23: Late Stages: Communication and Activities

This program will:

  • Teach you about the changes in communication capacities in the late stages
  • Provide some principles and strategies for communication
  • Present principles and ideas for activities appropriate for the late stages
  • 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
  • Problems with speech and language increase considerably
  • Difficult for a caregiver to know what the person needs
  • Close observation of body language is important
  • Any utterance or gesture should be viewed as an attempt to convey meaning

What was wrong with this interaction?

  • A. Mary failed to read Robert’s non-verbal message.
  • B. Robert was being uncooperative by not following directions.
  • C. Too many directions were given at once.
  • D. Mary focused on the task rather than on Robert.
  • E. All of the above.

Choice A: Mary failed to read Robert’s non-verbal message, is a very good possibility.

  • When people have difficulty making their needs known with words, they will use non-verbal ways of saying what they need

Choice B: Robert was being uncooperative by not following directions, is a possibility.

  • Robert may be acting out because his needs were not being met

Choice C: Too many directions were given at once, is also a good possibility.

  • Persons in the later stages of dementia have low attention span and difficulty concentrating on a message or task

Choice D: Mary focused on the task rather than on Robert, is another good answer.

  • Robert’s frustration could have been avoided if Mary had been “person-focused” with her care rather than “task-focused”

Choice E: All of the above, is the best choice

  • Expressive speech: Forming words
  • Receptive aphasia: Cannot understand what is being said
  • Receptive speech: Understanding words
  • Expressive aphasia: Know what they want to say but cannot make the words come out
  • Auditory cortex: Part of the brain that “hears” what is being said
  • Wernicke’s area: Part of the brain where understanding occurs
  • To improve communication, caregivers should
  • Engage with the person
  • Speak clearly and simply
  • Use gestures and facial expressions
  • Say the important word last

Verbal:

  • Words
  • Other utterances
  • Non-verbal:
  • Facial expressions
  • Posture
  • Gestures
  • Clothing
  • Eye contact
  • Position relative to person
  • Verbal abilities in the late stages
  • Poor vocabulary
  • Repeat words or phrases
  • Echo what others say
  • Use poor grammar and diction
  • Speak only in jargon
  • Make noises that lack apparent meaning
  • Understanding is poor to non-existent
  • Caregiver strategies
  • Rely more on the emotional and behavioral messages and body language to understand their needs
  • Use body language, facial expressions, voice tone and inflections
  • Non-verbal communication skills are valuable tools in providing care
  • Resistance to care
  • Agitation and aggressiveness
  • Wandering
  • Combativeness
  • Withdrawal
  • Sense of awareness and well-being
  • Emotional expression
  • Recognizing emotions in others
  • Express pleasure and displeasure
  • TAKE INTO CONSIDERATION
  • Hearing and vision loss
  • Fatigue
  • Check eye glasses and hearing aids
  • Short attention and concentration difficulties
  • CONVERSATION GUIDELINES
  • Introduce yourself
  • Sit close and make eye contact
  • Use preferred name
  • Speak clearly and slowly in a normal tone
  • Pleasant demeanor
  • ENVIRONMENT
  • Quiet setting without distractions
  • Comfortable, familiar setting
  • Speak softly, clearly, and slowly
  • Use nouns
  • Say the important word last
  • Give simple directions, one at a time
  • Related to the task at hand
  • Close to the time they need to be carried out
  • Use a “positive” mode
  • Use pleasant expressions, pictures, gestures and demonstration
  • Attentive and respectful
  • Make eye contact
  • Be patient
  • Listen and allow time for a response
  • Don’t interrupt or correct
  • Observe non-verbal messages
  • Focus on emotional communication
  • Double check their message
  • If they digress or lose their train of thought
  • Repeat last words said
  • Summarize what was said
  • Ask appropriate questions
  • Repeat or restate things as needed
  • Take a break if frustration develops
  • Affirm emotional content of message
  • Reflect back what you believe is the meaning
  • Validate emotions
  • Rephrase or restate concerns
  • Be aware of person’s history
  • Redirect to reduce anxiety
  • Careful listening and observation of body language and context
  • Gentle touch
  • Ask permission
  • Observe for signs of objection or resistance
  • Obtain permission to or at least provide a “warning” of what is to take place
  • Enjoy quality time with their affected loved ones
  • Gently stroke their arm
  • Hold their hand
  • Read to them
  • Sit with them
  • As death approaches, people need gentle care and family
  • Attend to spiritual needs
  • Should be part of hospice care
  • Dementia causes changes in the brain that affect speech and understanding
  • Expressive and receptive aphasias can lead to expressions of frustration
  • Nonverbal forms of communication become more important
  • Observe facial expressions, body language, context, and the tone of utterances
  • Consider the person’s vision and hearing loss and the communication environment
  • Give simple, positive directions
  • Attend to the person and the emotional content
  • Use empathy and validation
  • Convey a pleasant attitude
  • Listen and observe
  • Use appropriate, gentle touch
  • Continue to show respect
  • Meaningful and pleasurable activities
  • Interaction with family or staff
  • Diversions
  • Purpose is to affirm dignity and provide pleasure and opportunities for success
  • Recognize age & gender
  • Consider interests, personal preferences, beliefs, culture, life experiences and functional capacities
  • Have purpose and meaning
  • Reinforce retained capacities
  • Give pleasure
  • Allow for success at their level of abilities
  • Show respect and affirm dignity
  • Self-Care (Personal Care)
  • Bathing, dressing, grooming, eating, toileting
  • Make it a social time
  • Compliment
  • Singing
  • Recite poems/rhymes
  • Family stories
  • Show respect, reinforce retained capacities, and recognize personal preferences
  • Watching bird in an aviary
  • Enjoying a garden
  • Visiting with a children’s group
  • Listening to music
  • Singing
  • Attending services
  • Folding towels or napkins
  • Stirring batter
  • Group activities
  • Shelling peas
  • Walking
  • Chair exercises
  • Passive exercise
  • Meaningful and pleasurable activities are essential for quality of life
  • Activities can involve self care, productivity, or leisure
  • Physical exercise is an important activity that can be modified to the person’s level of ability
  • All activities should respect individuals and their personal preferences and interests, affirm their dignity, give pleasure, have purpose and meaning, reinforce retained capacities, and allow for success

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

Edited by:
Sasha Asdourian

www.LightBridgeHealthcare.com

22: Traveling, Driving, Holidays & Special Occasions

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

Click here to open Certificate of Completion
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