How dementia affects communication

Communication is the foundation of resident choice, yet communication skills are among the first skills that people with dementia lose. Unable to express their needs, feelings and thoughts verbally, many people with cognitive decline will become frustrated, act out or even become violent.

“All behavior is communication,” said Dayne DuVall, who served for the past three years as chief operating officer of National Certification Board for Alzheimer Care (NCBAC) and is now the senior director of Second Wind Dreams. In order to provide the best possible care for resident with Alzheimer’s disease and other dementia-related conditions, caregivers and families need to learn how to listen and converse differently, he explained in his session presentation today at the Memory Care Forum in Philadelphia.

Talking and listening

Forget trying to argue or correct a resident’s inaccuracies and allow the resident to be in their reality of the moment. “You’ll never win an argument with a person who has dementia. So she thinks you’re her sister—so what. It’s not about being accurate. It’s about making her feel safe and secure.”

Learn to listen as much as you talk. “Communication is also how they translate you,” he added. “They may be listening, but maybe they understand only one out of every four words.”

When asking for their input and preferences, keep the questions simple and don’t ask multiple questions at once. “They deserve choices in life, but they need help thinking about them one at a time,” he says. “They can get so frustrated because they know they should know the answer, but you’ve stocked the deck against them by flooding them with too many options all at once.”

Some people with cognitive decline can lose their “social filters” and spout inappropriate or cruel statements. It’s important to train staff and families to understand that it’s the disease talking, DuVall says. “Loss of motor skills, loss memory, loss of executive decision functions and aphasia can all lead to behaviors. Clinicians know all this, but can you educate all the way down your staff line?”

Non-verbal communication

Speaking may be a challenge, but most people living with dementia can communicate plenty in non-verbal ways. Head nodding, leaning while walking, shaking or twitching, body language and facial expressions can all be big clues to what a resident is trying to express. “This is where consistent staffing is an advantage,” DuVall says. “Listen with your eyes and observe changes.”

Watch breathing patterns for changes in breathing and aspiration sounds, since pain often is expressed in altered or irregular breathing patterns.

Non-verbal communication is a two-way street, and caregivers can broadcast negative vibes on a frustrating day, too. But people with dementia can pick up on the tiniest non-verbal cues from staff, and they can act out or shut down as a reaction to the staff member’s stressors, DuVall warns.

Activities need to be simple enough for the residents to participate in, but not to simple they become mundane and frustratingly boring. “Recognize their impairments, but focus on their preserved functions,” he says. “It’s not about what they can’t do, but what they can do. If ‘Sort the Buttons’ is the best you can do in terms of their activities, you need to rethink your engagement.”

Pamela Tabar

Pamela Tabar was editor-in-chief of I Advance Senior Care from 2013-2018. She has worked as a writer and editor for healthcare business media since 1998, including as News Editor of Healthcare Informatics. She has a master’s degree in journalism from Kent State University and a master’s degree in English from the University of York, England.