11/13/24, 8\:09 PM Guide | Dementia communication skills

Dementia communication skills

Table of contents

Introduction

Communicating with patients who have dementia and/or other forms of cognitive impairment is not just something that will be
encountered on an elderly care ward or in long-term care facilities. People with dementia get acutely ill too and can present in
A&E, a GP surgery or on any other ward. Being able to get the most out of communication is of the utmost importance for both
you and the patient.
Get worried about having to take the history? Dodge the patient in the corridor? Flounder about correcting? Not sure how to
attempt to di
with every patient, but we have some tips.

Redirection instead of correction

This is something I know a lot of people (myself included) struggle with. When a patient is talking about something you know
cannot be true\:
Do you agree with them?
Do you try to correct them?
The best answer here is a fairly unhelpful " T r y t o d o n e i t h e r"
.
Here's a scenario...
Mrs Jones is an 82-year-old lady who you know has moderate/severe Alzheimer's disease, but you're unsure about the rest of
her medical history. She has been on the ward for three days, being treated for a lower respiratory tract infection. She is
wandering through the ward and looks upset.
You\: " H e l l o , M r s J o n e s . M y n a m e i s .......... a n d I' m [ i n s e r t r o l e h e r e ] . I s e v e r y t h i n g o k a y ?"
Patient\: " N o , n o l o v e . I h a v e t o
I' m h e r e a n d g e t t i n g b e t t e r .
"
There are several ways to respond to this. It is improbable (but not impossible) that Mrs Jones' parents are alive and wondering
where she is.
'Correcting' Mrs Jones and attempting to orientate her to time and place may cause her to become more upset
and angry. Lying to Mrs Jones is not ethical, nor is it helpful to collude with the patient. Perhaps a helpful approach in this
situation would be to try to reassure Mrs Jones that you will ensure the necessary people will be informed.
For example\: " I c a n s e e y o u' r e q u i t e u p s e t , b u t t r y n o t t o w o r r y . Y o u r f a m i l y k n o w w h e r e y o u a r e a n d t h a t y o u a r e s a f e . I c a n ge t
t h e n u r s e s t o g i v e y o u r f a m i l y a c a l l i f y o u' d l i k e . W h o i s i n y o u r f a m i l y ?"
In this response, you haven't lied to the patient or colluded with them. Redirection in this sense is a good way to move the
conversation on, and avoid distress for the patient.
Also, see the point on "Validation" later on.

Respect

These are things which should be done with every patient..but have even greater importance in the confused patient\:
" H e l l o , m y n a m e i s ... a n d I a m [ r o l e ]" is missed worryingly often. In the references I've included information on Dr Kate
Granger's "H e l l o m y n a m e i s ...
" campaign. If you haven't read it, I really, really, really recommend you do!
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Find out the patient's preferred name. Use it. It often helps to start more formal.
Approach patients from in front whenever possible, to reduce the chance of startling them. These are often patients who are
not only confused but also have some visual and hearing impairment. If I was anxious and confused and someone crept up
on me, I reckon I'd get angry!
Try to be on a comfortable level for both of you\: some people can be patronised by having people kneel or sit beside them,
many people
important in a confused patient. Be aware that standing over someone can seem very threatening!
Patience with your patients, try not to interrupt (but steer the conversation when it's your turn)
Minimise the number of distractions/other sensory stimuli.
Give the patient the best chance they can of understanding you (e.g. glasses, hearing aids, pain-free)
Do what is natural for you. Some of the tips below contain things that might not feel right for you (some people are 'feelings'
types and some people not so much). Do what feels natural, and try not to force it.

Consistency

Consistent schedules, nursing and communication can help to keep a patient calm.

Keep conversation simple

This may seem a bit patronising, but I can rattle o
unfamiliar to a patient and asked about 6 questions in one. So give people time to process what you're saying. Use familiar
words. Refer to things/people by name if you can, rather than him/her/that. One question at a time, one decision at a time.
Choice is incredibly important, but too many options can overwhelm!
" W o u l d y o u l i k e c e r e a l o r t o a s t ?"
...
" H o t o r c o l d ?"
...
" R i c e c r i s p i e s o r c o r n
w a n t t o a s t w i t h j a m , o r j u s t t o a s t , o r p o r r i d g e o r r i c e c r i s p i e s o r W e e t a b i x o r c o r n
s o m e j u i c e t o o ?"
Similar rules apply when taking a history - one thing at a time, rather than " A n y h e a r t d i s e a s e , l u n g d i s e a s e o r d i a b e t e s ?"

Non-verbal communication

Often, as dementia progresses a person's verbal communication skills deteriorate.
Patients with dementia can be more sensitive to the body language of others, so moving suddenly/unexpectedly is best
avoided. Try to make sure your body language re
Talking to people who know the patient well (nursing sta
di

Collateral history

A great deal of knowledge can be gained from those who care for a patient with more severe stages of dementia. Knowledge
of what behaviour is normal (
any healthcare professional in terms of understanding your patient and allowing them to get the best care possible. Carers can
usually o

Avoid lots of direct questions

" D o y o u k n o w w h o t h i s i s ?"
,
" D o y o u k n o w w h o I a m ?"
- outside of an AMT (abbreviated mental test) or another cognitive test,
these type of questions are best avoided. Direct questions such as this can be very upsetting and frustrating to patients if they
can't answer. This goes back to the idea of giving choices rather than complex questions. If you can use visual cues, even better.
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Validation & re-iteration

Acknowledge what the person has said to you, even if it seemingly has no relevance to what you asked. If a person isn't
understanding the language you use (and it's that and not a hearing issue) try to rephrase or ask something in a di
Use visual cues - holding a cup when asking if they want tea or co
chest pain/heart attacks etc.
Validation involves addressing the emotions behind what is being said rather than focussing on the factual accuracy of the
person's thought.
If a patient is talking about being at work, instead of telling them they're in a hospital, not at work, try asking about their work
life. Where have they worked? What have they done for jobs? Did they get tea breaks? Tapping into pleasant memories can
also serve to calm as well as redirect, as can discussing something that can then happen (for example the cup of tea).
This can validate the person's feelings and redirect them, rather than trying to reorient them to our reality.

Positive rather than negative

Imagine this...
You are sat in front of a red button and a blue button.
Every time you stand up, you're sat back down by someone with no reason.
Every time someone passes you or engages with you, all they keep saying to you is " D o n' t s t a n d u p . D o n' t p r e s s t h e b l u e
b u t t o n .
"
I bet you're thinking about standing up and the blue button?
Again, with redirection, changing " D o n' t l e a v e t h e b a y !" to "L e t' s s i t d o w n h e r e f o r a l i t t l e w h i l e .
" can do the trick.

Physical touch

Use physical contact to communicate your care and a
reassurance you can give by holding or patting the person's hand or putting your arm around them if it feels right.
Remain aware of socio-cultural issues that may make this inappropriate.

Talking to non-verbal patients

Just because a patient themselves can not verbalise, doesn't mean you should refrain from talking to them. Letting the person
know of the plans can be reassuring if they can understand, and listening to a kind reassuring voice (even if the words aren't
understood) can allay anxiety. A lot of this is also very dependent on what you feel comfortable doing as a person.

"Challenging behaviour"

This in itself could be a whole article for me! I'm a big believer that 'challenging behaviour' is a person's reaction to an unmet
need (or needs).
If I'm not happy/hungry/need a wee\: I tell people, I
moan/eat/wee.
If I'm trying to talk to someone and they're just NOT GETTING what I'm saying, I get frustrated.
If you can no longer communicate your needs e
e
Some examples\:
Wandering
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Restlessness
Agitation
Incontinence
Perseveration (repetition)
Paranoia
Sleeplessness/'sundowning'
Hallucinations
Physically or sexually inappropriate behaviour
Try to identify triggers.
Distraction, validation, attempting to understand and meet needs are all key in reducing these symptoms. Try the VERA
approach!
VERA
Validate\: acknowledge the person's behaviour as a personal expression, not simply a symptom of dementia.
Emotional connection\: understand the emotional context behind the behaviour.
Reassurance\: Anything from presence and a calming voice, to a gentle hand on their arm.
Activity\: being occupied is a great anxiety-reliever! This can help to reduce agitation and give the person the feeling of
purpose.
S e e t h e V E R A F r a m e w o r k i n t h e r e f e r e n c e s f o r s o m e e x a m p l e s .

References

1. StarWards. Cambridge University Hospitals NHS Trust. Available from\: [LINK]
2. Dr Kate Granger's campaign for better communication.
"Hello, my name is...
"
. Available from\: [LINK]
3. VERA framework communicating with people who have dementia, by Blackhall A et al, Nursing Standard 26, 10, 35-39
4. Edward Leigh, How to communicate with patients with dementia. Available from\: [LINK]
5. Alzheimer's.org. Communicating with people who have dementia. Available from\: [LINK]
Source\: geekymedics.com
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