresses, the person may become less
able to start a conversation, so you may have to start taking
the initiative
●Pause frequently and summarise
●
Humour
Humour can help to break
the ice when communications
difficulties increase and
releases the stress of living
with dementia. Try to laugh
together about
misunderstandings and
mistakes – it can help.
●
What else can affect communication?
For a person with dementia, communication may
be affected by:
Internal environment
●Sensory environment
●Behavioural environment
●Physical environment
●
Internal Environment
Pain
●Discomfort
●Illness
●Side effects of medication, especially anti psychotics
●Poorly fitting dentures
●Hunger
●Thirst
●Too hot
●Too cold
●
Sensory Environment
Hearing loss and vision loss are key impairments in old age
and can compound communication difficulties for a person with
dementia
●Sensory loss can add to cognitive problems which further
compromises the ability to make sense of one’s surroundings
●Ensure glasses fit well, are clean and worn at all times
●Ensure a hearing aid is working and fitted
●NB People with dementia may forget to wear these aids or
have misplaced them in which case try to track down or get
replaced
●
Behavioural Environment
Your body language. Be calm and still while you
communicate
●
Your behaviour. Are you aware of how your words and
actions affect others?
●
●
Get to know the person’s body language
●
Understand the person’s emotions
Physical Environment
A person with dementia finds it more difficult to adjust to
their physical environment and way finding problems due
to damage to topographical memory are common
The physical environment can help a person with dementia
to communicate or hinder them
Signage
●Cues as to where they are
●Seeing the purpose of a room
●These can enable the person to ‘communicate’ with their
environment and be more independent
●
Environmental stressors
The physical environment of
care
homes and busy hospital wards
is often noisy.
Visual Aids
●
Talking Mats
●
Old photographs
●
Memory boxes
●
Objects
●
I Pad
●
Video messages
Talking Mats
An established communication tool, which uses a mat with
widgets (symbols) attached as the basis for communication.
●Designed to help people with communication difficulties to
think about issues discussed with them, and provide them with
a way to effectively express themselves in a visual way that
can be easily recorded.
●Used with adults and children with a range of communication
difficulties and helps people to understand, consider and
express their views.
●Can be adapted to people with different abilities, from different
cultures and in different living situations
●http://www.talkingmats.com/
●
Memory boxes
Prompting communication
through visual stimuli with
personal significance
●Can help prompt memory
●Provides visual cues e.g. to
a resident’s room in care
facility ( or by patient’s
bedside)
●Conversation aid
●Reminiscence aid
●
How recording affects communication
Documentation is a
communication tool
●A process of passing on
relevant, succinct information
●A form of guidance for the next
person coming into contact with
the service user
●Reflects a person’s strengths
●Language should be used
sensitively
●Facts not opinions
●
When recording information
Consider:
●How accurate is the information?
●Is there a story developing that builds on the person’s
strengths and choices or does it pathologise them? How
would you respond to the information ‘Mrs Smith has no
speech’ or ‘Mrs Smith shuffles and verbalises her feelings
when she wants to pass urine.’
●Are your observations of the person accurately documented
and easily understood by others?
●Are you too specific or general in your approach to
recording?
To summarise
Dementia affects how a person:
●
Thinks and processes information
●
How they receive and respond to stimuli
●
And how they interpret what they see, hear and say
●
How they act on that information
Conclusions
The person with dementia is increasingly trying to interpret a
world that no longer makes sense to them because their
brain is not able to process information correctly.
●Sometimes the person with dementia and the person they
are talking to will misinterpret each other's attempts at
communication this can be distressing (to both)
●Attend to the internal, sensory,behavioural and physical
environments
●The onus is on US to use all possible ways to promote
effective communication
●
Resources
Talking mats: an evaluation and useful references at http:
//www.jrf.org.uk/sites/files/jrf/2128-talking-mats-dementia.
pdf
●SCIE offer an e Learning programme in dementia that has a
range of useful information including several videos http:
//www.scie.org.uk/publications/elearning/dementia/index.asp
●Good example showing how our responses to a person with
dementia can help or hinder communication http://www.
youtube.com/watch?v=AFKACRqNJFE
●
‘Inhabitants of a lost kingdom’
Reinforcing the session’s key messages
You are lost at a railway station in a foreign country
where you do not speak the language, its getting dark and
unless you catch the next train you will miss your flight.
How do you make your needs known?
Thank you for listening!
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