11: Guidelines for Improving Communication

This program will help you to:

  • Understand the changes in communication associated with Alzheimer’s disease
  • Understand why good communication skills are critical
  • Apply these principles and strategies to improve communication
  • Create environments that help communication
  • There are no easy answer when its comes to the care of another
  • Our hope is to offer you useful information and guidelines for caring for someone with dementia
  • These guidelines will need to be adjusted to suit your own individual needs
  • Language understanding decreases
  • Difficulty expressing thoughts, emotions and needs
  • Not making sense or repeating things
  • Lose reading and writing skills
  • Lose recent memories before distant ones
  • Shorter attention span
  • Loss of conversational social skills
  • Assist with functioning and performing activities of daily living
  • Gather information about needs or wants
  • Monitor for pain or discomfort
  • Protect and provide support
  • Help maintain connections to the world
  • Prevent problems and difficult behaviors
  • Build a caring, trusting relationship
  • Show respect
  • Try to say please and thank you
  • Avoid using eldertalk
  • Avoid topics that trigger unwanted behavior
  • Be sensitive to signs of agitation and difficult behaviors
  • Use non-verbal forms of communication
  • Be flexible and patient
  • Have a good sense of humor
  • Show a positive attitude
  • Approach caregiving as if everyone is an important member of a team
  • Try to encourage and help them to contribute
  • Use a non-judgmental approach
  • Remain open-minded and learn about cultural differences
  • Give priority to the person’s needs over your own

Why did Robert fail to follow Sally’s instructions?

  • A. Sally did not get Robert’s attention before starting to speak.
  • B. Sally assumed that Robert knew where the bathroom was.
  • C. Sally gave too many instructions at once.
  • D. Sally left without seeing if Robert understood the instructions or needed assistance.
  • E. All of the above.

Choice A Sally did not get Robert’s attention before starting to speak, is an excellent choice. Always check to see whether the person is paying attention

Choice B Sally assumed that Robert knew where the bathroom was, is also a great choice. Do not assume that someone with dementia remembers things from day to day

Choice C: Sally gave too many instructions at once, is a very good answer. When giving instructions, use simple sentences with no more than one or two directions at a time.

Choice D Sally left without seeing if Robert understood the instructions or needed assistance, is another excellent answer. Making sure that the person understood what was said and is able to follow the instructions are essential parts of good communication Choice E All the above, is the best answer.

  • Make sure the person is paying attention
  • Watch and listen
  • Speak slowly and clearly with a pleasant tone of voice
  • Use body language to help convey messages
  • Help the person to participate in conversations
  • Find words
  • Offer clues and cues
  • Demonstrate, point, show
  • Avoid topics or words that point out memory problems
  • Talk about things that are easily remembered
  • Do not rush while communicating
  • Avoid pointing out errors, criticizing, scolding, or embarrassing the person
  • Focus on one topic at a time
  • Keep sentences short, simple, and direct
  • Use empathy and validation
  • Use the person’s preferred name
  • Use rephrasing to show that you understand
  • Ask questions when appropriate
  • Reflecting or restating the words lets the person know that you are paying attention
  • Matching emotions with words acknowledges the person’s emotions and body language
  • Reinforce using reassuring verbal and body language cues
  • Reminiscing can help redirect in situations of distress
  • Break down the activity into one or two simple steps at a time
  • Focus on familiar tasks and encourage the person to practice
  • Give specific, simple instructions
  • Be positive and supportive
  • Demonstrate steps if necessary
  • Use chaining (link activities together for logical prompting of next action)
  • Breaking down getting dressed by each article of clothing
  • Use hand-over-hand guidance if coaching is needed
  • Use cuing and prompting
  • Try to ask easy questions that require yes or no responses
  • Limit the number of possible choices to two or three if possible
  • Try to provide information rather than asking for it
  • Try to avoid using why questions
  • Try using the unfolding technique
  • Reduce noise and distractions
  • Try to maintain consistent routines and habits
  • Use calm voice tones and slow movements
  • Create a pleasant environment
  • Reduce glare from lights
  • Provide extra light on detailed tasks
  • Use stark color contrasts
  • Avoid standing in backlighting
  • Make sure that your face is easy to see
  • Directly face the person
  • Provide handheld magnification
  • Provide clean eyeglasses that fit properly
  • Allow plenty of time
  • Have the person’s full attention
  • Face the person directly
  • Lower your voice pitch
  • Speak slowly and distinctly
  • Do not shout
  • Reduce background noise and distractions
  • Make sure hearing aids are working
  • Use body language
  • Match the content of your message with the environment
    • Goals of communication
    • Build a trusting relationship
    • Help perform daily activities
    • Improve quality of life

PRINCIPLES OF GOOD COMMUNICATION

    • Show respect
    • Show flexibility and patience
    • Avoid topics that trigger agitation
    • Be sensitive to non-verbal behavior

STRATEGIES FOR IMPROVING COMMUNICATION

  • Get the person’s attention
  • Focus on one idea
  • Speak clearly, using simplified instructions and important words last
  • Use body language and facial expressions that match your words
  • Use cues, prompts, questioning techniques, and limiting options
  • Create a pleasant environment without distractions or sources of stress
  • Do not argue, criticize, scold or embarrass

Written by:
Catherine M. Harris, PhD, RNCS.
Mindy J. Kim-Miller, MD, PhD

Edited by:
Sasha Asdourian

www.LightBridgeHealthcare.com

10: Sleep: Managing Hallucinations, Illusions, Delusions, Nightmaires, Sundowning, Anxiety And Depression

Select the best answer from the list of choices following each question.

Click here to open Certificate of Completion
  • Bates, J., Boote, J. & Beverley, C.A. (2003). Psychosocial interventions for people with milder dementing illness: A systematic review. Journal of Advanced Nursing, 45 (6), 644-658.
  • Bayles, K. (2003). Effects of working memory deficits on the communicative functioning of Alzheimer’s dementia patients. Journal of Communication Disorders, 36 (2003), 209-219.
  • Bayles, K.A., Tomoeda, C.K., Cruz, R.F. & Mahendra, N. (2000). Communication abilities of individuals with late-stage Alzheimer Disease. Alzheimer Disease and Associated Disorders, 14 (3), 176-181.
  • Bethea, L.S., Travis, S.S., & Pecchioni, L. (2000). Family caregivers’ use of humor in conveying information about caring for dependent older adults. Health Communication, 12 (4), 361-376.
  • Broton, M., & Koger, S.M. (2000). The impact of music therapy on language functioning in dementia. Journal of Music Therapy Association, 37 (3), 183-195.
  • Chalmers, J. (2000). Behavior management and communication strategies for dental professionals when caring for patients with dementia. Special Care in Dentistry, 20 (4), 147-154.
  • Ekman, S., Norberg, A., Viitanen, M. & Winblad, B. (1991). Care of demented patients with severe communication problems. Scandinavian Journal of Caring Science, 5 (3), 163-170.
  • Ekman, S., Wahlin, T., Biitanen, M., Norberg, A., & Wiknblad, B. (1994). Preconditions for communication in the care of bilingual demented persons. International Psychogeriatrics, 6 (1), 105-120.
  • Epps, C.D. (2001). Recognizing pain in the institutionalized elder with dementia. Geriatric Nursing, 22 (2), 71-77.
  • Gerdner, L.A., Josefsson, K., & Kihlgren, M. (1998). Probable reasons for expressed agitation in persons with dementia. Clinical Nursing Research. 7 (2), 189-200).
  • Gotell, E., Brown, S., & Ekman, S. (2002). Caregiver singing and background music in dementia care. Western Journal of Nursing Research, 24 (2), 195-216.
  • Gleeson, M. & Timmins, F. (2004). Touch: a fundamental aspect of communication with older people experiencing dementia. Nursing Older People 16 (2), 18-21.
  • Hadjistavropoulos, T. & Craig, K.D. (2002). A theoretical framework for understanding self-report and observational measures of pain. Behaviour Research and Therapy, 40, (2002), 551-570.
  • Hansebo, G. & Kihlgren, M. (2002). Carers’ interactions with patients suffering from severe dementia: a difficult balance to facilitate mutual togetherness. Journal of Clinical Nursing, 11, 225-236.
  • Holm, A., Lepp, M., & Ringsberg, K. (2005). Dementia: involving patients in storytelling—a caring intervention. Journal of Clinical Nursing, 14, 256-263.
  • Kim, W.J., & Buschmann, M.T. (1999). The effect of expressive physical touch on patients with dementia. International Journal Nursing Studies, 36 (1999), 235-243.
  • Maas, M.L., Reed, D., Park, M., Specht, J.P., Schutte, D., Kelley, L.S., Swanson, E.A., Trip-Reimer, T. & Buckwalter, K.C. (2004). Outcomes of family involvement in care intervention for caregivers of individuals with dementia. Nursing Research, 53 (2), 76-86.
  • Mahendra, N. & Arkin, S. (2003). Effects of four years of exercise, language and, social interventions on Alzheimer discourse. Journal of Communication Disorders, 36 (2003), 395-422.
  • Mayhew, P. A., Acton, G.J., Yauk, S., & Hopkins, B. A. (2001). Communication from individuals with advanced DAT: Can it provide clues to their sense of self-awareness and well-being. Geriatric Nursing, 22 (2), 106-110.
  • Moore, T. & Hollet, J. (2003). Giving voice to persons living with dementia: The researcher’s opportunities and challenges. Nursing Science Quarterly, 16 (2), 163-167.
  • Murray, L.L., Dickerson, S., Lichtenberger, B., & Cox, C. (2003). Effects of toy stimulation on the cognitive, communicative and emotional functioning of adults in the middle stages of Alzheimer’s disease. Journal of Communication Disorders, 36 (2003), 101-127.
  • Normann, H, K., Norberg, A.& Asplund, K. (2002). Confirmation and lucidity during conversations with a woman with severe dementia. Journal of Advanced Nursing, 39 (4), 370-376.
  • O’Donovan, S. (1996). A validation approach to severely demented clients. Nursing Standard. 11 (13-15), 48-52.
  • Packer, T. (1999). Dementia Part 3: communication. Professional Nurse, 14, (10), 727-730.
  • Reese, D. (December, 1998). Through their eyes. Contemporary Long Term Care, pp. 44-52.
  • Ripich, D. (1994). Functional communication with AD patients: A caregiver training program. Alzheimer Disease and Associated Disorders, 8 (Supplement 3), 95,109.
  • Roudier, M., Marcie, P., Grancher, A-S., Tzortzis, C., Starkstein, S., & Boller, F. (1998). Discrimination of facial identity and of emotions in Alzheimer’s disease. Journal of Neurological Sciences, 154 (1998), 151-158.
  • Runqvist, E.,& Severinsoon, W. (1999). Caring relationships with patients suffering from dementia—an interview study. Journal of Advanced Nursing. 29 (4), 800-807.
  • Savenstedt, S., Brulin, C., & Sandman, P-O. (2003). Family members’ narrated experiences of communicating via video-phone with patients with dementia staying at a nursing home. Journal of Telemedicine and Telecare, 9, 216-220.
  • Silvestri, A., Rosano, G., Zannino, G., Ricca, F., Marigliano, V., & Fini, M. (2004). Behavioral Disturbances in Alzheimer’s Disease: A nonpharmacological.
  • therapeutic approach. Archives of Gerontology, Geriatric Supplement 9, 279-286.
  • Smith, J. (2001). Communication and dementia. Nursing Older People. 12 (10), 14-15.
  • Sutor, B., Rummans, T.A., & Smith, G.E. (2001). Assessment and management of behavioral disturbances in nursing home patients with dementia. Mayo Foundation for Medical Education and Research, 76 (5), 540-550.
  • Tappen, R.M., Williams-Burgess, C., Edelstein, J., Touhy, T., & Fishman, S. (1997). Communicating with individuals with Alzheimer’s disease: Examination of recommended strategies. Archives of Psychiatric Nursing, 11 (5), 249-256.
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