Memory and intellect deteriorate as dementia progresses, yet people with dementia continue to interact. How staff respond can have profound effects on a person’s wellbeing.
Barriers to communication may relate to individual issues or to social and physical environments.
Personal barriers may include:
- health status
- physical ability
- cognitive and sensory ability
- emotional wellbeing
- personality and mood
- culture and knowledge of English.
A facility’s institutional values and philosophy affect the social environment through policies on:
- staff recruitment and training
- staff–staff communication
- staff–resident ratios
- staff encouragement and support.
In the physical environment, communication is affected by:
- building design and layout
- size of rooms
- size and placement of furniture
- width and length of corridors
- extent of private space
- ambient noise.
Change: As dementia progresses adjust how you communicate to suit a person’s changing needs.
Context: Guide a person through any task, activity or request by explaining or describing what is happening or about to happen.
No expectations: Make it clear verbally and non-verbally that a person may respond or not as they wish; that nothing is required of them.
Reassurance: Communicate verbally and non-verbally to reassure a person they are accepted.
Consistency: Verbal responses and non-verbal communication should not contradict each other.
- Talk to a person, rather than about them to others.
- Address a person by their preferred name, not ‘dear’ or ‘love’.
- Tell a person what you are doing or going to do.
- Focus your full attention on the person and make eye contact.
- Use words and sounds of encouragement.
- Do not use a demeaning or condescending tone of voice or hostile gestures or stance.
- Do not invade a person’s personal space.
- Speak at a slower pace.
- Pause between one topic and the next.
- Use prompts such as pictures, photographs and simple signs.
- Accept a person’s feelings.
- Use non-threatening physical contact.
- Do not make abrupt changes to routines.
- Get to know a person’s life story so you have a store of background information for questions and conversations.Use individualised memory books to improve and keep communication skills.
- Use written and pictorial signs in significant places around the facility.
- Place memory charts containing photographs, brief statements about the person and conversation topics on bedroom walls and other appropriate places to aid communication.
- Use other techniques and therapies that help communication like aromatherapy, attention focusing, bright light therapy, massage, music therapy, pet therapy, reminiscence sessions and walking.
Strategies for sensory and language barriers
- Minimise noise, for example loud television and competing noises from radios, vacuum cleaners, leaf blowers and dishwashers.
- Check hearing aids have batteries, are properly fitted and turned on.
- Check people with dentures or glasses are wearing them.
- Schedule annual hearing and vision checks.
- Attract attention by speaking or touching the person if appropriate.
- Greet the person by name, repeat your name and speak clearly, keeping your face in view.
- Avoid speaking to a person from behind.
- Speak clearly and slowly if a person is very deaf. You may need to raise your voice, but avoid shouting. Keep sentences short, and use predictable words as much as possible.
- Avoid using modern slang unless you know it will be familiar.
- Allow people from different cultural and linguistic backgrounds time to explain what they want. Check what you think you understand by repeating it as a question.
- Use resources helpful and acceptable to older people from different backgrounds: smiles, touch, gestures, pictures, photos, objects or a dictionary.
- Use interpreters if readily available and consult family members where appropriate.
- Learn a few everyday words in the languages of people you care for, such as ‘hello’ and ‘goodbye’, ‘please’ and ‘thank you’. This shows your interest and wish to connect, even if you cannot share stories.
- Life stories
- Maintaining personal identity: respect and dignity
- Person-centred care
- Personal care: how to communicate
- Staff: culture change, education and support