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Understanding
Dementia
Introduction
In February 2009 the Department of Health published the first ever
National Dementia Strategy. Within the strategy are 17 key
objectives designed to:
Make the lives of people with dementia, their carers and families
better and more fulfilled (DoH 2009).
Objective 13 calls for an informed workforce for people working with
dementia. This is to be achieved by effective basic training and
continuous professional and vocational development in dementia
care.
As part of SEPT’s Workforce and Development strategy to support
this document, this e-Learning training has been created for all staff
involved in health and social care in older people services including
primary, secondary and tertiary care pathways providers.
DH UK – Dementia
or you can order a copy from: Orderline UK
Key Points
This e learning training course should take learners up to 45 minutes to complete.
Learners will be able to stop and revisit at any given point.
On completion of this e learning training, learners should be able to:
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Understand the definition of dementia
Gain an awareness of incident rates in the UK
Identify the most common types and causes of dementia
Gain an awareness of signs and symptoms of dementia
Recognise the difference between dementia, depression and confused states
Understand where behavioural interventions may be helpful
Identify different methods of communication
Understand why people with dementia may experience difficulties with communication.
Identify communication skills and approaches which may be useful when working with people with
dementia.
Understand the need for a positive and effective communication with the person experiencing
dementia.
Prevalence
Key data for the UK as a whole includes the following:
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More than 750,000 people in the UK are affected by dementia
It affects one person in six over 80 (late onset)
One in 14 over 65 (early onset)
Dementia is predominantly a disorder of later life, but there are at least 15,000
people who have young onset dementia , click for more information you may wish
to view or download the following fact sheet:
Fact Sheet
Source: alzheimers.org.uk
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Approximately two women for every man is affected
It is estimated that there are 11390 people from Black minority ethnic groups
(BME) with dementia. Its note worthy that 6.1% of all people with dementia
among BME groups is young onset, compared to 2.2% for the UK population as a
whole.
Projected Impact
• The total number of people with dementia in the
UK is forecast to increase to approximately
950,000 by 2021
• Increasing to 1,735.000 by 2051
• An increase of 38% over the next 15 years and
154% over the next 45 years
• Information taken from Dementia UK: the full
report (Knapp, Albanese et al 2007)
To view copies of the full report go to:
Dementia UK Full Report
What is Dementia?
The Department of Health (2009) defines the term “dementia” as a syndrome
which may be caused by a number of illnesses in which there is a progressive
decline in multiple areas of function. Dementia is not a part of the normal
ageing process.
In essence dementia is a term used to describe a collection of symptoms
which for most people are progressive and irreversible. This means the
dementia usually gets worse slowly and often over a period of years, meaning
that in most cases, the person with dementia can no longer live
independently. This can have a profound affect on both the person with
dementia and their carers. Additionally, there are different causes of
dementia and this will have a direct impact upon the experience of the illness
which the person with dementia has.
There are currently no cures for dementia but there are medications and
other psychosocial interventions/ treatments available. These can improve
symptoms in some people and optimise their functioning level, thus
increasing their quality of life.
Common Types and Causes of
Dementia
There are a hundred different forms of dementia, with the most common being:
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Alzheimer’s disease, affecting 62% of sufferers
Vascular dementia or Multi infarct dementia is attributed to 17%
Mixed Alzheimer’s disease and Vascular dementia account for 10%
Lewy bodies dementia accounts for another 4%
Fronto-temporal lobe dementia is responsible for another 2% and a remaining 2%
for Parkinson’s disease
The remaining 3% of cases are related to other causes which may be treatable.
Taken from:
‘A comprehensive free Tutorial for Dementia Management in Primary care, a
resource pack for GP’s and patients. Funded by the Department of Health’.
(Alzheimer’s Society 2009)
Common Types and Causes of
Dementia (continued)
Rarer, Less Treatable Conditions
• Fronto- temporal lobe dementia
Factsheet 404, Source: alzheimers.org.uk
• Learning disabilities and dementia
Factsheet 430, Source: alzheimers.org.uk
• Creutzfeldt Jakob Disease
Factsheet 427, Source: alzheimers.org.uk
• AIDS related dementia
Factsheet 446, Source: alzheimers.org.uk
Other Conditions
Of which are caused by physical & psychological pathology include:
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Depression (severe forms can mimic symptoms of dementia)
Factsheet 444, Source: alzheimers.org.uk
Acute Confusional State /Delirium
Delirium PDF, Source: NHS Library
Hypothyroidism
Factsheet 442, Source: alzheimers.org.uk
Vitamin B12 deficiency
Factsheet 442, Source: alzheimers.org.uk
Tumor
Brain tumor associated dementia, Source: find-health-articles.com
It is of paramount importance that any underlying physical or psychological causes are
eliminated before someone is investigated for suspected dementia.
Alzheimer’s Disease
For purpose of achieving the learning outcomes in this module we will be
concentrating on the three most common conditions. In addition to these we will also
explore ‘depression’ which can be mistaken by non-specialists as a dementia and
Acute Confusional States as the latter two conditions may be responsive to
appropriate interventions.
Alzheimer’s Disease
Although the features of Alzheimer’s disease are not dissimilar to other conditions, it
is not an umbrella term for dementia as each condition has distinct differences in their
clinical and behavioural presentations. No case of Alzheimer’s is the same as people
react in different ways. This fact sheet gives a simple overview of the condition. You
may wish to download this and use it as a resource.
What is Alzheimer's disease?
Source: Alzheimer's Society
Vascular / Multi Infarct Dementia
Vascular dementia has a less predictable decline than Alzheimer’s disease. The
condition refers to a syndrome caused by different mechanisms all resulting in
vascular lesions in the brain. Early detection and accurate diagnosis is of paramount
importance as this type of dementia is partially preventable. There can be relative
stability if vascular disease is minimised, but if left untreated there will be further
deterioration in the condition after subsequent vascular accidents.
There are a number of potentially modifiable risk factors that appear to have an
influence on the disease including common cardio-vascular risk factors i.e. smoking,
high cholesterol, alcohol abuse, hypertension and obesity.
Initial symptoms are often physical in presentation, such as weakness in limbs, slurred
speech and dizziness with accompanying short term memory impairment. If a person
continues to have minor strokes or ischemic attacks and they remain undetected,
there will be an exacerbation of early symptoms and less treatable physical and
psychological presentations.
Types of Dementia
Source: dementiaweb.org.uk
Dementia with Lewy Bodies
Dementia with Lewy Bodies is caused by abnormal protein deposits which disrupt the brain’s normal
functioning. These proteins are also found in the brain stem of people with Parkinson’s disease hence
they deplete the neurotransmitter dopamine, which causes parkinsonian symptoms such as shuffling
gait, stooped posture, rigidity, rest tremor, slowness and balance problems which regularly lead to
numerous falls. For additional information on Parkinsons Disease, click here:
Parkinsons UK
Source: Parkinsons UK
These deposits also lead to disruption of perception and frequently cause recurrent complex visual
hallucinations, fluctuating variations in attention and alertness. Prominent memory impairment may
not be evident in the early stages. Other common Alzheimer’s pathology may become apparent as the
condition progresses.
LBDA Org
Source: LBDA Org
As with all other types of dementia, each person’s experience is different with varying levels of
pathology.
Acute Confusional states (Delirium)
Onset is often rapid over the preceding 24-48 hours.
Occurrence is due to underlying physical pathology. There are a number of potential
causes, some of the most common being: The following mnemonic ‘DELIRIUM’, taken
from the Merck manual of geriatrics, is a useful way of checking possible causes of
delirium.
Drug use, especially when the drug is first introduced or the dosage is adjusted. It is
therefore of paramount importance that medication is reviewed at frequent intervals.
Electrolyte and physiologic abnormalities e.g., hyponatremia and hypoxemia
Lack of Drugs commonly referred to as withdrawal.
Infection, especially urinary tract or respiratory infections.
Reduced sensory input e.g., blindness, deafness, darkness or a change in
surroundings.
Intracranial problems e.g., stroke, bleeding, meningitis, postictal state.
Urinary retention and faecal impaction
Myocardial problems e.g., myocardial infarction, arrhythmia and heart failure.
Acute Confusional states (Delerium)
continued
The person is often confused and disorientated in time and
place and depending on severity, there may even be clouding
of consciousness. They may become restless and agitated,
with these behaviours possibly being exacerbated by
hallucinatory experiences. This is where a person may see,
feel, hear or taste things which others around them do not.
The condition is usually transient once the person receives
appropriate treatment for the underlying pathology.
REMEMBER, delirium can occur in people with dementia so
it is extremely important that the individual’s ongoing
physical health and well being is continually monitored.
Depression
Depression in its severe form in older people can often be mistaken for
dementia by non specialists as the person exhibits symptoms
consistent with dementia, but the cause is pre existing psychological
illness rather than a degenerative one.
It is often of short and abrupt onset where dementia is insidious and
cognitively debilitating in nature. As with clinical depression the causes
may be re-active and often linked to some form of psychosocial stress
or Endogenous pathology, where there is no identifiable external
factor. Endogenous manifestations include persecutory delusions,
where people may present suspicion, often claiming that others are
trying to harm them. They also have negative, false fixed ideas of low
self worth and poor health. Sometimes they experience nihilistic
delusions where the person believes they are no longer their self or
parts of their bodies are missing i.e. “I am dead”, “I have no bowels”.
Depression (continued)
The prominent cognitive symptom of depressive dementia is loss of
shortterm memory accompanied by reduced alertness and impaired
concentration. It isimportant to note that people with this condition have an
awareness ofcognitive impairment (Cummings and Benson 1992) on careful
testing memory andlanguage functioning are intact:
http://alzheimers.about.com/od/glossary/g/pseudodementia.htm
Source: Alzheimers.com
Psychomotor retardation is also evident. This means the person may be slow
intheir movements and speech is often slow and monotonous. Sometimes
there isevidence of emotional blunting or agitation and anxiety.
Once detected, this condition will respond favourably to antidepressant
therapyand other psychotherapeutic interventions.
It is therefore significantly important that a comprehensive psychological&
cognitive assessment is completed before a diagnosis of dementia is
explored.
Common Features
Dementia is an umbrella term for a collection of clinical presentations which
will vary according to the stage and nature of the condition.
Impaired Cognitive Functioning
This is the umbrella term for the disturbance or decline in all our intellectual processes. It involves all
aspects of thinking, reasoning and remembering things. This will ultimately have a profound impact on a
person’s judgement and severely affect all aspects of a person’s ability to engage in everyday life.
Anecdotal examples of each of these experiences will follow.
Memory Problems
Memory problems are commonly seen as a key symptom of dementia. Initially it is characterised by
fluctuating short term memory (recent events). The person may forget appointments or significant
dates but during this period they will usually remember past events related to their childhood or adult
years (long term memory). Problems with new learning and impaired working memory are evident i.e.
the person may not be able to repeat something you have just told them (new learning), or they might
appear to forget how to put their coat on for example (working memory). As the condition progresses,
their long term memory invariably becomes disrupted.
Last time I saw my sister was 2 years ago, granted she did seem a bit more forgetful but we all become
forgetful as we get older don’t we? When I arrived at the care home today she did not even recognise
me and kept on saying her husband was coming home for tea...but he died in the Second World War. It’s
so sad I wish l didn’t live on the other side of the world.
Disorientation to time, place and
person
During the early stages of dementia, a person may regularly forget recent events, names and places but
will often respond to prompting or reality orientation. However, as the condition progresses they may
have little or no recollection of self or others. This can be extremely distressing for both the person with
the condition and their loved ones.
The neighbours have brought mum home several times this week. She has been found walking up and
down the street claiming she cannot find her house. I am really worried as a local taxi driver brought her
home in the early hours of the morning. He told me she could not recall any of her personal details.
Inability to carry out daily activities
As poor concentration and distraction becomes evident people start to neglect their personal hygiene
and dressing. They start to find it increasingly difficult to cater for their everyday needs. At its worse it
may be necessary to activate 24 hour care due to the risk of self neglect.
Dad was found by a local shopkeeper wandering aimlessly up the high street. He was only wearing his
shirt and underpants and he looked so dishevelled, as he hadn’t even washed or shaved. When I visited
today his cupboards were bare and he was eating his meals on wheels lunch with his hands. He seems
to have forgotten how to use a knife and fork.
Problems with Speech and
understanding
People often forget common words used in everyday language. A person may start to find it difficult to
identify everyday objects and experience problems in communicating the right terms or using the
correct language.
Initially dad would forget what certain things were called; instead of asking for a cup he would say
something like can I have one of those things I drink tea out of? Now I get really frustrated as he cannot
identify many everyday objects. The other day I asked him to put his watch on and he came back with a
glove in his hand….he couldn’t remember what I had asked him to do.
Difficulty in completing familiar tasks
Tasks or activities which were automatically completed become impossible.
My sister used to forget sequential activities such as making a cup of tea but with some gentle
encouragement she would be able to complete the task. Everything is so muddled now. Yesterday, I
found her putting her washing in the fridge and she got very agitated and angry when I told her what
she was doing. She continued to insist her washing machine had broken down and told me to get the
hell out of there.
Problems with Speech and
understanding (continued)
Misplacing things
Initially people will misplace and forget where they have left certain personal belongings but they will eventually come
across them. However, as the condition progresses they may become suspicious and start accusing others of stealing
things from them. This can be extremely distressing for both the person with dementia and their carers or loved ones.
My brother’s neighbour called me in a distressed state last night. Apparently he was shouting and cursing at her
claiming she had stolen his wallet…. they have been neighbours for fifty years, he even called the police!
Decline in personal ability to cater for themselves
As the condition reaches its latter stages, the person with dementia will become increasingly dependent on others to
meet their daily needs. At the most advanced stage mobility becomes hindered and loss of bladder and bowel control is
a common experience.
Last year dad managed to make himself a meal and drinks with visual written prompts around the house, but he became
so forgetful he just wasn’t looking after himself. He ended up dehydrated and was showing signs of malnutrition; he
stopped going shopping and was in such a muddle. His personal hygiene became poor and he has been dressing in
clothes inappropriate to prevailing weather conditions. We are now looking in to residential and care facilities because
he is at such a risk of accidental harm and self neglect.
Hallucinations
These are experiences which affect one or more of our five senses. People may hear (auditory), see
(visual), smell (olfactory) taste (gustatory) or feel (tactile) something in the absence of any external
stimuli.
I asked to see my mother’s Community Mental Health Nurse today as I am extremely worried. Mum
seems to be picking at the air and dusting herself down, she keeps saying insects are crawling all over
her and its really upsetting for us.
Delusions
Delusions are false beliefs which are fixed and resistant to reason or argument, and not in keeping with
the person’s cultural or religious background (Lyttle 1986). Often the delusions are accompanied by
hallucinations. In the following case it would be an olfactory hallucination causing persecutory
delusions.
My grandfather believes his neighbours are running gas through his air vents and he thinks they are
trying to kill him. I try to reassure him this isn’t the case but he becomes very angry and accuses me of
being in on it.
Confusion
A person with dementia’s attention and behaviour appears to become detached from people and
events occurring around them. Concentration and judgement becomes impaired. Initially carers say
their loved ones seem to engage in a series of purposeless activities.
I went to see Dad on the ward today and he appears increasingly confused, he did not even recognise
me. He kept wandering around picking up things along the way. When I arrived today he was carrying
someone else’s shoes, a box of tissues and a tablecloth. He became so angry when the staff attempted
to take them from him.
Personality and Mood Alteration
Certain existing personality traits may become magnified or the person may behave in a way that is
increasingly out of character. This is a very troublesome experience for both the sufferer and their loved
ones. This can put immense strain on relationships and the concerns expressed by others may
exacerbate hostile reactions.
At the beginning we noticed mum was becoming short tempered but that was born out of pure
frustration. Now she uses obscenities and physical aggression for no apparent reason. Her mood can
change in an instant she can be shouting and cursing one minute then switch back to her true soft and
gentle self.
Confusion (continued)
Impaired Judgement
As the condition progresses, people with dementia may lack insight into potential risks to health and
safety. A person may unintentionally leave gases on or hot pans unattended.
Last week a neighbour found dad’s door wide open during the early hours of the morning. This week he
left the gas on which caught light to his coat which he placed on the counter next to the cooker. Thank
god the home help had just arrived.
Behavioural changes
Behavioural changes can appear out of character or existing behavioural traits may become
exaggerated. Changes may be subtle at first but gradually increase as the condition progresses.
I feel mortified when my father keeps undressing himself. He appears oblivious to the staff and other
residents and when anyone attempts to intervene he becomes really angry.....he never used to swear.
Loss of interest and initiative
People often lose interest and volition in previous activities or hobbies they used to
gain pleasure from.
The lady next door was always in the garden pottering about, she would spend hours
on it and it used to look so beautiful. Now she just wanders out and stares at it, her
expression is so blank and she seems to have lost all interest in it.
Disturbed Sleep
Disorientation and confusion often leads to reversed or disrupted sleep patterns.
I am so tired as my husband is sleeping periodically through the day, but during the
night he just wanders around the house saying ‘Where am I’ or ‘Where is everybody?’
Loss of interest and initiative
(continued)
Agitation and Restlessness
These symptoms are usually caused by one or many of the complex experiences
already explored in this section. However, it is important that other potential
underlying physical factors such as pain or infection, for example, are eliminated.
Consideration should also be made to the person’s underlying emotional and
psychological well being.
Dad is much more relaxed since he started to take the antibiotics. He still has his
moments but he is much more responsive to prompting and reassurance. He is back to
enjoying our afternoon walks now.
For more information go to:
Alzscot.org
Source: Alzscot ORG
Behavioural interventions
Behavioural interventions may typically involve working with those individuals
who provide care or support for someone with dementia.
Behavioural interventions may be helpful when working with individuals who
present with challenging behaviours and risk issues (e.g. wandering,
aggression, safety issues and sexually inappropriate behaviour).
There are different ways of working with people who present with behaviour
that challenges. Here is one example:
• Changing those events that happen before the behaviour
• This can be considered to be the most important way to change behaviour.
• This involves changing or modifying the environment so that behaviour is
less likely to happen in the first place.
• E.g. adapting a ‘busy’ environment by reducing noise, modifying lighting
and the number of people present.
Communication disorder
Communication disorder becomes apparent during the
course of all types of dementia, varying according to
disease type, duration and other factors such as premorbid skills, personality and environment.
Research shows communication represents one of the
major problems for carers and families of the person with
dementia (Touzinksy 1998)
Communication is a basic part of human life. For people
with dementia their ability to communicate can be
significantly impaired (Bryan, Maxim 2006)
Communication disorder (continued)
This in turn can have a profound affect on their loved ones
and carer’s abilities to communicate effectively with them;
ultimately it will impact negatively upon the care process and
the quality of life for the person with Dementia.
Communication skills should be pivotal to the care planning
process. The Joseph Rowntree Foundation (2001) state that
communication skills “are an essential element of good care”
This module has been designed to assist learners in
developing or refreshing their understanding of
communication skills and identify approaches which may be
useful in improving the quality of life and care for the person
with dementia.
What is Communication?
Communication involves the exchange of
thoughts, messages or information, as by speech
signals, writing or behaviour:
http://www.thefreedictionary.com/communication
Source: The Free Dictionary
So how do we communicate?
Where do you think each method of communication belongs?
Why do we communicate?
For the person with dementia the reasons are the same!!!
What are the benefits of Good
Communication?
Time to reflect
The following message was written by the
Author of “Dancing with dementia” and “Who
will I be when I die” five years after her
diagnosis of dementia.
Try to understand how hard it is for us…
It’s just that you can’t see the missing bits
That we are having to cope without
Christine Bryden (2009)
Let’s look a little deeper
Try to visualize yourself in a building with many rooms and corridors, you
cannot find yourself back to the starting point because everywhere looks so
unfamiliar, people are approaching you that you have never met before but
they seem to know you. There are other people around you who seem
muddled and you cannot communicate with each other. The people that
seem to know you tell you that you cannot go home to your spouse or
partner because they are no longer around. Sometimes these people want
to take you to the toilet, sometimes they want to bath you, and dress you in
clothes you do not like, they give you food you do not like because when
you try to tell them it comes out disjointed and garbled, it’s almost like you
are speaking an alien language. They keep telling you to stop crying.
How would you feel...? TAKE A LITTLE TIME TO THINK ABOUT THIS.
Socially inclusive communications
The ability to relate to people experiencing
communication problems can impact upon all
areas of care, in either a negative or positive
way.
Let’s now look at the possible consequences of
good and poor communication
Possible consequences of good and
poor communication
Communication and the person with
dementia
For people experiencing dementia the area of the brain that deals with understanding and interpreting
what is said gradually dies. This in turn acts as a barrier to verbal interaction and understanding.
Dementia impairs a person’s ability to receive and understand information and the ability to express
information is often affected, these troublesome symptoms are exacerbated by loss of memory,
disorientation, impaired concentration and attention.
Some examples include:
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Difficulty in saying words
Saying a related word not the right one
Not being able to understand what is being said to them
Grasping only parts of what is said to them
Deterioration in the ability to write and understand the written word
Able to talk about distance past but not recent events
Loss of social conventions of conversation e.g. taking turns
Difficulty in communicating emotions appropriately
Repetitive verbalisations
Confabulation where a person talks fluently but does not make any sense. Gaps in memory…are
filled by fabricated dialogue.
For communication to work
For communication to work it is necessary that everyone can
convey and understand the message. The key to positive
experiences is a clear and concise understanding of an
individual’s unique communication patterns
It is therefore of upmost importance that a clear assessment
of an individuals communication skills is completed for all
service users and incorporated into their individual care plans.
This will ensure their ability to be understood is maximised
and assist carers in optimising the person’s level of daily
functioning, independence and ultimately improve their
quality of life.
For communication to work
What information should be considered?
Information such as:
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How much does the person understand?
Can they express their needs wants and wishes?
Situations the person finds distressing.
Hearing and visual impairments.
Primary language and cultural background.
Health problems, pain for example, this can often be an underlying cause of challenging behaviour.
Existing speech impairments
An individual’s unique communication patterns.
SEPT has a comprehensive therapeutic tool (My life story) for staff to use in order to develop strong
and meaningful relationships and interactions with the person with dementia and their loved ones.
my life story folder
Source: SEPT
Staff handbook
Body language
It is important to recognise that for people experiencing
dementia non verbal language (Body language) is often
their only means of expressing themselves
Also remember a person with communication problems
may pick up on your negative body language such as sighs
and raised eyebrows for example.
An ability to be sensitive and responsive to non verbal
behaviour is a key skill for staff to develop when working
with people with dementia. This skill is possessed by us
all and is often based on instinct or our primitive
heritage, for some it may be more developed than others.
What is non verbal behaviour?
When you watch most people, you will see they
communicate non-verbally; how often have you
been in a social environment and observed other
peoples non verbal behaviours which have revealed
clues about the nature of their relationships and
interactions.
It is important to remember Non verbal
communication varies culturally. It is therefore
necessary to find out about a persons cultural
background to avoid misinterpretation.
Non verbal communication
Verbal Skills
The emphasis so far has been on non verbal
behaviours because as we have already
identified verbal memory and language skills will
be impaired to a lesser or greater degree
depending upon the nature and course of the
Dementia .This does not however mean non
verbal communication is exclusive but should be
supplemented with verbal communication
Verbal Skills
(continued)
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Verbal skills include:
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Questioning
1. Using closed questions which elicit yes no answers will minimise over complication i.e.
“Mrs B would you like a cup of tea with your breakfast?
2. ”An open ended question would sound something like this “Mrs B would you like tea,
coffee, apple juice , toast or cereal for your breakfast?” Too much information!!
Clarifying
This is where you try to break down complicated communications
I.e. Mrs B states “I am sad …. Breakfast, where’s my husband …..It’s all too difficult?”
Response
Mrs B am I right in thinking you are missing your husband? Are you saying you would like
your breakfast now? Are you saying you would like help you get your breakfast? Your
response should be broken down into closed questions and dealt with one by one.
Reflection
This is where you try to identify the underlying emotions of feelings a person may be
feeling. I.e. Mrs B repeatedly says “It’s not good it’s not good I…….wa…..” Mrs B also appears
slouched and has her arms folded tightly across her body.
Response
Mrs B you seem upset are you in pain?
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Good practice
The way you deliver your verbal skills is important too:
Communicate a normal TONE of voice, loud or high pitched verbalisations can
be anxiety provoking.
• Pace
Speaking slowly and clearly this will promote understanding.
• Pauses
Will allow the person time to assimilate what information they can
pacing communications will also help to minimise further confusion
and agitation. Always wait for an answer, if the person does not
answer try again.
• Diversion or Distraction
This is where you divert a person’s attention away from repetitive or
preoccupying feelings for example.
Finally remain calm, show you are listening and smile when appropriate.
Good practice (continued)
Regardless of the stage of dementia it is so important to focus on working creatively with the person
with dementia to find alternative ways of communicating. Remember it is a two way process.
We have already identified the Trust’s Life story books, the benefits of being aware of our own non
verbal communication and being sensitive to the individual’s unique communication patterns.
In recent years the use of talking mats as an aid to communication with the person with dementia has
been researched and found to have positive outcomes .The Social Care institute of Clinical Excellence
completed a research study which showed that using talking mats improved communication for all
people at all stages of dementia.
Using 'Talking Mats' to help people with dementia to communicate
Source: rf.org.uk
Talking mats offer a low cost tool which families and staff can use. Click here to view a video of Talking
Mats being used with a person with Dementia
http://www.talkingmats.com/news.htm
Source: talkingmats.com
For further information on talking mats and training go to
http://www.talkingmats.com/dementiatraining.htm
Source: talkingmats.com
Communication checklist
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Ensure you have a full knowledge of the person’s unique communication patterns i.e. Mrs B tends
to wander around a lot more when she needs the toilet.
Position yourself in line with the person’s vision and maintain balanced eye contact, unwavering
eye contact can be interpreted as confrontational.
Do not invade a persons personal space…do not assume the person is hard of hearing because they
are old!!!
Always adopt a calm and approachable posture this will promote feelings of safety and security.
Check for any sensory impairments i.e. hearing and eyesight.
Listen carefully and keep checking for understanding.
Keep sentences short and simple.
Give short, clear and precise instructions allow time for what you have said to be interpreted and
repeat if necessary.
Promote understanding by giving instructions such as “you clean your teeth with it “
Always promote independence do not be tempted to complete activities of daily living for someone
who is able to respond to non verbal and verbal prompts
Modify gestures which may be distracting
Listen for and learn to recognise the feelings and emotions rather than the words.
Communication checklist (continued)
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Always promote independence do not be tempted to complete activities of daily living for someone
who is able to respond to non verbal and verbal prompts
Modify gestures which may be distracting
Listen for and learn to recognise the feelings and emotions rather than the words.
Checklist - continued
Use non verbal behaviour such as tone of voice, touch and the way you move to convey messages
to the person with difficulty in understanding language.
Offer verbal prompting “good” and “that’s right”
Non verbally demonstrate the activity you are helping the person to complete i.e. mimic brushing
your teeth or shaving.
If you are actively engaging in self care with someone less able to attend to their needs
independently give a commentary of exactly what you are going to do in advance, as this will
promote feelings of security.
Modify gestures which may be distracting
Use head nodding in agreement and shaking it to disagree
Supplement your speech with gestures such as thumbs up or ok.
Never shout this will only serve to distract and frighten the person. Caring can be a stressful
experience at times and may sub-consciously influence your pattern of communication.
If you feel frustrated take time out and return a minute or two later (along as persons safety is not
compromised)
Communication checklist (continued)
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Never be Judgemental i.e. “that’s him he’s a nasty aggressive man”
Remember remain calm and be aware of your non verbal behaviour as the person with dementia
may recognise negative non verbal clues.
Do not patronise a person, conversation should be simple but remain on an adult level to preserve
dignity and self esteem.
Incorporate information in your conversation which tells the person where they are, what is
happening around them and who they are with, this will make them feel more secure and less
confused.
Avoid too many choices present only one at a time.
It may help to ask questions which require only yes no answers.
Be aware of environmental factors which may interfere with communication i.e. competing noises
such as TV or radio always make sure the environment is conducive for communication.
Make sure glasses, hearing aids and dentures are correctly prescribed and well fitting.
Ensure the environment has adequate signage.
To access a more comprehensive free downloadable fact sheet on communication and Dementia
(written by the Alzheimer’s Society) click on the link below
Communication and Dementia
Source: alzheimers.org.uk
Finally…
It is important to remember that behaviour that might be seen as challenging
or difficult is often the person’s way of trying to communicate.
Such behaviour can develop out of sheer frustration of not being able to
understand what is being said to them or from not being able to express
themselves as they would wish. Other reasons may include physical
manifestations. It is important to always be mindful of this and ensure steps
are taken to identify and eliminate such causes.
Always be respectful to the person with dementia and remember
communication is essential to all forms of quality of care. If you continue to
remain aware of your own communication skills and sensitive to the persons
unique communication patterns it will help to reduce challenging behaviour
and positively impact upon the care process.
Valuing People with Dementia
Conclusion
Each person’s experience of dementia is different, but always has direct consequences for their physical,
social and mental health. The severity is dependant upon the nature and pace of the illness. Although
dementia is a terminal condition, people can live up to 10 years after diagnosis.
People with dementia survive an average of four and a half years following their diagnosis. However,
age, sex and any existing disability can alter life expectancy, according to the report in the Jan. 11 online
issue of the British Medical Journal.
Article: Survival times in people with dementia
Source: BMJ
The study found a nearly seven-year difference in survival between the youngest and oldest dementia
patients - 10.7 years for those aged 65 to 69 and 3.8 years for those aged 90 and older. The average
survival time after dementia diagnosis was 4.6 years for women and 4.1 years for men.
Dementia must not be viewed as a “living death” as Woods (1989) quite crudely describes the
experience of Alzheimer’s disease. Dementia care is about building upon each individual’s strengths to
maximise independence and continually work towards maintaining a person’s quality of life.
References
Knapp M Prince M, Albanese E et al (2007) Dementia UK: The full report
London: ALZHEIMER’S society
Cummings.J.L. and Benson.D.F (1992) Dementia a Clinical Approach. Boston
Butterwork Heinemann
Lyttle, J. (1986).Mental Disorder.Bailliere Tindall, London
Woods, R. (1989) Alzheimer’s Disease coping with a living death. Souvenir
press ltd, London.
A comprehensive free Tutorial for Dementia Management in Primary care, a
resource pack for GP’s and patients. Funded by the Department of Health.
(Alzheimer’s Society 2009)
Living Well with Dementia: A national Dementia strategy, Department of
health, 2009