Question
As health care professionals, should we alter our communication depending on the stage of dementia a patient is in?
Answer
In healthcare, adapting our communication approaches in accordance with the varying stages of dementia is pivotal. The effectiveness of our strategies hinges on a nuanced understanding of the patient's condition.
During the early stages, it is imperative not to make assumptions about a person's communicative abilities. Memory impairment doesn't equate to a decline in intellectual capacity. Instead of automatically adjusting our tone, volume, or withholding information, we should include them in conversations. Speaking directly to the individual, allowing time for responses, and avoiding premature assumptions are crucial elements.
As the disease progresses into the middle stages, one-on-one communication proves most effective. Clear, deliberate speech, sustained eye contact, and providing ample response time remain essential. Visual supports, such as written instructions, can aid in comprehension, enhancing the individual's ability to perform tasks.
In the late stages, a respectful and dignified approach becomes even more paramount. Approaching the individual from the front, identifying oneself, and clearly stating intentions are crucial. They may not remember who you are. Reading nonverbal cues, such as tone of voice and facial expressions, becomes increasingly important. Inferring the individual's emotions and responding accordingly fosters a more meaningful connection.
Regardless of the stage, condescension is never appropriate. Recognizing the person's identity and avoiding assumptions about their capabilities is vital.
Compensatory strategies, both verbal and written, can be employed to support communication.
Verbal compensatory strategies can include describing or spelling out words and asking clarifying questions to help improve understanding. Non-verbal compensatory strategies can include pointing, gesturing,or facial expressions to help a patient communicate their wants, needs, and pain if unable to do so verbally.
Written compensatory strategies can include alternative methods, such as writing or finger spelling, which can assist individuals in overcoming word retrieval challenges. When someone struggles to find a specific word, guiding them through a focused thought process, asking about relevant details, and narrowing down options can be effective. For instance, if they can't recall the word "salt" while asking for it, prompting them to think about its purpose, where it's found, or the starting sound can aid in word recall. Employing strategies that structure conversations with choices, rather than broad inquiries, can simplify communication. Instead of asking a general question like "What do you want for dinner tonight?" offering specific options like "Spaghetti or pot roast?" facilitates easier responses.
Enhancing engagement in conversations involves crafting questions that are specific and offer choices. Simple yes/no inquiries empower individuals to respond easily. Open-ended questions that encourage sharing opinions are effective in fostering meaningful communication. For instance, instead of asking about a challenging recall like breakfast, inquire about preferences or opinions on food. Seeking advice is a valuable approach, prompting individuals to share their thoughts and experiences. By asking for advice on topics like choosing a hostess gift or holiday food, you stimulate memory and encourage discussion. It's crucial to respect opinions, especially for those with dementia or Alzheimer's, as it fosters confidence in communication and allows them to share without judgment.
Ultimately, the goal is to adapt our communication strategies with sensitivity, ensuring that individuals with dementia are consistently treated with respect and afforded the opportunity to express themselves throughout the progression of the disease.
This Ask the Expert is an edited excerpt from the course Alzheimer's and Other Dementias: Overview for Healthcare Professionals by Megan L. Malone, MA, CCC-SLP
