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DEMENTIA AWARENESSCERTIFICATE COURSE

UNIT FOUR

COMMUNICATION AND DEMENTIA

Introduction

So far we have considered what it is like to experience dementia (Unit One), how dementia is conceptualised (Unit Two), and the nature of care (Unit Three). Unit Four builds on this information and seeks to explore the nature and importance of communication with people with dementia. In achieving the learning outcomes of this unit, you will explore your own perceptions and experiences of working with people with dementia, and comparing these to research that has specifically addressed the nature of communication. This will involve, firstly, exploring what is meant by communication, and its importance within relationships. Then, there is a need to consider the nature of breakdowns in communication for people with dementia and, in particular, explore these within a needs-based model of communication. Finally, means of facilitating communication with people with dementia will be addressed.

What is Communication?

As has already been noted in Unit 2, communication problems are a symptom of the dementing process. People with dementia experience problems with both communicating to others (expressive aphasia) and comprehending information that is communicated to them (receptive aphasia). As such, it was once assumed that it was impossible to communicate with them and, instead, carers became their voice. However, there are problems with this: firstly, carers may not accurately represent the views of the person with dementia and, secondly, it invalidates the person with dementia, suggesting that he or she is a person with nothing to say (explored in Unit Three under malignant social psychology). As such it is necessary to explore what communication is, why it is important, and how carers (both formal and informal) can better engage in communicating with the person with dementia.

Dementia Awareness Certificate Course – Unit Four – Page 1

ACTIVITY 4.1: QUESTION

In your experiences of working with people with dementia:

a. What have been some of the issues for you with regard to communication?b. Why should communication be considered as an essential issue within dementia care?

Allan and Killick (2008) make the following points as to why communication is important:

Communication is important to the reality of personhood Dementia’s effect on communication The need to know what it is like to experience dementia Care necessitates communication The morality of how and why we value persons

As such, communication is an essential aspect to consider within dementia care because it specifically concerns the valuing of the person with dementia and allows for the carer to understand not only what it is like, but also offers a means to ensure that the care and support offered are actually meeting the needs of the person with dementia.


Make a list of all the things that come to mind when you consider the question: What is communication?

Powell (2000:162) has defined communication as:

“person-to-person transmission of ideas through... language or... non-verbal media”

This expresses two elements of communication that are worth noting. Firstly, communication is a purposeful activity (the person-to-person transmission of ideas). According to Westmyer et al (1998:28):

“To understand why people engage in interpersonal communication, we must remember that communication is goal directed. Interpersonal needs establish expectations for communication behaviour. Communicators are mindful in that they are capable of acknowledging their needs and motives, and realise that they can choose particular communication behaviours to fulfil these needs”

This notion of communication being purposeful will be discussed more fully later on.


The second aspect of Powell’s (2000) definition of communication is that it occurs through a medium.


Consider what mediums communication utilises.

Communication utilises various mediums (Powell 2000; Hargie 2006). As such, communication can occur:

Verbally: the spoken word Paralingually: the way it is said Non-verbally: the body language that accompanies the spoken word As writing: the written word Visually: in pictures, for example


How does dementia affect these mediums of communication?

A Model of Communication

A traditional understanding of the context of communication speaks of it as a linear process between two people. The first (the Sender) has some information to communicate (the message). This message is encoded by the sender and sent by some means (the channel) to another person (the receiver), who decodes the message.


A simple exercise to gain some understanding of this model of communication. You will require a lined piece of paper. All you need to do is the following task:

On line one, write your name.

In the above activity I had the idea of conceptualising the communication process and encoded this idea as the activity. As the Sender, I sent this message to you through the channel of the written word. You, as the receiver, decoded the message and, on your lined piece of paper, addressed the statement given.


This activity highlights some of the problems of communication even with two competent people fulfilling an apparently simple task. These are:

Due to this medium of communication, I do not know if you understood the task. Even if I were present, the following highlight the limitations of communication.

As the Sender, I am clear what the message is that I wish to send (write your name on line one of a piece of lined paper)

As the Receiver, you will have some preconceived ideas that will influence your understanding of the message sent:

o What is meant by “your name”?

Some may have written their Christian name; some may have written their Christian and Surname; some may have written any middle names they have; some may have written initials and surname; some may have wrote their title and surname.

o What is meant by “line one”?

Some of you may have written on the very top line of your lined paper; some may have written on the line beneath the very top line.

So what has happened? A simple task has been sent in a language both sender and receiver understand (I assume that we both speak English). Yet the message has been decoded by the receiver in a variety of ways. This form of communication has not allowed for the process of feedback.


Why is feedback important in communication?

Fitts and Posner (1973) have identified three functions of feedback:

Motivation: if feedback is suggestive of a successful completion of task, then there is motivation to continue with it

Knowledge: feedback gives knowledge of what works and what doesn’t when completing a task

Reinforcement: the receiver sends messages to the sender to carry on, thereby giving reinforcement to continue.


A final consideration with regard to communication is the context within which it occurs. This consists of both the environmental context (for example, in a private room for counselling, or with a group of friends at a concert) and the socio-cultural context (for example, communication between a teacher and a pupil will be different from communication between two friends due to such things as power differentials between the people concerned).

Figure 4.1: Communication Model


Consider each of these elements to communication and state what factors may hinder the process of communication.

Sender Receiver Channel Feedback Environment


The process of communication consists of the following elements:

A sender A receiver A channel Feedback Environment

Communication can break down at any of these points for a variety of reasons. This process can be affected with regard to:

Language spoken (for example, accent, terminology)

Perceptions (for example, how the receiver and sender perceive the other)

Interest (for example, if you are interested in the other person and/or what they have to say)

Emotional state of mind (for example, if you are angry or sad it will have an effect on your ability to comprehend what is being communicated)

Toxicity (for example, if one of the people is drunk or high on drugs it will have an effect)

Preconceptions (for example, if you decide you do not trust the other person you are less likely to be fully attentive to what they have to say)

Sensory problems (for example, being hard of hearing will affect the communication process)

Environmental issues (for example, communicating in a loud environment or power differentials in the relationship between sender and receiver)

Physical health (for example, if the receiver is in physical discomfort it will have an effect)

Mental health problems (for example, depression, schizophrenia, and dementia will have a marked effect on communication)


With regard the person with dementia, all of these elements of the communication process can be affected. However, it is important to note that communication occurs within a relational context (Zgola 1999). As such, power differentials between the sender and receiver will have an effect upon the message communicated. For example, how often have you been with a client whilst a doctor explains some aspect of their health problems and the client smiles and says thank you? Yet, when they have left, they ask you to explain what they have just been told.


In light of what you have learnt so far about communication, what is the effect of dementia on the communication process?

You may find it useful to consider this with regard to the elements of the communication process outlined in Activity 4.7.

Jones (1992) summarises some of the effects of dementia on the communication process. With regard to the message, it may not be clearly given. For example, it may be given too fast, lack clarity, or be given in an environment that is not conducive to clear reception. The person with dementia may experience sensory deficits that may have an impact on their ability to receive the information being communicated. They may also experience problems with attention and motivation due to the dementing process. This may be temporary, partial or total and, as a result, will inhibit their ability to receive information. These memory deficits may also have an effect on their ability to receive and retain information, even for a short period of time. Dementia causes some neurological damage that will affect the communication process. Innes and Capstick (2001) note the following communication problems that may be experienced by a person with dementia:

Perseveration (for example, the person repeats key words or phrases) Paraphasia (for example, speech that appears inconsequential and/or vague) Nominal dysphasia (for example, being called by the name of someone else) Echolalia (for example, repeating your own words back to you) Confabulation (for example, covering up memory problems by making answers up) Aphasia (for example, the person may rarely or never speak) Dysphasia (for example, the person becomes anxious because they are unable to select the

correct words)

Due to the dementing process, nerve and motor damage will affect the person’s ability to give feedback during the communication process.


Challenging Behaviours as Communication

Harris and Sherblom (1998:85) state that:

“You cannot not communicate”

Indeed, studies have shown that our communication is divided into three elements:

Verbal: what we say Paralanguage: the way we say it Non-verbal: what out bodies say


Consider a typical situation in which you communicate with another person. Complete the following pie chart with your estimations of how much you communicate by the three elements of:

Verbal Paralanguage Non-verbal

Please state your answers as a percentage (with the total equalling 100%).

When it comes to a typical face-to-face encounter between two people, Bayliss (1970) has noted that the amount of communication generated through the aforementioned are:

Verbal communication = 7% Paralanguage = 38% Non-verbal communication = 55%

As such, over 90% of all our communication is not through the use of words alone. This means that we need to pay careful attention to how we speak and how we act when communicating with people. An illustration of this within a dementia context is given by Koenig Coste (2003) when she referred to an incident with her husband who had dementia. She was trying to direct her husband to sit down after a busy day when she was feeling tired. After several failed attempts, she told him to sit down “because I love you”.


“He immediately stepped close to me and placed his forefinger gently on my eyes. “No.” And he was right. At the moment that I was declaring love, my eyes denied the words. In his own way, he was saying loudly and clearly, “Your eyes don’t love me.” (Koenig Coste 2003:82)

Although the verbalised communication was simple (sit down because I love you), the non-verbal communication was the message that was picked up by her husband.


Consider a situation where you were communicating with a person with dementia and there was an apparent communication breakdown.

Reflect on:

What you actually said (verbal communication) How you actually said it (paralanguage) Your body language (non-verbal communication)

If communication is inevitable (Harris and Sherblom 1998) and is purposeful (Westmyer et al 1998), then the question is: what is the purpose of communication by the person with dementia? The traditional approach to people with dementia was that they were unable to communicate at all. Due to their inability to communicate verbally, it was deemed impossible to understand what they wished to communicate, even if it had a meaning. However, this view has been challenged on two counts:

1. Communication is a part of being human – so unless we are saying that the person with dementia is not a human being, then we must assume that they can communicate

2. All communication has a purpose – so we need to understand what needs are being communicated to us

The needs-based model of communication (Algase et al 1996) has been developed to explore the purpose of communication for people with dementia. This model advocates that the purpose of communication is to address certain needs. If these needs are not met, then communication is required. The issue for the person with dementia is that they are unable to express simply their desires due to their neurological problems (for example, receptive and expressive aphasia).


If communication is about needs, what needs do people have?


The humanist Maslow has developed and adapted a theory of need that originally comprised five needs (Maslow 1943). This was later complemented with the addition of two other needs (cognitive and aesthetic) (Maslow 1976) and, finally, transcendence was included (Maslow 1998).

Figure 4.2: Hierarchy of Needs

Kitwood (1997) advocated a model of needs that were not hierarchical (that is, one level of need must be met before the person can maintain the next level of need). Rather:

“I suggest that we might consider a cluster of needs in dementia, very closely connected, and one all-encompassing need – for love” (Kitwood 1997:81)

Although he acknowledged that these needs were “tentative”, they provide a useful framework for understanding the needs of the person with dementia and, within the context of a needs-based theory of communication, a conceptualisation of why some forms of behaviour occur.

Kitwood (1997) proposed that the person with dementia has a need for:

Comfort:

“This word, in its original sense, carries meanings of tenderness, closeness, the soothing of pain and sorrow, the calming of anxiety, the feeling of security which comes from being close to another” (Kitwood 1997:81)


Attachment:

“people with dementia are continually finding themselves in situations that they experience as “strange,” and (that) this powerfully activates the attachment need” (Kitwood 1997:82-83)

Inclusion:

“To be part of the group was essential for survival, and in some cultures temporary exclusion was a form of severe punishment” (KItwood 1997:83)

Occupation:

“To be occupied means to be involved in the process of life in a way that is personally significant, and which draws on a person’s abilities and powers” (Kitwood 1997:83)

Identity:

“To have an identity is to know who one is, in cognition and in feeling” (KItwood 1997:83)

To express their interrelatedness, he represented these needs diagrammatically as a flower:

Figure 4.3: Dementia Needs



Considering each of these five needs, answer the following:

Comfort: Think of a time when you experienced a great loss (this could be a traumatic event such as the death of a loved one or the loss of something you valued). How did you feel?How did you act? Attachment:Imagine you are lost in a strange place and do not know the way back home. How would you feel?How would you act? Inclusion:Consider what it would be like to be excluded from a social grouping (for example, your friends alienated you when you were at school). How would you feel?How would you act? Occupation:Imagine you are bed-bound and unable to do anything for a period of time.How would you feel?How would you act? Identity:Consider a situation in which other people make decisions for you without seeking your views.How would you feel?How would you act?

If these needs are met, then the person with dementia will express signs of well-being. Well-being has been defined as:

“the subjective state of being healthy, happy, contented, comfortable and satisfied with one’s quality of life” (DH 2007:99)


For the person with dementia, signs of well-being have been categorised under the Dementia Care Mapping tool as (Bradford Dementia Group 1997):

Assertiveness Bodily relaxation Sensitivity to the needs of others Humour Creative self-expression Showing pleasure Helpfulness Initiating social contact Showing affection Signs of self-respect Expression of a range of emotions

If a person’s needs are met, then the person with dementia will display signs of well-being. However, if their needs are not met, then signs of ill-being will emerge. These may express themselves as what are frequently referred to in the literature as “challenging behaviours” (Stokes 2000). Signs of unmet need are frequently reported in the literature. For example, Meaney et al (2005) conducted a study of people with dementia and their carers to ascertain their needs, and whether or not these needs were being met. They utilised the CARE-NAP-D assessment framework (McWalter et al 1998) that has seven domains:

Behaviour and mental state needs Thinking and memory needs Self-care and toileting needs Social interaction needs Health and mobility needs Community living needs House-care needs

They found that, on average, a third experienced unmet need. These manifested themselves in such things as: aggression and anxiety (behavioural needs); repetitive questioning (thinking needs); bathing and day-time wetting (self-care needs); withdrawn and not joining in with others (social interaction needs); balance and falls (mobility needs); taking medication and managing finances (community living needs); and securing the home and using the cooker (housecare needs).


Communicating Unmet Need: Challenging Behaviours

Kitwood (1995:7) describes environments where poor care is given as one in which:

“There is a sense of deadness, apathy, boredom, gloom and fear; most of those being cared for appear to have given up hope, their last resort being an occasional moan, or shout, or angry outburst”

In these environments which epitomise the “old culture”, Kitwood (1995) lists behaviours that are frequently referred to as “challenging”. These are simply seen as symptoms of the dementing process within the medical model, what Stokes (2000) refers to as the “standard paradigm”. However, within a more psychosocial conceptualisation of dementia, these behaviours are seen more in terms of communicating a need (Algase et al 1996; Frazier-Rios and Zembrzuski 2005).

In Activity 4.12 you considered how you would act if your needs were not being met. Your list may have included some of those more frequently attributed as “challenging behaviours” within dementia care. These include:

Hallucinations Delusions Anxiety Depression Apathy Agitation Aggression Wandering Disinhibition

They are important to consider because of:

their frequency: it is estimated that between 60-90% of people with dementia will display such behaviours (Lykestos et al 2002; Roberts et al 2005)

their effect: it is associated with caregiver stress (Livingstone et al 1996; Neville and Byrne 2007) and increased chance of admission to institutional care (Gilley et al 2004)


Stokes (2000) provides a model of assessment when such behaviours occur. This involves three stages:

1. Write the “label” for the “challenging behaviour” to be considered2. Formulate an operational definition for this behaviour3. Note the behavioural characteristics that occur as a result

This three-stage approach ensures that everyone knows what is understood when the “label” is used. It also has the benefit of ensuring that staff consider carefully what they see and interpret it in a more positive light.

A Worked Example: Wandering

Step One: The “label”

Stokes (2000) asks the pertinent question: “Why do we walk, and they wander?” The label “wandering” implies a meaningless behaviour, whereas the label “walking” implies some sort of purpose (be it a destination or just for fun). Hope and Fairburn (1990) proposed a descriptive typology of wandering behaviour. They defined nine types of wandering behaviour:

Trailing/checking Pottering Aimless walking Purpose not appropriate Purpose appropriate, excessive frequency Excessive activity Night-time walking Needs to be brought back home Attempts to leave home

The advantage of this typology is that it gives a sense of meaning and purpose to a behaviour that, according to the “standard paradigm”, was just a symptom of an illness.


Step Two: An “operational definition”

Stokes (2000:31) proposes the following definition of wandering:

“a single-minded determination to walk that is unresponsive to persuasion: (a) with no or only superficial awareness for personal safety (for example, an inability to return; impaired recognition of hazards); or (b) with no apparent regard for others (for example, in terms of time of day, duration, frequency or privacy); or (c) with no regard for personal welfare (thereby disrupting the essential behaviours of eating, sleeping, resting)”

This definition makes the useful distinction between wandering with risk (a) and wandering as nuisance (b), and wandering excessively (c).

Step Three: Behavioural characteristics

These include:

Pottering with purpose (for example, busying themselves) Following behaviours (for example, walking behind a carer) Apparently aimless walking Pacing/restless movement (for example, apparent inability to remain seated) Comfortable behaviour (pursuing personal habits) Comfortable remnants (pursuing tasks from the past) Trailing/tracking a significant other (for example, clinging to a carer) Searching for their past (for example, wanting to go home/work) Attachment behaviour (for example, seeking a person/place that gives sense of security) Exit behaviour (for example, persistently trying to “get out”) Place disorientation (for example, getting lost within a building) Walking with risk towards an appropriate goal (for example, trying to locate the toilet) Appropriate goal, inappropriate time (for example, seeking the toilet when they have just

been)

Algase et al (1996:12) note that:

“Wandering may reflect a variety of needs or goals under varying personal and environmental circumstances. Information about the relationship between these goals, needs, environmental conditions and particular rhythms and patterns of wandering, will provide the foundation for designing and targeting effective interventions.”


Although interventions employed to tackle wandering behaviour have largely been based on anecdotal evidence (Neville et al 2006), clearly their adoption is associated with the attitudes of professionals towards the behaviour. The “standard paradigm” would seek to diminish such behaviour:

“the strain can promote a range of coping strategies as extreme as physical restraints, chemical control (medication and alcohol) and “aggression”.” (Stokes 2000:31)

However, a more person-centred approach would see the behaviours as a means of communicating a need. This would depend largely upon the interpretation of why the behaviour was occurring. For example, the desire to “go home” may be an expression of the need to feel secure. After all, for most of us, home would be a familiar environment where one would feel safe and secure. If the person with dementia was wandering with a desire to locate the toilet, then the physical need of toileting would be the need that was not being met. The desire to locate a loved one could be an issue with the attachment need.


Consider a “challenging behaviour” that you experience within your own working context.

Utilising the tripartite assessment model proposed by Stokes (2000), consider an operational definition for the behaviour (the “label”) in question and outline the possible behavioural characteristics:

Label:

Operational Definition: Behavioural Characteristics: Finally, consider the possible reasons for such behaviour when viewed as a response to an unmet need.


Improving Communication

So far we have considered aspects of communication in general, and acknowledged that communication has a purpose. In the context of working with people with dementia, this purpose has been seen to be a response to an unmet need. However, the question remains, how do we improve the way we communicate with people with dementia? As NICE/SCIE (2007):17) notes:

“The importance of and use of communication skills for working with people with dementia and their carers; particular attention should be paid to pacing of communication, non-verbal communication and the use of language that is non-discriminatory, positive, and tailored to an individual’s ability”

To improve communication with people with dementia will result in:

Decreased “challenging behaviours” (Algase et al 1996; Stokes 2000) A promotion of the person’s autonomy and self-efficacy (Kitwood 1997; Sabat 2001) Maintaining self-care abilities and independence (Woods 1999; Allan 2001) An improvement in social interaction (Melin and Gotestam 1981) An improved sense of well-being for the person with dementia and consistency of care with

reduced staff turnover (McCallion et al 1999)

As we have already noted, communication difficulties arise in people with dementia due to the neuropathological problems inherent in the disease process. Innes and Capstick (2001: 138) neatly summarise some of these changes and possible responses.


Table 4.1

Common Communication Problems

Problem Possible Response

The person repeats words/phrases or particular questions (Perseveration)

The person may be worried about something and need reassurance and support

The person’s speech appears inconsequential (Paraphasia)

Go with the flow and respond to things that the person appears animated over

The person calls you their mother, for example (Nominal dysphasia)

Take it as a compliment – they must think a lot of you!

The person repeats your words back to you (Echolalia)

Could be a request for clarification, a call to slow-down, or a bit of fun on their part.

The person answers with another question or makes up a story to cover their memory problems (Confabulation)

Seek accuracy from other sources (e.g. family or friends) if needed. The person may just like telling stories as they feel this makes them interesting – so show them that they are interesting!

The person rarely or never verbally communicates (Aphasia)

Slow down your pacing of communication and wait long enough for a response. Be aware of nonverbal responses/indicators of feelings

The person has difficulty using the right words (Dysphasia)

Try to respond to the “sense” of what the person is saying

There have, however, been other approaches to improving the quality of communication with people with dementia. Two will be considered here by way of example: firstly, “verbal ping-pong” as advocated in the SPECAL approach (James 2008) and, secondly, the use of “talking mats” (Murphy et al 2007).


Verbal Ping-Pong

A novel approach to working with people with dementia is advocated by the SPECAL approach (James 2008). Although it proposes a complete approach to working with people with dementia, it makes some pertinent points regarding communication. It refers to “SPECALSENSE” in addressing the need to ensure that you do not present new information to the person with dementia. The theory behind this is that to do so results in the person becoming in a state of ill-being because of their problems in accessing and storing new information. As such, SPECALSENSE is based on three “commandments”:

Don’t ask questions Learn from the expert – your client! Never contradict

The first rule (don’t ask questions) is based on the issues of following even a simple question. For example, if you were asked: “Do you want a drink?” there are a further series of questions you would ask yourself before answering (for example, have I just had one? What do I fancy? What have I got in? Is there enough tea/coffee/milk/sugar? etc). These questions can be answered in a very short period of time for people without cognitive impairment. However, for the person with dementia, this could lead to distress and/or increased confusion. James (2008) cites an incident recited by Penny Garner, the founder of SPECAL to illustrate this point. At lunch with friends one day, the hostess asked the people present if anyone would like a second helping. Penny declined and gestured to her mother, who had dementia, to respond. Her mother’s face visibly turned grey and she glanced at her plate, then at the hostess, with no apparent comprehension of what was being asked of her. When another person told her she was “holding everyone up”, she stood up, apologised for holding them up, and announced that she must be going. Upon reflection, Penny realised that the problem was the question:

“It demanded information [her mother] did not have about the events that immediately preceded it. That also made sense of the sudden rise from the table to depart. She thought that Sam had provided her with a clue that she must move. She took the context he had offered and acted on it, completely in character … No wonder she was so perplexed when told to sit down again. It questioned the whole basis of her reality as profoundly as it would question yours if I was able to prove to you right now that you are someone other than the person whose name is on your birth certificate” (James, 2008:69)


In order to avoid such potentially distressing situations, SPECALSENSE advocates that the carer does not ask any questions of the person with dementia. Rather, they should engage in what is referred to as “verbal ping pong”. This is an approach that utilises your knowledge of the person’s likes and interests so as to improve their social interaction skills and personal sense of well-being. It involves the following:

Select a topic to discuss from areas of previous strength, happiness or expertise, at work or at home

Limbering up stage: Begin the engagement with some light conversation (what Burnard (2004) refers to as phatic communication), that is, about the weather, clothes, etc.

Lob over your first ball: that is, based on the topic you have chosen, make a casual statement pertaining to that topic. If no response, try a different format. The key is to keep doing it, noting how the person responds (both verbally and non-verbally). Begin by saying such things as: “perhaps…”, “I suppose…” or “I’ve heard that…”

Once there is a response, lob it back: it is important to respond in a very enthusiastic manner. Begin with such things as: “How fascinating”, “No! You’re pulling my leg!” or “Everything falls into place now!”

Note the precise words used by the person with dementia and repeat them verbatim after a brief pause

Be mindful to mirror their delivery, considering: speed, timing, and timbre

Match their body language as much as possible: consider, for example, their body posture, hand gestures, etc.

Keep the rally going: Once the person with dementia is responding, keep the communication process going with as little input as possible (for example, nods, single words, smile, etc.)

This approach has been shown to decrease ill-being, increase a sense of well-being, promote social interaction and a sense of self-worth (RCN 1999).


Select a person with dementia whom you know very well. Utilise the steps of “verbal ping-pong” stated above, and reflect on their impact on the person with dementia.


Talking Mats

Talking Mats is a low-technology tool that allows a person with dementia to express their opinions. It consists of a textured mat upon which are placed picture symbols as the communication process develops. The picture symbols utilised are:

A picture symbol that represents the topic to be discussed Picture symbols to represent possible options pertaining to the topic being discussed A visual scale that allows for the person to show the extent of their feelings about the topic

being discussed

Similar concepts have been around for some time. I remember working with one lady with Huntington’s disease and she had a board with several pictures on it representing various aspects of daily living (for example, a cup of tea, a toilet, a bed, etc) and she would point to whatever represented her need at that time. As such, it does not depend on verbal fluency, but merely on the ability of the person with dementia to understand what is being asked of them, what the possible options are, and the degree of feelings towards each option (for example, happy, sad or indifferent). In their evaluation on the use of Talking Maps with people with dementia, Murphy et al (2007) found that:

Talking Mats were more effective than either structured or unstructured interviews in eliciting their views about their well-being

They improved the participant’s understanding, the researcher’s understanding, participant engagement and the amount of time the participant could engage with the discussion

Even people in the latter stages of dementia could utilise Talking Mats to express their viewpoint


Reflect on how you would communicate with a person with dementia who has problems in verbally articulating their thoughts and feelings. How beneficial would low-technology apparatus such as Talking Mats be in your practice?


Unit Summary

This Unit has considered the important topic of communication. It has discussed what is meant by communication (it has a purpose and operates through a medium). We have considered some of the problems with the medium in relation to the person with dementia and have discussed the purpose of communication which is, namely, the need to meet an unmet need. We have considered the possible needs that a person with dementia has, and the expression of unmet need in terms of the presentation of so-called “challenging behaviours”. Finally, we have discussed some ways of improving our communication skills with people with dementia, both verbally (“verbal ping-pong”) and through the use of pictures (Talking Mats). Allan and Killick (2008:214) note that:

“our natural bias is to disregard or devalue the kinds of relationships and communication … which seems to lie outside the domain of full cognitive competence”

It is hoped that this Unit has emphasised that communication is still possible with people with dementia (Allan 2001) – it is just that we have to make the necessary adjustments to ensure that it can be achieved (Williams et al 2009).

Further Reading

Allan K and Killick J (2008) Communication and relationships: an inclusive social world In: Downs M and Bowers B (2008) Excellence in Dementia Care: Research into practice Open University Press: Maidenhead

Cohen-Mansfield J (2008) The language of behaviour In: Downs M and Bowers B (2008) Excellence in Dementia Care: Research into practice Open University Press: Maidenhead

References

Algase DL, Beck C, Kolanowski A, Whall A, Berent S, Richards K, et al (1996) Needdriven dementia-compromised behaviour: An alternative view of disruptive behaviour American Journal of Alzheimer’s Disease 11(6): 10–19

Allan K (2001) Communication and Consultation: exploring ways for staff to involve people with dementia in developing services Policy Press: Bristol


Allan K and Killick J (2008) Communication and relationships: an inclusive social world In: Downs M and Bowers B (eds) Excellence in Dementia Care: Research into Practice Open University: Maidenhead

Bradford Dementia Group (1997) Evaluating Dementia Care: the DCM Method (7th Edn) University of Bradford: Bradford

Burnard P (2004) Phatic communication and community nursing Journal of Community Nursing 18(3) [online:]

http://www.jcn.co.uk/journal.asp?MonthNum=03&YearNum=2004&Type=backissue&ArticleID=675 (accessed: 13-03-09)

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TUTOR TALK: Congratulations on coming to the end of this unit. Move on and answer the questions then return your completed test paper to the College for marking. Good luck and well done.

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ENVIRONMENTAL AUDITING AND REPORTING€¦ · Web viewTaken from Web 13/8/08. CERTIFICATE COURSE. UNIT FOUR COMMUNICATION AND DEMENTIA Introduction So far we have considered what