Role of communication and interactions with individuals who have dementia
1. How do individuals with dementia communicate through their behaviour (1.1)
Persons with dementia may communicate through behaviours such as:
•Repetition of actions or questions, this may communicate anxiety over memory loss, boredom from inactivity, to seek reassurance, picking at clothing due to anxiety.
•Aggression, this may communicate depression, an inability to rationalise, impaired judgment, feeling embarrassed and fearful of humiliation, frustration that they are unable to remember what they are meant to be doing or that others do not understand their need to accomplish tasks that they feel to be important. Can find no other way to express themselves.
•Pacing or walking, this may communicate a desire to visit a certain place or person. Although the individual may have forgotten who or where. They may be bored and attempting to use up energy, uncomfortable from sitting, confusion about what they are meant to be doing or where they are, to enter in to past routines of behaviour that once served an important purpose that the individual feels they need to accomplish.
•Becoming suspicious of others, this may communicate that the individual is experiencing memory loss and is having difficulty recognizing familiar faces
•Pointing and vocalizing to communicate their intentions as the individual loses the use and understanding of their vocabulary
2. How you as a carer can misinterpret communication (1.2)
•Not being attentive and missing behavioural communications such as picking at items, failing to make eye contact or being out of the persons view, not creating an environment conducive to communication (adequate lighting, low background noise levels etc)
•Not allowing the individual time to process information before continuing the conversation.
•Misunderstanding the intention behind a given response as the individual may mean one thing but say another. •Individuals in a support team may fail to record information
and communicate with one another when they have identified a need for a behaviour and the correct response to that need. i.e., the individual may pace because they are anxious remembering a forgotten routine (the need to catch the bus so they are not late for work).
•Asking open rather than closed questions requiring a yes or no answer. Making communication difficult.
3. Explain the importance of effective communication with individuals with dementia (1.3)
We all communicate to express needs and share information. In order for these needs to be met there must be someone open to receive information and a receptive environment in order for information to be shared effectively. As a person with dementia already has a compromised ability to communicate, communication needs to be effective and understood or the client may not understand what is being done to them, where they are being taking. It is important that for effective communication to take place the care giver:
•Creates an environment that supports effective communication oAdjust lighting so you can be seen and you can in tern see, adjust lighting, close curtains if excessively sunny etc.
Reduce the distraction of background noises
Approach communication when there is reduced or no distracting activity in the surrounding environment oTry to make the individual’s environment comfortable in terms of temperature, seating arrangements, attempting to meet baser needs, food, drink, toileting.
•Presents themself in a way that supports communication:
Position yourself in a way that enables eye contact to be made (but not to invade personal space or intimidate) oBe aware of your non-verbal bodily communication, allow the individual to see your body language as they will be more receptive to this than speech, ensure your body language is in keeping with your intentions to avoid mixed messages
oRemain positive and present information in an enjoyable and pleasurable manner but avoid patronising oWhen assisting with tasks attempt to offer direction by decompiling tasks to their fundamental components rather then
assuming the individual will recall how to carry out complex activities i.e. putting on shoes. Redirect the topic of conversation or activity if the individual becomes distressed rather then arguing your point oAssume that the individual can understand what you are saying. If they are present while other conversations are taking place, be respectful and show dignity by not discussing them in their presence oAttempt to retain as much of the persons autonomy as is possible by offering choices, i.e. food, clothes, activity. However keep choices simple, in the present and not abstract. Asses the individual’s ability to choose; as the illness progresses, simple choices can become overwhelming and may need to be revised.
•Assisting with activities:
Do not boss the individual; allow them time to attempt tasks at their own pace. If people feel that they are being controlled they may resort to aggression or withdraw. oUse hand over hand techniques as opposed to carrying out tasks for individuals. Praise efforts and avoid highlighting errors.
4. Describe how 3 different forms of dementia can affect the way an individual communicates. (1.4) Vascular Dementia:
•Caused by a series of small strokes, Vascular dementia can compromise understanding of language, memory and ability to follow instructions. Early symptoms may include slurring of speech (affecting the individuals ability to verbally express), dizziness (affecting concentration), short term memory (affecting the ability to take in new information, adjust to new situations, settings and people). More dominant symptoms affect a person’s control over bladder and bowel movements compromising the ability to communicate these baser needs, ability to process information and abstract thought affecting a person’s independence and autonomy.
•Brought upon by a repetition of concussions, the dementia commonly effects a decline in mental abilities, lack of concentration (affecting a person’s ability to hold a conversation, process information, attention to tasks). Personality disorders including psychomotor retardation (a slowing-down of thought and a reduction of physical movements affecting processing skills, learning new information, recalling learnt information and ability to complete tasks), exacerbation of aggression, suspiciousness (effecting trust in relationships and inclusiveness), loquacity (becoming talkative). Huntington’s Disease:
•A neurodegenerative genetic disorder that affects muscle coordination and leads to cognitive decline and psychiatric issues. Some of the symptoms and their effect on communication could be: Motor dysfunction, jerky, random, and uncontrollable movements may affect both the individual’s confidence in their ability to communicate and their ability to express and gesticulate. Slowed saccadic eye movements (quick, simultaneous movements of both eyes in the same direction) may affect the individual’s ability to make or maintain eye contact affecting attention, ability to read both facial and bodily expression. Rigidity, writhing motions or abnormal posturing would affect the individual’s ability to express themselves through body language. Abnormal facial expression, difficulties chewing, swallowing and speaking would affect both use of the spoken language and accurately conveying emotion and intent through facial expression. oSleep disturbances would leave the individual feeling tired, affecting concentration, temperament, attention and emotional state Ability to correctly initiate appropriate actions and to inhibit inappropriate actions could affect the individual’s ability to gesticulate creating, misunderstandings and possible offence. Impairment in the range of short-term memory and deficits to long-term memory may affect the individual’s ability to retain information required to hold conversations in context, identity of others, what’s their relationship, what are their intentions. 5/6. Give 3 examples of how you have positively interacted with clients with Dementia and explain how these positive interactions contribute to their wellbeing. (2.1)(2.2)
Although I do have experience of interacting with people who have dementia, this was at a time when I was not a support or care worker. As I used to be a cook in a large care home, I interacted frequently with persons with dementia; I will use those experiences along with the information I have learnt as a result of this unit to answer questions 5 and 6.
•As I would go about my work in the kitchen at the nursing home, there was a lady resident who would often stand at the kitchen door and would mutter to herself and occasionally look at me and say short sentences that to me made no sense as I did not know the content. Despite not knowing much about dementia, I felt comfortable in this lady’s company and felt that she was also comfortable with standing and chatting at the door: her stance, demeanour, tone and facial expression supported this. I would always speak to her in a calm, clear pleasant manner; as this was not only polite but reflected how she spoke in my presence. I’d greet her when she came to the kitchen door and ask how she was, I would tell her about what I was doing as a running commentary (cooking, chopping, baking etc). Although she never appeared to directly interact with me I sensed that standing in a kitchen and chatting were both familiar and comforting for her, as she would spend frequent parts of her day doing this. I felt it important to accommodate her presence and interact on her terms (not pushing for answers), using common politeness and manners, offering information as a framework for my conversation. I believe this allowed her to feel comfortable in the social situation while lacking social skills.
Example 2: 3:
•The only part of my job role that required me to assist individuals with daily living tasks was serving, describing and presenting their meals to them. I would assist the support staff in serving meals as dinner was a busy time. One gentleman in particular would often become distressed when his meal was presented to him; the nurse requested that when I write the meal choices on the menu board I present this particular individual with physical representations of the food for him to be better informed and have clearer expectations. Although it was not my place to help the patients make choices, the gentlemen when presented with the food items did take an interest in them and I presented him with his meal accordingly. Although the instances of anxiety still remained around dinner time they did however significantly decrease. I now know that the food items were used as objects of reference and I believe it would have been of greater benefit to all residents if they received a combination of a written menu, objects of reference, photographic or pictorial representations of meal choices according to their individual abilities around choice making. I also believe that with the information gained in this unit, in hindsight the gentlemen in question would have benefited from a smaller range of choice, 2 items as opposed to 4.
7. Why is it important to involve clients with dementia in a range of activities, give three examples of how you have done this. (2.3)
As stated in questions 5 and 6, I have no experience in supporting people with dementia. For the purposes of this question I will give three examples of activity that could be considered essential for most people.
Humans are occupational and social beings, physically and mentally built to interact with their environments. Therefore activity would not only be a natural pursuit for all people, but, for individuals with dementia who are losing the ability to interact with the world around them, the use of activity would allow them both structure and purpose for interaction: linking familiar experiences of the past to the unfamiliar experience of the present.
•Supporting individual with their morning ablutions. This task would have taken place for almost every morning of the individual’s lives, with guided and prompted support the individual may benefit from a sense of pride in appearance that would have been culturally important for members of the older generation. The support worker could reinforce the activity and the individual’s attention to task by complimenting them on their appearance. There may be a range of ways in which the client chooses to cleanse themselves; shower, bathing, or it may be appropriate for individuals of a certain generation to wash at a hand basin. The act of washing may hold some religious significance for the individual (Muslims are required to be clean when handling and reading the Qur’an) allowing them the benefits of their religious convictions.
•Accessing social occasions (tea at a village hall). The individual may benefit from time spent away from their home in the company of others from a familiar cultural generation. Socialising may combat isolation, loneliness, feelings of despair, suicidal thoughts, offer the individual an opportunity to positively experience their identity.
•Accessing reminiscing sessions. This activity may immerse the individual in an environment filled with remnants of their formative years; familiar objects, smells, clothing etc; creating a sense of identity and safety, stimulating the mind and senses in a bid to prolong their cognitive abilities, believes that are supported by the Orientation Approach.
8. Compare reality Orientation Approaches to Validation Approaches. (2.4)
The validation approach attempts to offer extremely disorientated individuals (predominantly the elderly at the end of their lives) an opportunity to express what are believed to be unresolved feelings and offers the care giver an insight in to the underlying meaningful reasons for what may be perceived as odd behaviours. The care giver attempts to empathise with the individual’s behaviours, mannerisms and expressions, presenting themselves in a non-confrontational and non-judgemental way; engendering trust and acceptance. Thus allowing the individual to communicate as they are able, rather than as they should.
Unlike the validation approach, which attempts to enter the world of the disorientated individual, the orientation approach attempts to focus the individual’s perceptions in the real world. Using prompts such as calendars, clocks, current magazines or newspapers, menu boards, staff boards to orientate them in to the time and place that they currently occupy. It is thought that continual, repetitive reminders will keep the patient stimulated and lead to an increase in orientation.
However, I have found through researching this topic that some care givers and providers have adapted the orientation approach (which advocates the present time) by creating and orientating individuals to the particular reality or time that they may be experiencing.
9. List the physical and mental health needs that may need to be considered when communicating with some one with dementia. (3.1)
•Effects of stroke ( multiple TIAs bringing about vascular dementia) oParalysis on ether side of the body
•Problems with vision
•Speech and language problems
•Disruptions in sleep patterns
•Unable to remain settled, pacing
•Loss of hearing and or tinnitus
•Loss or increase of physical sensation, touch, sight, smell.
•Ability to accurately form facial expressions
Mental health needs
•Sense of agency
•Loss of hope, experiencing despair
•Lack in recognition of familiar people or places resulting in possible suspicion •Experiencing frustration
•Heightened sense of anxiety
•Short and long term memory loss
10: Describe how a sensory impairment of someone with dementia can affect their communication skills (3.2)
•The individual may not be able to accurately gauge a person’s body language or facial expressions, minimising the amount of information they receive. The interpretation of light fall on objects and surroundings may be distorted resulting in confusion and anxiety.
•Heightened sense of smell (Hyperosmia), this may affect how an individual smells both people and places around them, they may find bodily odours, perfumes, deodorants, and cleaning products offensive, reminiscent and confusing; affecting the individual’s tolerance of these smells and ability to concentrate on tasks such as communication.
•Loss of proprioception (body’s internal sensory network of muscle and movement), this may affect an individual’s ability to express body language or gesticulate.
•Taste, an individual may cease to communicate their desire, choice, interest in food if eating has become a displeasurable or confusing experience due to a change in their taste.
•Change in the sense of touch, a heightened or dampened sense of touch may result in individuals recoiling from another touching them to show reassurance or gain attention as the sensory information received may relay pain, discomfort or not register at all.
•A change in sensory input of any of the senses may be distressing and confusing for the individual, affecting their concentration, perception and desire to communicate.
11. Describe how an environment can have an affect on a client with dementia (3.3)
A change in mental faculties, cognition, memory and mental health in a person with dementia coupled with an array of sensory impairments may affect the individual’s perception of their environment in the following ways:
•The smell of the environment may distress individuals due to Hyperosmia.
•A loss of vision may alter the perception of visual stimuli, bright light from a window or light bulb may wash out the visual field, shadows may create the illusion of people or objects, a change in depth perception may alter a person’s ability to gauge depth of furniture.
•Reactions to the alterations in visual perceptions may be interpreted with fear, confusion, anxiety as objects may appear different to what they are, or the individual is unable to correctly identify or comprehend their purpose
•The environment can be arranged to effect positive change, the décor and items can be chosen to resemble familiar surroundings from a time or era that the individual is remembering. The Orientation Approach fills the environment with informative and stimulating objects (present time frame): large clock, calendar, staff board, meal board, current literature.
12. Describe how your behaviour and that of other carers can have an affect on a client with dementia (3.4)
The care giver needs to consider the way they speak: whether it is positive or negative, does it show that you are attentive and caring, if a carer rushes their speech or does not allow the client time to respond, it may convey a lack of respect and that they don’t want to be there. The messages that the carer’s body language communicates must not be at odds with their verbal content; this may create confusion and appear as insincerity. The carer must be focussed on the needs of the client, not becoming distracted by personal discussions with other carers; at all times the chosen language must be that of the clients while in their presence. Interpersonal staff conversations conducted while staff are delivering care show a lack of respect and compassion, the client may not feel that they have a right to talk if they are not involved or may become distressed about the content of conversation and feel a need to become involved. Clients may feel that they can assist with a staff member’s personal problems, offering money or possessions, accepting gratuity is both unethical and would be in contravention of the code of conduct.
This may be interpreted by clients as payment for preferential services or as theft: after a client having forgotten there offering discovers their money or possessions gone. Carers need to remain professional and stick to their roles as described in their job descriptions; if the client should request services that are in contravention of their role, the carer should politely decline the request and seek support/advice from their manager if they feel it necessary.
13. Describe how the use of language can hinder positive interactions and communications. (3.5)
Clients with dementia will be experiencing a deterioration in their cognition, attention, memory, producing and understanding language, learning, reasoning, problem solving. It is therefore necessary that the carer not only use their language and communication skills appropriately but they also recognise deficit in the client’s abilities and change their approach accordingly. The client’s deterioration in cognition will result in a struggle to comprehend both spoken and written language; if a client does not understand information they are more likely to withdraw and accept their confusion with feelings of embarrassment and ineptitude rather than seeking clarification. The carer should be attentive to the client’s communication needs; noticing if they are struggling to understand, offering the information in a more appropriate way. The carer should always adapt their vocabulary to that of the clients; considering the use of slang, euphemism, colloquialism, allowing time to process and respond, realising that the clients may have lost the ability to ask questions and seek clarification.