DEM 308 Understand the role of communication and interactions with individuals who have dementia by Gaël Romanet
Understand the role of communication and interactions with individuals who have dementia
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DEM 308 Understand the role of communication and interactions with individuals who have dementia by Gaël Romanet
Level 2 Diploma in Health and Social Care
Unit DEM 308
Tutor Name: Akua Quao
Thursday 12th September 2013
Release Date: 20/08/2013 23:18
Assignment task – DEM 308 Understand the role of communication and interactions with individuals who have dementia
Unit purpose and aim This unit provides the underpinning knowledge required to develop therapeutic relationships with individuals with dementia based on positive interaction and communication. It does not assess competence.
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DEM 308 Understand the role of communication and interactions with individuals who have dementia by Gaël Romanet
Task ① Understand that individuals with dementia may communicate in different ways
• Explain how individuals with dementia may communicate through their behaviour • Give examples of how carers and others may misinterpret communication • Explain the importance of effective communication to an individual with dementia • Describe how different forms of dementia may affect the way an individual communicates Task ② Understand the importance of positive interactions with individuals with dementia
• Give examples of positive interactions with individuals who have dementia • Explain how positive interactions with individuals who have dementia can contribute to their wellbeing
• Explain the importance of involving individuals with dementia in a range of activities • Compare a reality orientation approach to interactions with a validation approach Task ③ Understand the factors which can affect interactions and communication of individuals with dementia
• List the physical and mental health needs that may need to be considered when communicating with an individual with dementia
• Describe how the sensory impairment of an individual with dementia may affect their communication skills
• Describe how the environment might affect an individual with dementia • Describe how the behaviour of carers or others might affect an individual with dementia • Explain how the use of language can hinder positive interactions and communication
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DEM 308 Understand the role of communication and interactions with individuals who have dementia by Gaël Romanet
Assignment task – DEM 308 Information Carers are:
• Partner • Family • Friends • Neighbours Others are:
• Care worker • Colleagues • Managers • Social worker • Occupational Therapist • General Practitioner • Speech & Language Therapist • Physiotherapist • Pharmacist • Nurse • Psychologist • Admiral Nurses • Independent Mental Capacity Advocate • Community Psychiatric Nurse • Dementia Care Advisors • Advocate • Support groups Well being:
• Sense of Hope • Sense of Agency • Confidence • Self esteem • Physical health
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DEM 308 Understand the role of communication and interactions with individuals who have dementia by Gaël Romanet
Evidenced in well being indicators:
• Can communicate wants, needs and choices • Makes contact with other people • Shows warmth and affection • Showing pleasure or enjoyment • Alertness, responsiveness • Uses remaining abilities • Expresses self creatively • Is co-operative or helpful • Responding appropriately to people • Expresses appropriate emotions • Relaxed posture or body language • Sense of humour • Sense of purpose • Signs of self-respect Reality Orientation: This approach tries to place the individual in the here and now, reminding them of the day, place, time and situation they are in.
Validation Approach: Using non-judgmental acceptance and empathy to show the individual that their expressed feelings are valid. Focussing on the feelings rather than the content of speech.
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DEM 308 Understand the role of communication and interactions with individuals who have dementia by Gaël Romanet
Assignment task – DEM 209 Answers Task ① Understand that individuals with dementia may communicate in different ways
• Explain how individuals with dementia may communicate through their behaviour (5 pages to answer the question)
What is communication?
It is VERY important to observe reactions of individuals living with dementia, when communicating with them because the body language is more than the half (55% body language) of personal communication. That means that you are going to miss a large part of communication if you don't pay attention to facial and body reactions of an individual living with dementia. By observing and understanding the body language of an individual living with dementia, you can know how the individual is feeling inside the nursing care home. Only 7% of personal communication is spoken words. To observe body language is a perfect way to know how the individual is feeling inside the nursing care home. Is the individual smiling? Laughing? Is the individual seemed to be stressed when close to staffs? Is the individual's voice sound stressed or scared? More than a third of elements of personal communication (38%) are about the voice and tone. How sound the voice and the tone of an individual living with dementia matter, and help to detect any form of abuse that could occur inside the nursing care home.
Communication may also include technological aids and Braille.
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DEM 308 Understand the role of communication and interactions with individuals who have dementia by Gaël Romanet
Communicate in an appropriate way with an individual living with dementia Explain the information in a way that is easier for the individual living with dementia to understand, by using simple language or visual aids. Examples of verbal communication skills which significantly help when communicating with an individual living with dementia: Verbal communication: -
speak in a calm way; notice the tone of your voice use short sentences giving small amounts of information vocabulary pitch allow time for the individual to answer don’t argue about facts or try to ‘correct’ the person
If required, explore different methods of communication including non-verbal communication. Examples of non verbal communication skills which significantly help when communicating with an individual living with dementia: Non-verbal communication: -
move to the individual’s level body language behaviour gain eye contact where possible touch use gestures, objects or signals as well as words e.g. show the individual an object that relates to what you are saying
Does the individual living with dementia have all the relevant information they need to make a particular decision? If they have a choice, have they been give all information alternatives? Could anyone else help with communication (for example, a family member, support worker, interpreter, speech and language therapist or advocate)? It is VERY important for an individual living with dementia, to feel at ease. Are there particular times of day when the individual's understanding is better? Are there particular locations where they may feel more at ease? Could the decision be put off in order to see whether the individuals can make the decision at a later time when circumstances are right for them? Can anyone else help or support the individual to make choices or express a view? This questions matter during communicating with an individual living with dementia. Page 7 of 46
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DEM 308 Understand the role of communication and interactions with individuals who have dementia by Gaël Romanet
Summary of communication To speak clearly and slowly when communicating face to face with an individual living with dementia is VERY IMPORTANT! -
it makes sure the individual can understand everything you are saying it provides a calming way of getting your message across it will help the individual who have hearing difficulty to understand every word it will help anyone who is foreign to understand you in an easy way Many things can go wrong during communicating between an individual and you. Lots of BARRIERS, especially if the English language is not your mother language!
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background Noise difficulty to hear bad Work Environment staff problems and competencies Also, individuals react differently:
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Kinematics (Touch) Auditory (How it sounds, what will be said MATTER!) Visual (Pictures) Olfactory (Smell memories)
To enter in the private sphere of an individual living with dementia take lot of time.
As a friend, a carer will do everything in action to make feel the individual living with dementia like home.
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DEM 308 Understand the role of communication and interactions with individuals who have dementia by Gaël Romanet
Individuals living with dementia inside a nursing care home communicate with care assistants to express their needs and preferences (generally at breakfast, lunch and supper time) to ensure they are met. (Proposing a real choices to the individuals by showing the menu allow them to be informed of what's going on, this is very true with individuals living with dementia because it's help them to figure out what happen at what time and why!)
Individuals living with dementia may communicate through their behaviour because the way of the individuals living with dementia behave, is a good indicator of what they are trying to express, especially if they have difficulties expressing their feeling and needs with words. The body language provide important clues in the ways an individual living with dementia behave, because the body language is more than the half (55% body language) of personal communication. That means you are going to miss a large part of communication if you don't pay attention to facial and body reactions of an individual living with dementia.
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DEM 308 Understand the role of communication and interactions with individuals who have dementia by Gaël Romanet
Individuals living with dementia wish to be heard and validated and the way they behave may indicate how they are feeling, so an individual presenting as angry may be feeling frustrated, and individuals resenting as sad may be experiencing vivid memories of a past event that seems very real and current to them. Individuals with dementia living inside the nursing care home may feel they are losing control of their world, so they may come across as aggressive when you enter their room, when you propose a cup of tea or other drinks. Individuals living with dementia may communicating through a positive or negative behaviour, use of gestures, use of inappropriate verbal response, inability to speak, becoming withdrawn, tactile approach, non-verbal language, and sign language.
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DEM 308 Understand the role of communication and interactions with individuals who have dementia by Gaël Romanet
Task ① Understand that individuals with dementia may communicate in different ways
• Give examples of how carers and others may misinterpret communication (2 pages to answer the question) There are lot of examples of how carers and others may misinterpret communication for an individual living with dementia. For example, individuals living with dementia that can’t walk, may shout to go to toilet several times by day because they feel pain in stomach, due to anxiety, and ask to carers to go to toilet immediately. Moving an individual living with dementia that can’t walk, require from carers, the utilisation of the Oxford elevate electric stand aid hoist and a wheelchair.
Utilisation of the Oxford elevate electric stand aid hoist to move an individual living with dementia that can’t walk, utilisation of a wheelchair to move through corridors the individual living with dementia, reutilisation of the Oxford elevate electric stand aid hoist into the bathroom to help to sit the individual on the toilet seat, explaining what going on to the individual living with dementia, giving some privacy time to the individual, cleaning and changing the adult diaper, cleaning the hands of the individual, and finally moving the individual in the day room with the Oxford elevate electric stand aid hoist to sit the individual living with dementia on a pressure cushion, requires two carers and about 20 minutes. Carers and others may misinterpret communication for an individual living with dementia that can’t walk, and shout to go to toilet several times by day due to feeling pain in stomach because of anxiety, to finally not doing nothing when sitting on toilet seat, can be considered by carers like a waste of times, but is very important for the individual living with dementia because the individual feels to be listened. Carers and others may misinterpret communication for individuals living with dementia, when the individuals are shouting in the day room. Page 11 of 46
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DEM 308 Understand the role of communication and interactions with individuals who have dementia by Gaël Romanet
Carers and others may believe they are just trying to attract attention by making noise, but individuals living with dementia is increasingly trying to interpret a world that no longer makes sense to them because their brain is not able to process the information correctly. For example, sometimes two individuals living with dementia are talking, and they may misinterpret the communication, and this can be distressing for both, and they can start shouting or fighting physically. Carers and others can misinterpret how the two individuals living with dementia behave, and believe they are just trying to make troubles.
Diagram of brain of an individual living with dementia
An individual living with dementia is experiencing memory losses and feels frustrated and angry; this is why an individual may start shouting to another individual living with dementia, carers and others. Dementia is the less of everything you know! Individuals living with dementia are often rude or exhibiting sexual behaviours. This is why, carers and others may misinterpret communication because the individuals living with dementia is trying to interpret a world that no makes sense to them; because of the brain functions, that are not able to process the information correctly. Examples of how carers and others may misinterpret communication can be found, as being abusive, individual having a mental illness, individual being affected by drug or alcohol abuse, individual having learning difficulties, missing needs, and being deliberately uncooperative. Page 12 of 46
Source: gaelromanet.com/DEM308.pdf
DEM 308 Understand the role of communication and interactions with individuals who have dementia by Gaël Romanet
Task ① Understand that individuals with dementia may communicate in different ways
• Explain the importance of effective communication to an individual with dementia (2 pages to answer the question) The importance of effective communication to an individual living with dementia is very important to know how the individual is feeling. Did you sleep well? How do you feel today? Would you like a drink? This simple and very important questions help to make feel the individual important, listened and valued. Taking time to listen to an individual living with dementia, to chat and to enjoy being with an individual, and to show affection as appropriate, matter for an individual living with dementia. An individual living with dementia needs to feel respected and valued for who they are now, as well as for who they were in the past. They must be treated with respect and dignity and as an individual person. They are a unique and valuable human being. An individual living with dementia lives in a world where things that have just happened, are quickly lost. An individual who have dementia may forget where they are now, and where they live. They also may forget what age they have, and where their loved one is. Carers and others can help to make feel better an individual living with dementia by answering and reassuring the individual, by telling them the facts that they are missing. It may be necessary to repeat the answers several times, to make sure the individual living with dementia understands what you are talking about. Example of the importance of effective communication to an individual living with dementia: An individual living with dementia may ask you the same question a number of times. Why? Because the individual forgets he/she has just asked the question. Avoid confrontation is very important. Don’t confront the individuals with their mistakes, this could make the problem worse. Don’t say "You’ve just asked me that" just repeat the answers and make sure the individual living with dementia understand your answer. Generally the individuals will valid your answers by "Oh ok" "All right" "Ah" "You sure" Be practical by doing something practical to catch the concentration of the individual living with dementia, and give a short simple answer each time to make sure the individual understand your words. Clarify the feelings and give comfort, for example "You seem worried, you can’t remember the time of the appointment"
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DEM 308 Understand the role of communication and interactions with individuals who have dementia by Gaël Romanet
Importance of effective communication to an individual living with dementia, help to increased engagement for the individuals and the carers, help boosting self esteem, make feeling more valued, help being less isolated, help social inclusion, help to feel calmness. It's also an enjoyable process for the individuals and the carers because carers feel more motivated and individuals feel more "listened to"
Summary of effective communication with an individual living with dementia -
reduce as far as possible any ambient noise give a short simple answer ensure the individual is comfortable gain eye contact when it is possible get the individual’s attention before speaking to them call the individual’s preferred name and say the same name every time you meet the individual speak clearly and calmly avoid speaking sharply or raising your voice as this may distress the individual, even if they can’t follow the sense of your words
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DEM 308 Understand the role of communication and interactions with individuals who have dementia by Gaël Romanet
Task ① Understand that individuals with dementia may communicate in different ways
• Describe how different forms of dementia may affect the way an individual communicates (13 pages to answer the question) Different forms of dementia may affect the way an individual communicates because dementia is not a disease in and of itself. It is instead classified as a series of symptoms related to other disorders and diseases.
The most common type of dementia is Alzheimer’s disease, followed by vascular dementia, dementia with Lewy bodies and fronto-temporal dementia.
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DEM 308 Understand the role of communication and interactions with individuals who have dementia by Gaël Romanet
Alzheimer’s disease Alzheimer's disease is the most common cause of dementia in the elderly. Since dementia targets the brain, it affects how individual think, remember, behave, perceive and communicate. Alzheimer's disease is a degenerative brain disease that causes chemical and structural changes to the brain which destroys the ability to remember, reason or relate to others. Individuals living with cortical dementia (the type that affects Alzheimer's sufferers) experience memory loss and the increasing inability to understand language. This means that the individual with Alzheimer's disease may lose empathetic feelings towards others and may not recognise someone from one day to the next. Alzheimer's disease can affect speech and language. An individual living with Alzheimer's disease may lose words gradually or get the order of their words muddled which makes conversation very difficult. Images showing Preclinical Alzheimer’s disease, Mild Alzheimer’s disease and Severe Alzheimer’s disease Preclinical Alzheimer’s disease
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DEM 308 Understand the role of communication and interactions with individuals who have dementia by Gaël Romanet
Mild Alzheimer’s disease
Severe Alzheimer’s disease
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DEM 308 Understand the role of communication and interactions with individuals who have dementia by Gaël Romanet
How Alzheimer’s disease affects the brain for an individual to communicate and to do things?
What's going on in a brain with Alzheimer’s disease?
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DEM 308 Understand the role of communication and interactions with individuals who have dementia by Gaël Romanet
Alzheimer’s disease: How speech is going on?
As Alzheimer’s disease progresses, the damage to the brain increases. More areas of the brain may get impacted. Visible symptoms increase depending on the areas of the brain affected, and the severity of the damage. As more and more parts of the brain are impacted, the individual’s ability to perform activities of daily living keeps decreasing. Every task requires coordination of various parts of our body and the ability to pay attention. Multiple parts of the brain have to function properly to perform this. For example, to light the gas stove, we need to position the lighter near the burner and click its button at the exact moment that we turn the corresponding knob of the gas stove.
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DEM 308 Understand the role of communication and interactions with individuals who have dementia by Gaël Romanet
As Alzheimer’s disease progresses, at least some parts of the brain required for this coordination and focus are likely to be damaged. Individual will no longer be able to do complex tasks that require precision and coordination. Attempts to do such tasks are likely to lead to frustration or accidents. The individual living with Alzheimer’s disease will not be able to do that task independently and will need assistance from carers or others. Communication is often impacted. Memory loss and major personality changes are common in Alzheimer’s disease. There is an overall deterioration. In the final stages of Alzheimer’s disease, the individual is fully dependent and often unable to communicate.
Vascular dementia Vascular dementia is caused by a series of mini strokes or by a gradual failure of brain cells. This can result in the individuals being unable to understand what is being said to them and cannot therefore respond.
How Vascular dementia affects the brain for an individual to communicate and to do things?
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DEM 308 Understand the role of communication and interactions with individuals who have dementia by Gaël Romanet
Vascular dementia is the third most common cause of dementia. It is caused by disease of the small blood vessels in the brain. Parts of the brain called white matter are injured, often by multiple small strokes.
What's going on in a brain with Vascular dementia? Vascular dementia occurs when cells below the surface of the brain receive an inadequate supply of oxygen and nutrients and, in turn, die. This process is due to hardening of the blood vessels within the white matter of the brain, which affects the blood supply. As a result, the oxygen and nutrient supply to the neurons and their supporting cells are also affected.
Vascular dementia usually affects older individuals. Vascular dementia and Alzheimer’s dementia can occur together, making the diagnosis of one over the other difficult. The main symptoms of vascular dementia include: -
Abrupt onset
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Progressive memory loss
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Progressive deterioration of intellectual abilities, processing speed, cognitive and motor abilities
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Slow, unsteady gait
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Focal neurologic symptoms
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Individuals unable to understand what is being said, so they cannot respond and are unable to communicate Page 21 of 46
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DEM 308 Understand the role of communication and interactions with individuals who have dementia by Gaël Romanet
Dementia with Lewy bodies Dementia with Lewy bodies disease affects the cerebellum part of the brain. This can cause difficulties with balance, co-ordination and visual recognition. The individuals may have hallucinations which are very real to them. An individual living with dementia with Lewy bodies will eventually not recognise their loved ones, and the individual is unable to act with the familiarity towards people that they used to.
How Dementia with Lewy bodies affects the brain for an individual to communicate and to do things?
What's going on in a brain with Lewy bodies dementia? All of us have some fluctuation in our abilities over days, depending on our mood and health and energy. With individuals living with dementia, we often find fluctuations in the abilities to do a specific task or remember something. Fluctuations in cognitive ability are particularly common in Lewy bodies dementia. Carers and others interacting with individuals living with dementia, it seems strange to see the individual able to remember something on one day, and not be able to remember it later.
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DEM 308 Understand the role of communication and interactions with individuals who have dementia by Gaël Romanet
When carers and others see the individual do something on one day and not be able to do it the very next day, carers and others begin thinking the individual is not trying hard enough. It is helpful to know that such fluctuations may be characteristic of Lewy bodies dementia. Often, individuals living with dementia with Lewy bodies, get disoriented because of problems like loss of memories, visio-spatial problems, discomfort with too much stimulus or noise, and inability to understand objects around them. This leads to multiple problems, such as: -
the individual may wander and forget the way back to return to him/her room
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the individual may consider himself/ herself as younger and expect a different home, and may not recognize the children and grandchildren, or mistake the daughter for the wife
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the individual may keep insisting he/ she wants to go home
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the individual may be anxious about not knowing where the toilet is
In Lewy bodies dementia, recent memories are lost, and individuals often revert to older memories, or unconsciously try to fill gaps in their memories using their imagination. Individuals living with Lewy bodies dementia cannot recognize people or places, and may not even recognize their home and family. Often, individuals living with Lewy bodies dementia are unable to create new memories, and they may also have problems understanding complex instructions or concepts. This affects their ability to learn new things, use new devices, and adjust to new places. Individuals living with Lewy bodies dementia may also get stressed when they meet new persons or see new things, and start avoiding such situations. In dementia with Lewy bodies, individuals may suffer from hallucinations, delusions and paranoia. Individuals who hallucinate may sometimes realize they are hallucinating, but at other times, they may be confused or frightened because they believe what they are seeing or hearing. Hallucinations may make familiar tasks difficult when they cannot distinguish between reality and hallucination (for example, if they see a road split into four, they cannot drive). Carers and others near them may not realize that the individual living with dementia with Lewy bodies, is hallucinating and then confused and frightened. Delusions and paranoia also affect how the individuals living with dementia with Lewy bodies interacts with others. They may accuse people of stealing their possessions or even of trying to kill them. It is difficult to make the individual understand what is real and what is delusion, or to calm down a paranoid individual. Page 23 of 46
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DEM 308 Understand the role of communication and interactions with individuals who have dementia by Gaël Romanet
Fronto-temporal dementia Difficulties with language occur in all forms of dementia but the particular problems experienced by an individual will vary according to the type of dementia and level of disability they have. For example, in fronto-temporal dementia it may be the first symptom that an individual develops. In many instances, language skills will vary from day to day and time to time. Make the most of 'good' days and learn to cope with the 'bad' ones.
How fronto-temporal dementia affects the brain for an individual to communicate and to do things?
An early sign that individual's language is being affected by dementia is that they can't find the right words – particularly the names of carers and others. The individual may substitute an incorrect word, or may not find any word at all. There may come a time when the individual can hardly communicate accurately or successfully through language. This may be distressing for their loved ones, but it's a normal aspect of their memory loss. Other factors may also affect the ability of an individual living with dementia to communicate – including pain, discomfort, illness or the side-effects of medication. Make sure the individual's glasses are the correct prescription, that their hearing aid is working properly, and that their dentures fit well and are comfortable. Difficulties with communication can be upsetting and frustrating for the individual living with dementia and for those around them, as carers and others, but there are lots of ways to help to make sure that you understand each other. Page 24 of 46
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DEM 308 Understand the role of communication and interactions with individuals who have dementia by Gaël Romanet
Individuals living with Fronto-temporal dementia often cannot communicate what they want. They may have problems remembering the right word, or may not know the meaning of words carers and others use. They may not be able to frame sentences. Individuals may also have problems knowing what they are feeling; they may not realize they are hungry or thirsty or hot or cold, or even that they are unwell or in pain. They may not be able to tell carers and others what they want. They may not be able to indicate that they are unwell or are in pain. So their needs remain unfulfilled. This may also frustrate, distress, or anger them, even if they don’t know how to express it. If they are ill, their illness will affect their ability to do things, but carers and others may not understand why the individual is acting differently today. Also, carers and others may not realize that the patient needs rest and treatment. Individuals living with Fronto-temporal dementia become disinhibited or are unable to behave in socially correct ways because the part of the brain that regulates behaviour is damaged. The personality of the individual is changing. Emotions may also get flattened and the individual may show apathy. Such problems are typical in behavioural variant frontotemporal dementia. Often, this leads to embarrassing situations where carers and others may assume the individual has “bad character” or is inconsiderate and insensitive. For example, the individual may made rude remarks (even sexual comments), yell or abuse. Or the individual may laugh when others are crying. Or the individual may lose interest in everything and not show any reaction to emotions of carers and others nearby. Repetitive behaviour and compulsive behaviour are common in many forms of dementia. Such behaviour may occur for many reasons, such as forgetting having said or done the thing earlier, boredom, anxiety and agitation. Common examples are the individual may say the same thing repeatedly, ask the same question, make the same gesture, and do the same action. Often, such repetitive behaviour is harmless, but at times it may be problematic (like the individual insisting on eating breakfast multiple times) or even harmful (taking medication multiple times) or exhausting (such as packing/ unpacking a suitcase or pacing). It can also be annoying or distressing for carers and others if they don’t understand it is happening because of dementia and don’t know how to cope with it. In many instances, individual living with fronto-temporal dementia show changed behaviour in the evenings and night, called “sun downing” While causes for such behaviour are not fully understood, they are expected to be related to day time activities, exhaustion, body clock, food cycles, intake of liquid foods near dinner time, and so on. Individuals start acting agitated as evening approaches. They may be restless and start pacing. They may seem more agitated and anxious. Sleeplessness is another problem. They may walk up and down all night, mumbling or even shouting at times. All this can be very tiring for the individuals and the carers and others.
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DEM 308 Understand the role of communication and interactions with individuals who have dementia by Gaël Romanet
What's going on in a brain with fronto-temporal dementia?
Fronto-temporal dementia is an umbrella term for a diverse group of uncommon disorders that primarily affect the frontal and temporal lobes of the brain, the areas generally associated with personality, behavior and language. In fronto-temporal dementia, portions of the frontal and temporal lobes are atrophy, or shrink. Page 26 of 46
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DEM 308 Understand the role of communication and interactions with individuals who have dementia by Gaël Romanet
Signs and symptoms vary, depending upon the portion of the brain affected. Some individuals living with fronto-temporal dementia undergo dramatic changes in their personality and become socially inappropriate, impulsive or emotionally blunted, while others lose the ability to use and understand language. Fronto-temporal dementia is often misdiagnosed as a psychiatric problem or as Alzheimer’s disease. But fronto-temporal dementia tends to occur at a younger age than does Alzheimer’s disease, typically between the ages of 40 and 70. Different forms of dementia that may affect the way an individual communicates are for example: -
vascular disease Alzheimer’s disease dementia with Lewy bodies Parkinson’s disease multiple sclerosis fronto-temporal dementia Huntingdon’s disease HIV and Aids motor neurone disease
Different effects due to different forms of dementia that may affect the way an individual communicates are for example: -
slurred speech word substitution loss of language skills use of inappropriate language reduced communication inability to express oneself reduced understanding frustration repetition
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Source: gaelromanet.com/DEM308.pdf
DEM 308 Understand the role of communication and interactions with individuals who have dementia by Gaël Romanet
Task ② Understand the importance of positive interactions with individuals with dementia
• Give examples of positive interactions with individuals who have dementia (2 pages to answer the question) A positive interactions with individuals who have dementia mean to be in a positive mood, tone of voice, and body language will go a long way to providing a better opportunity to positively interact with an individual living with dementia. In my work place (I work as a care assistant in dementia care home), I care of 29 individuals living with dementia who present many different behaviours associated with dementia. For example in my work place, Mrs Joan wants to go to church every Sunday to pray the Lord. Hopefully, my work place is very close to a Church, which makes it easy to Mrs Joan to go to church to pray the Lord. My work place, have a positive interactive environment, very close to a Church, close to a big garden and many local shops. That helps to meet the needs, and to capture the attention of an individual living with dementia, like Mrs Joan. So every Sunday, Mrs Joan and I are going to the Church for a couple of minutes. Mrs Joan likes to talk about her marriage, and how she likes to be in a Church to pray the Lord. This allows her to talk about her deceased husband who she misses greatly. On the Church way, I remind to Mrs Joan who I am and my relation to her, and anything else that may help her to focus on what I have to discuss with her, like how she is feeling today, what she would like to drink, etc Of course, I use a short and simple language when I communicate with Mrs Joan, to make sure she understands what I am talking about. Also I never raise my voice and always give time to Mrs Joan to answer my questions. Asking yes or no questions, giving simple choices are also ways for a chance at successful communication with Mrs Joan. Another example, about a positive interaction with individuals who have dementia can be find with Mr Michael in my work place. From time to time, Mr Michael asks me to go together to the local shops to buy chocolate and the newspapers. I never refuse because I know he likes my company and trust me. On the shops way, I like to talk with Mr Michael, it is very important for him to know that, he is listened and got all my attention. That makes feel him valued. Mr Michael needs constant reassurance about where is his son. As Mrs Joan, I use a short and simple language when I communicate with Mr Michael, to make sure he understands what I am talking about and give time to Mr Michael to answer my questions about how he is feeling today, what games he would like to play later, etc Also, for a successful communication, I never raise my voice when communicating with Mr Michael.
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DEM 308 Understand the role of communication and interactions with individuals who have dementia by Gaël Romanet
Mrs Joan and Mr Michael are very special individuals with special needs. Dementia is the less of everything you know, to feel reassured and loved are very important for individuals living with dementia. They are human being with a big heart. Examples of positive interactions with individuals living with dementia: -
perceiving and integrating information
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recalling enjoyable experiences eg family outing
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celebrating important memories or events
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appreciating emotions and feelings
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reminiscence therapy
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use of gestures
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using sign language
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through memory books
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pictorial approach
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DEM 308 Understand the role of communication and interactions with individuals who have dementia by Gaël Romanet
Task ② Understand the importance of positive interactions with individuals with dementia
• Explain how positive interactions with individuals who have dementia can contribute to their wellbeing (3 pages to answer the question) Positive interactions with individuals who have dementia can contribute to their wellbeing by making a change in the way the individuals living with dementia behave. Living with dementia mean change of behaviour; for example in my work place, individuals living with dementia can become aggressive and refused to go for breakfast because they believe they need money to pay for breakfast. In this situation, humour can help to break the ice when the communication releases the stress of individuals living with dementia. Trying to laugh together about misunderstandings can help to make change the mood of an individual living with dementia, to start the day with a big smile, ready to enjoy breakfast. Making a change of behaviour with a positive interaction for an individual living with dementia contribute to the wellbeing. Behavioural environment include carers and others body language. Be calm while you communicate with an individual living with dementia. Carers and others behaviour are very important. Knowing how your words and actions affect individuals living with dementia, help to provide positive interactions by contributing to their wellbeing. Knowing the individual’s body language and understand the individual’s emotions, frustrations, worries and fears of living with dementia, help to reduce the agitation caused by the frustration and give to the individuals a feeling that they do matter. Giving to the individual living with dementia, your full attention, contribute to remain calm.
everything Dementia is the less of
you know.
It's a lonely illness with lots of fear.
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Source: gaelromanet.com/DEM308.pdf
DEM 308 Understand the role of communication and interactions with individuals who have dementia by Gaël Romanet
An individual living with dementia is still an adult. It is important that carers and others treat the individual living with dementia as an adult and with courtesy, however advanced their dementia. Be kind and reassuring without talking down to the individual living with dementia as though they are a small child. Never talk over the head of an individual living with dementia or across them as though they are not there. Do not talk about the individuals living with dementia in front of them unless they are included in the conversation. Avoid scolding or criticising the individuals living with dementia as this will make them feel small. Look for the meaning behind what individuals living with dementia may be trying to communicate even if it seems not to make sense.
Focus on abilities Help the individuals living with dementia to avoid situations in which they are bound to fail since this can be humiliating. Look for tasks they can still manage and activities they can still enjoy. Give them plenty of praise and encouragement and let them do things at their own pace and in their own way. Do things with the individuals living with dementia, rather than for them, so they can maintain some independence. Break activities down into small steps so that the individuals living with dementia has some feeling of achievement, even if they can only manage part of a task. Much of our self-respect is often bound up in the way we look. Encourage the individuals living with dementia to take pride in their appearance and give them plenty of praise.
Respecting privacy Try to make sure that the individual’s right to privacy is respected. Carers and others may knock on their bedroom door before entering, for example. When the individual living with dementia needs help with intimate activities such as washing or going to the toilet, this should be done in a sensitive way. Make sure that the bathroom door is kept closed if other individuals are around.
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Source: gaelromanet.com/DEM308.pdf
DEM 308 Understand the role of communication and interactions with individuals who have dementia by Gaël Romanet
Offering choice It is important that the individuals living with dementia should be informed and wherever possible consulted about matters which concern them. They should also be given every opportunity to make appropriate choices. Even if you are unsure how much the individuals living with dementia can understand, always explain what you are doing and why. You may then be able to judge their reaction from their expression or body language. Although too many choices can be confusing, you can continue to offer choice by phrasing questions that only need a “yes” or “no” answer such as "Would you like to wear your blue jumper today?"
Expressing feelings Dementia affects the thinking and reasoning part of the brain and memory. It does not mean that the individual no longer has feelings. Individuals living with dementia are likely to be sad or upset at times. Individuals living with dementia have the right to expect from carers and others, understanding how individuals are feeling and to make time to offer support rather than ignoring them or jollying them along. In the earlier stages, individuals living with dementia may want to talk about their anxieties and the problems they are experiencing. It is important that carers and others do not brush these worries aside, however painful they may be, but listen and show that, carers and others are there for them and will be there for them.
Feeling valued Individuals living with dementia needs to feel respected and valued for who they are now, as well as for who they were in the past. It helps when carers and others are flexible and tolerant, and can make time to listen and to chat and enjoy being with the individuals living with dementia. Positive interactions that contribute to wellbeing of individuals living with dementia are meet by, treating the individuals living with dementia as an adult, to focus on abilities, respecting the privacy of the individuals, offering choice, expressing feelings and make feel valued the individuals living with dementia. All this help to provide positive interactions to ensure the well being of individuals living with dementia. Also positive interactions contribute by; giving a sense of hope; giving improved confidence; improving self esteem; improved physical, intellectual, emotional and social health; enabling social inclusion; enabling engagement; and increasing self respect. Individuals living with dementia are human being. Right to privacy, right to have choice, right to be respected, doesn't stop when dementia comes. Page 32 of 46
Source: gaelromanet.com/DEM308.pdf
DEM 308 Understand the role of communication and interactions with individuals who have dementia by Gaël Romanet
Task ② Understand the importance of positive interactions with individuals with dementia
• Explain the importance of involving individuals with dementia in a range of activities (1 page to answer the question) The importance of involving individuals living with dementia in a range of activities, are benefits to help to slow the decline of dementia in the early stages, via cognitive stimulation that help to keep the processes of the brain functioning. The most common causes of challenging behaviour of individuals living with dementia are boredom and frustration. Taking part in activity provide a welcome distraction from the stresses of the illness and helps to enables an individual to make choices, and focus the individual on the positive aspects of life. Activity can be as simple as holding a conversation, reading out loud for the individual, singing, playing card games, going for a walk and discussing what is seen, painting, making collage, doing gardening, or exchanging ideas.
Example of activity board in dementia unit
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Source: gaelromanet.com/DEM308.pdf
DEM 308 Understand the role of communication and interactions with individuals who have dementia by Gaël Romanet
Task ② Understand the importance of positive interactions with individuals with dementia
• Compare a reality orientation approach to interactions with a validation approach (3 pages to answer the question) What is a reality orientation approach? A reality orientation approach tries to place the individual living with dementia, in the here and now, reminding them of the day, place, time and situation they are in. What is a validation approach? A validation approach mean, using non-judgmental acceptance and empathy to show the individual living with dementia that their expressed feelings are valid. A validation approach means to focus on the feelings rather than the content of speech.
To make understand easy about the difference between a reality orientation approach and a validation approach, it is best to use simple words. Reality orientation helps confusion and memory loss by reminding the individuals living with dementia of basic facts such as the time of the day, the date of the week, and where they are. A reality orientation approach is about present time and real things. For example, at 3pm today, individuals living with dementia will have a cup of tea with biscuits. A reality orientation approach help to place the individuals living with dementia in the right time, date and space, by telling them what is the time, what the date of today is, and where they are now. For example, a white board may be used with the date written on it reminding the individuals of what has already happened and what will happen next. This may assist with reducing anxiety and uncertainty about anticipated events. Photography of the individual's family and newspaper can provide daily stimulation. For example, an activity board help the individuals living with dementia to remind what will happen during the day. Activity board in dementia unit help to stops the individuals from spending all day believing they are doing nothings, or seen anybody. A validation approach is about feeling of the individuals living with dementia, time and real things doesn't matter. For example, an individual living with dementia can tell you the tender bears are real members of family, or this table is a car. A validation approach is about entering the individual’s reality rather than trying to bring back the individual living with dementia, in our reality. Some individuals living with dementia can no longer make sense of the present so a validation approach helps to understand and empathize with the needs what the individual is trying to express.
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Source: gaelromanet.com/DEM308.pdf
DEM 308 Understand the role of communication and interactions with individuals who have dementia by Gaël Romanet
Validating individual's words and actions is a way of encouraging the individuals living with dementia to keep communication with carers and others. In this way empathy is developed with the individuals, around a sense of trust and security. For example, an individual living with dementia who believes her tender bears are her babies and members of her family would be distressed to be told that it is not true. In a validation approach, carers and others must say things in the same direction than an individual living with dementia take for real, as the tender bears are real members of family, or this table is a car. It's all about dream world that makes feel good the individual living with dementia for this own well being.
Example graphic of Reality Orientation
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Source: gaelromanet.com/DEM308.pdf
DEM 308 Understand the role of communication and interactions with individuals who have dementia by Gaël Romanet
Example graphic of Validation Approach
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Source: gaelromanet.com/DEM308.pdf
DEM 308 Understand the role of communication and interactions with individuals who have dementia by Gaël Romanet
Task ③ Understand the factors which can affect interactions and communication of individuals with dementia
• List the physical and mental health needs that may need to be considered when communicating with an individual with dementia (1 page to answer the question) List of the physical and mental health needs that may need to be considered when communicating with an individual living with dementia are: Inability to recall information, memory loss, requires clear information, use of large printed images, awareness of hearing impairment, use appropriate communication methods, speak in short sentences, allow time for response, do not be afraid of silence, to be able to communicate nonverbally, recognise cultural needs and recognise lack of motor control.
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Source: gaelromanet.com/DEM308.pdf
DEM 308 Understand the role of communication and interactions with individuals who have dementia by Gaël Romanet
Summary of effects of dementia on communication
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Source: gaelromanet.com/DEM308.pdf
DEM 308 Understand the role of communication and interactions with individuals who have dementia by Gaël Romanet
Task ③ Understand the factors which can affect interactions and communication of individuals with dementia
• Describe how the sensory impairment of an individual with dementia may affect their communication skills (2 pages to answer the question)
Our five senses combine to give us a better view of the world.
For an individual living with dementia, the world gradually makes less and less sense because the processes of the brain functioning treating the information slow to decline in the early stages. Individuals living with dementia, with poor eyesight and poor memory may find it difficult to move, even in their own home. Individuals living with dementia, with poor hearing will find it very difficult to hold a conversation because they have problem to hear properly and they may have problem to find the correct words to answer due to dementia.
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Source: gaelromanet.com/DEM308.pdf
DEM 308 Understand the role of communication and interactions with individuals who have dementia by Gaël Romanet
Also, it is very difficult to persuade an individual living with dementia to wear hearing aids because it's may cause irritation. The individual living with dementia may also not understand how to use correctly the hearing aids. Some individuals living with dementia develop hands and face tremors which can affect their body language and therefore some communication signs may be misinterpreted. Individuals living with dementia with Alzheimer's disease are affected with the brain functions of the process to think, remember, behave, perceive and communicate. The sensory impairment of individuals living with dementia may affect their communication skills because they often have some degree of sensory impairment and this have an impact on communication. Individuals living with dementia may need image printed and enlarged, they may misunderstand what carers and others are speaking about due to dementia because they may be confused. Individuals living with dementia may be disorientated, they may feel withdraw and isolated. Also, individuals who have dementia may need specialist equipment like Braille.
About The Braille Alphabet
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Source: gaelromanet.com/DEM308.pdf
DEM 308 Understand the role of communication and interactions with individuals who have dementia by Gaël Romanet
Task ③ Understand the factors which can affect interactions and communication of individuals with dementia
• Describe how the environment might affect an individual with dementia (3 pages to answer the question) The environment might affect interactions and communication of individuals living with dementia, by: -
Internal environment
-
Sensory environment
-
Behavioural environment
-
Physical environment
-
Environmental stressors
Internal Environment include, pain, discomfort, illness, side effects of medication, especially anti psychotics, poorly fitting dentures, hunger, thirst, too hot and too cold Sensory Environment include, hearing loss and vision loss are key impairments in old age and can compound communication difficulties for an individual living 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. Also, individuals living with dementia may forget to wear these aids or have misplaced them in which case try to track down or get replaced Behavioural Environment includes your body language. Be calm and still while you communicate with an individual living with dementia. Your behaviour, are you aware of how your words and actions affect individuals living with dementia? Get to know the individual’s body language, and understand the individual’s emotions. Physical Environment: An individual living 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 an individual living with dementia to communicate or hinder them. Signage, cues as to where they are, and seeing the purpose of a room, can enable the individuals living with dementia to ‘communicate’ with their environment and be more independent. Environmental stressors: The physical environment of dementia care homes and busy hospital, are often noisy, and can be very stressful for individuals living with dementia. Page 41 of 46
Source: gaelromanet.com/DEM308.pdf
DEM 308 Understand the role of communication and interactions with individuals who have dementia by Gaël Romanet
Summary of how the environment might affect an individual living with dementia
Environment include: physical (resources, decor, layout, background noise), people (carers, other residents, health care professionals), and environmental (culture, routines and practice) Examples: -
lack of space could cause challenging behaviour lack of attachment could cause withdrawal loss of identity could cause a feeling of exclusion change of familiar environment may cause confusion
A good environment might not affect interactions and communication of individuals living with dementia, include: -
Talking Mats Old photographs Memory boxes Familiar objects Video messages
Talking Mats is a low-tech, easily accessible, inexpensive tool that uses picture symbols to help individuals living with dementia with a communication difficulty to express themselves more successfully. Page 42 of 46
Source: gaelromanet.com/DEM308.pdf
DEM 308 Understand the role of communication and interactions with individuals who have dementia by Gaël Romanet
The simple framework of picture symbols and textured mat allows individuals living with dementia to indicate their feelings about various options within a topic by placing the relevant image below a visual scale. It is an approach which helps carers and others to think about issues in a different way. Memory boxes help to prompt communication through visual stimuli with personal significance. That can help prompt memory, and provides visual cues for an individual living with dementia, and help to know this is individual's own room. This provide a great help for conversation aid and reminiscence aid. To resume, dementia affects how an individual thinks and processes information, how they receive and respond to stimuli, how they interpret what they see, hear and say, and how they act on that information. An individual living 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 an individual living with dementia is talking to another individual living with dementia, and they can misinterpret each other's attempts at communication, and this can be distressing for both. Attend to the internal, sensory, behavioural, physical, and environmental environments. The onus is on carers and others to use all possible ways to ensure effective communication to provide as good as possible, well being for individuals living with dementia. Caring of individuals living with dementia is a full time job!
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Source: gaelromanet.com/DEM308.pdf
DEM 308 Understand the role of communication and interactions with individuals who have dementia by Gaël Romanet
Task ③ Understand the factors which can affect interactions and communication of individuals with dementia
• Describe how the behaviour of carers or others might affect an individual with dementia (1 page to answer the question) The behaviour of carers or others might affect an individual living with dementia, when carers and others are not saying the truth and lie intentionally to an individual living with dementia who asks simple questions. Living with dementia is a terrible illness for young and older individuals affected by dementia. What time is it? Do you know where I am? Where is my family? are common questions. To give short answers "yes" or "no" help to relax an individual who was ready to shout and makes troubles. An individual living with dementia might be affected by the behaviour of carers or others when ignoring the individuals or responding too quickly. To feel ignored make the individual shouting straightaway, and to respond too quickly to an individual living with dementia makes feel the individual lost and “still waiting an answer” because the brain affected by dementia can’t process correctly the information and the individual doesn’t understand what carers and others are talking about. So the individual become aggressive. The lack of empathy from carers and others to individuals living with dementia might affect the care provided. If you don't have a good heart, it is literally impossible to work with individuals living with dementia. Just imagine for one single day to be an individual living with dementia, and your view of life and own way of working will change radically and forever. One thing who affects an individual living with dementia is to feel socially excluded from carers and others. It's result a change in the mood of the individual. The individual start to lose self trust and that makes everything worse, loss of appetite, loss of motivation for living life day after day. Carers and others that use an abusive language, never fulfil care with individuals living with dementia. The consequence is the individual not allow carers and others who shout and use aggressive language, to provide basic cares, like assisting individual to go toilet, shaving and washing, assisting feeding and drinking. Carers and others, who make assumptions on behalf of an individual living with dementia, will affect the individual in the worse possible ways. The "trust contact" between carers and individuals living with dementia is fragile and no prize. Making bad assumptions on behalf about an individual will broke the "trust contact" and open big difficultly to provide care because the individual will simply refused to be assisted. An individual living with dementia is first a human being and request first to feel loved by others and carers. The human rights don’t stop when dementia comes. Feeling to be an unique individual, to have choice, to have privacy, to have some independence, to be treated with dignity, to be treated with respect, and to feel a fair partnership between carers and individuals living with dementia. are the basics of well being. Page 44 of 46
Source: gaelromanet.com/DEM308.pdf
DEM 308 Understand the role of communication and interactions with individuals who have dementia by Gaël Romanet
Task ③ Understand the factors which can affect interactions and communication of individuals with dementia
• Explain how the use of language can hinder positive interactions and communication (2 pages to answer the question) The use of language can hinder positive interactions and communication for an individual living with dementia, if carers and others are speaking too fast to the individual. Brain affected by dementia is not longer able to process the information correctly, and so have a direct impact of the way an individual living with dementia behave, by becoming aggressive. Inappropriate tone of voice from carers and others might affect the mood of an individual living with dementia. The individual may feel aggressed and can start shouting. If carers and others are using technical terminology inappropriately, that might affect individuals living with dementia to feel more confused than usual because they will not understand what carers and others are talking about and individuals can becomes upset and frustrated. Individuals living with dementia are increasingly trying to interpret a world that no longer makes sense to them because their brain is not able to process the information correctly. I remember an individual living with dementia in my work place who was laughing when carers were talking in a foreigner language, other than English. I asked to this individual why he was laughing so loud, and the answer really surprised me, this individual told me “they try to speak English but they just making noise, that so funny” I did enjoy this answer because how natural and logical it was for this individual. The use of language can hinder positive interactions and communication for an individual living with dementia, when carers and others are not communicating in the individual’s preferred language or foreigner languages. This may confused the individual more than normal. Better for carers and others to not patronising the individuals living with dementia in their mistakes, this could make the problem worse. Carers and others who are verbally abusing an individual living with dementia can hinder positive interactions and communication of an individual. It's will result the individual will not allow carers and others to provide care like assisting the individual to go to toilet, to be shaved and washed, and worse the individual will refused to be assisted for feeding and drinking, and will simply refused to open the mouth. It's can push the individual in severe troubles.
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Source: gaelromanet.com/DEM308.pdf
DEM 308 Understand the role of communication and interactions with individuals who have dementia by Gaël Romanet
Almost two years now I am sharing my life by 48 hours of a week, with individuals living with dementia. I have to say they did change totally my view of life. Simple things as proposing a cup of tea to an individual living with dementia, request a certain “dementia logic” For example, an individual living with dementia will refused more tea in a cup of tea if the cup of tea is not completely empty. You have to say "let me do a new cup of tea" then, the individual will accept. I really feel close to my dementia residents, they are simply fascinating.
During writing my dementia awareness, I found out with internet some excellent short video on YouTube by a lady called Teepa Snow which illustrates exactly how to manage some aspects of dementia when communicating with individuals living with dementia. I would highly recommend watching them, you will be amazed at how simple her suggestions are and how acutely she observes behaviour.
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Source: gaelromanet.com/DEM308.pdf
