SPECIFICS AND METHODS FOR COMMUNICATION WITH DEMENTIA PATIENTS
SPECIFICS AND METHODS FOR COMMUNICATION WITH DEMENTIA PATIENTS
Liubov Erlikh
independent researcher,
Israel, Tel Aviv
ABSTRACT
This article provides an explanation for the nature of such a disease as dementia, as well as an insight into the urgency of the problem of organizing quality communication with people suffering from this disease. Based on a research performed by scientists from Linchopin University, the article considers the importance of the command of the patient’s language, as well as alternative methods for communication with such a patient. Later on, the methods for quality communication implementation are reviewed here based on an investigation done by researchers from Radboud University. They analyze two methodologies, one of which is communication at a certain fixed time and the other is the implementation of communication into the patient's routine. An important part of this article is the description of “quality communication” from the point of view of the patients themselves, based on a study conducted by scientists from the University of Michigan.
Keywords: dementia; communication; help; recommendations in dementia care; methods; dementia care.
Introduction:
Dementia is a syndrome resulting from a brain disorder, which is manifested by impairment of cognitive functions including memory, speech, spatial orientation, mentation; behavioral disorders, and communication ability disorders.
The wellbeing of a person suffering from dementia can deteriorate for a number of reasons; here we are going to consider one of them, which is impairment of cognitive functions. Oftentimes, the symptoms are as follows: aggressive behavior, apathy, stubbornness of the person in care, which creates difficulties in their communication with the medical staff, as well as their family and friends. Another cause of communication impairment is the vocal apparatus disorder. It can manifest by forgetting words, confusing their meanings; one of the consequences of this disease can also be muteness.
Communication with people suffering from dementia has different aspects which should be paid regard to. It is associated with the peculiarity of world perception by the person in care, as well as with the specifics of the disease manifestations.
This article presents the data of three studies touching upon different nuances and possible difficulties in the communication with patients, methods which are efficiently used in communication, and the perspective on the issue from the point of view of the person in care.
This topic is urgent for medical staff, as well as for relatives and friends of people with dementia. The results of the researches presented here may be of assistance in building quality communication, which would provide for most comfortable and favorable conditions of the patient’s existence. In addition to that, it will facilitate the challenging task of care provision for the carers.
Methods’ review and discussion.
Dementia can manifest in different forms, which should be treated in a certain manner. The study conducted by scientists Lisa Starndrus and Eleonora Antelius (Linchopin University, Sweden) touches upon one of the most important components of the life where dementia patients and their caregivers encounter the greatest number of challenges: communication. This disease has a negative effect on someone’s ability to initiate and maintain communication. The ability to communicate with other people being an integral part of the relations with those around the patient, impairment in these skills may lead to their social isolation. In polyglots (people having command of several languages), one of the disease symptom manifestations is confusing the languages or totally forgetting all of them except for their native language. The research objective is to review the methods for taking care of the institution’s residents by the medical staff with different cultural backgrounds. Special attention is paid to bilingual interaction when the people do not speak the same language, and the ways of solving the issue.
Over the course of one year, the scientists observed the communication between the persons in care who spoke Swedish (the main language of a Swedish medical institution) or other languages, and the center’s employees some of whom had command of the same languages as the persons in care, such as Finnish.
With regard to the findings of the study, it can be concluded that communication in the patient’s native language is critically important in some cases. An example is provided in the findings: a person in care named Paul constantly began to worry that he had to pay his bills or pay the rent, and searched for his wallet. Being able to speak the same language with him, the staff had a chance to explain to the person in care that he needn’t worry about that as everything had already been paid for. Someone who did not know the patient’s native language wouldn’t have been able to understand the cause of his anxiety, and consequently, to set his mind at ease.
Another example is Anastasia whose only remaining language was Polish. She was a very sociable person and wanted to communicate with the people around her, but the other patients couldn’t speak her language, and she was unable to take part in common activities. It made her frustrated, Anastasia expressed a negative opinion of the other people’s inability to speak Polish, and felt lonely.
Nonetheless, the study demonstrates that despite it is necessary in a number of cases to know the language spoken by the patient, there are situations where this skill would be of no use for building quality communication. Due to impairment in the functioning of the brain regions responsible for speech, the medical center residents sometimes pronounced a number of random words in their native language, which made no sense. Even their friends and relatives were unable to understand what the patients tried to convey because their speech was disjointed.
In situations where speech is not the best way of communication, nonverbal methods of communication can be used, such as gestures. For instance, you don’t necessarily have to use words to ask someone to sit down. You can, for example, point at the chair, call them by their name, or bring them somewhere by the hand and help them sit down. In this case, the level of command of any language is unimportant.
After polling the staff, it was concluded that the degree of communication quality also depended on the patients themselves. The absence of possibility to speak the same language was a great problem with some of them, while it didn’t cause any difficulties with others. It depended on how much the patient talked, and how loudly, in a language unknown to the caregiver (because it exerted a kind of pressure on the staff, and hindered communication).
The study also reviews other aspects of communication and the ways they can help in the interaction with the persons in care:
Body language. Even if the staff cannot speak the patient’s language, they have to communicate anyway, and this is achieved by way of reading the body language through facial gestures, the positions of the hands, and most importantly, the expression of the eyes. It is very important for the staff to be kind and patient, and also to avoid showing stress when talking to the persons in care because they can feel it at the emotional level and will respond in kind, mirroring the caregiver’s behavior. The staff members must create a positive atmosphere of comfort with the aid of voice and tone, as well as smiling.
Embodiment. There is no analog for this word in the Russian language, in this context it means using demonstrative instructions instead of oral ones. For example, an alternative for saying to the patient, “You must eat with a fork and not with your hands”, would be to put the cutlery into their hand, scoop some food, and draw it to their mouth. Oftentimes, this results in the patient with dementia automatically beginning to eat on his or her own. The scientists refer to a number of studies stating that the body “has memory”, even if it seems that the actions have lost sense. This can be used for everyday things like brushing their teeth, combing their hair, as well as other actions which used to be habitual for the patients before they became disabled. This theory also often works in the places where the persons in care gather in groups. The patients observe one another and begin to “mirror” the others’ behavior. This technique can be used both by residents who speak the medical staff’s language and by those who cannot speak Swedish.
The environment. A person’s environment can play a great role in reaching mutual understanding. In this case, communication is achieved by way of positioning items of furniture and people in a special manner. In other words, through creating a setting for the person in care that would correspond to a certain action you can help them understand where and why they are. For example, in a room where there is a table with dishes on it a medical institution resident may realize that it is mealtime and he or she is a part of a group. This helps reduce the level of lack of confidence and facilitates communication in the context.
Duration. Another important aspect of interrelations is the time devoted to interaction. This is applicable both to everyday situations and to building long-term relations. An example of the first type of interaction is a situation where the patient is confused, the staff should devote more time to setting his or her mind at ease. The study presents such a case: to say on the fly to Paul who is searching for his wallet that he needn’t do it will not bring the patient peace of mind, he will continue his search. The situation requires a longer conversation with some arguments presented. It should be noted that the medical staff would often pose a question to the person in care and walk away without waiting for his or her immediate response, which is most often pronounced a few minutes later. This is a bright illustration of the importance of the time aspect of communication, and highlights the necessity for patience in the communication with the persons in care.
The second aspect of the importance of time is building quality long-term communication. An example of correct use of time is the story of Harold. He is defined as a patient from the “non-speaking” group, but this statement is not true. A few of the center’s employees use a method of communication that has been individually developed for him over time: during some interval of time the caregivers talk between themselves, involving Harold in the conversation, or directly to him, maintaining eye contact, addressing him (without waiting for his response), and touching his hand. At some point, Harold stands up and wants to leave but they are aware of this stage and ask him to come back, carefully getting him to sit down. After an indefinite interval of time, he pronounces a phrase or a word. They refer to this method as “waking Harold up”. Thus, it appears that if the staff members insist on communication with him and devote some time to it, he begins to interact with them and to use forms of communication which he does not use in other situations.
Close acquaintance. Having reviewed the particular situation with Harold which demonstrates that the communication method had been worked out due to long-term communication, there is an additional positive aspect of this which should be highlighted: time is important not only at certain points but also over the longer term. The trend shows that both sides (the carer and the person in care) grew closer over the course of long-term communication. Their communication improved due to getting to know each other, getting familiar with the ways of expressing their needs and determining the meaning of signals. Oftentimes, people work out their own ways of communicating over time.
An interesting example of communication that has been built due to time is Justin. He practically does not speak, and his relatives suppose that he might understand them better when they talk to him in Finnish. Also, he keeps his eyes closed practically all the time. Despite the patient’s silence, it did not cause any problem for the staff to help him with eating. Over the time they had spent together they were able to find out that that when he wanted another spoonful of food, he would open his mouth. And after being helped with the first spoonful, he didn’t require any further reminders; he would continue to chew his food and open his mouth again and again until he was full. That was an easy and problem-free way of helping the person in care with his concerns.
The medical staff notes that “getting to know one another” is a very important stage of the communication building process. In this way, the person in care begins to feel more comfortable, and the carer finds out about the specific features of communication with each patient individually. In the interview, some mistakes were also mentioned which had not taken place due to the staff’s “incompetence” but due to the fact that they did not know about the patients’ special features and the latter did not know about theirs.
Having considered the study conducted by scientists from Linchopin University, it can be concluded that being able to speak the same language with a person suffering from dementia is important in a number of situation. But there are examples where it is impossible or does not have the required effect. In such cases, alternative methods should be used for building communication, such as body language or embodiment. It is also necessary to devote time to solving particular situations and to building quality communication.
Having reviewed the importance of communication and the ways of building it, it is necessary to pay attention to implementing it into the life of people suffering from dementia. Scientists from Radboud University in Nijmegen, the Netherlands, have studied the impact of non-pharmacological intervention in nursing homes on the communication between the patients diagnosed with dementia and the medical staff, as well as its effect on the neuropsychiatric symptoms. The study used the findings of 19 scientific investigations which specialized in the “sessions at a fixed time” structured system of communication and in adding the communication techniques into the patients’ “daily routine”. Communication was carried out by means of speech, gestures, writing, glances, and tone.
The first part of the analysis is focused on 10 studies, the main subject of which was to consider the efficiency of sessions at a fixed time, including conversations during walks (e.g., 30 minutes, 3 times per week), participation in validation therapy groups (30 minutes, 4 times per week), programs for review of life (twice per week), and active therapy (30 minutes, 3 times per week).
The second part is focused on 9 studies based on and comprised of intervention into the daily routine and including training programs for the staff about the techniques of communicating with the patients, such as practicing non-verbal sensitivity, behavior analysis, communicating one on one with the person in care, and emotionally oriented communication.
Based on the findings of this research, it can be concluded that these methods did not have a significant impact on the patients’ neuropsychiatric measures, and this aspect of the disease requires further research. Nonetheless, the positive outcome has been that “sessions at a fixed time” and implementation of communication techniques into the patients’ “daily routine” had a favorable impact on the communication between them and the medical staff. These methods can help improve the quality of care of residents with dementia by way of their implementation into interpersonal communication.
Having paid attention to the ways for building communication and implementing it into the life of people suffering from dementia, it is worth giving further consideration to a research performed by scientists from Manchester University who considered communication from the point of view of the person in care: what exactly is important for him or her in the communication, and what properties make the interaction good and meaningful. They state that communication problems occur in all dementia types, and range from confusing and forgetting words at early stages to muteness or gabbling. This effect of the disease has a great impact on the patient’s comfortable life activity.
The study highlights that it is admitted more and more often that people with dementia have an opinion, and it must be taken into account when making recommendations on communicating with them, in order to make sure that the actions would match their needs. Responses to communication may be verbal with the use of words, or through all sorts of signals (the glance, involuntary body movements, sounds, etc.).
The article mentions the key recommendations for building quality communication with people suffering from dementia, elicited from the patients’ responses: verbal communication by way of pronouncing short and simple phrases, a calm tone of speech, maintaining eye contact, touches, and eliminating any external distracting factors. There was also a positive response, from the patients’ point of view, to the use of alternative methods, such as boards with pictures or biography books. An important factor was pointed out in building quality communication, which is showing respect for the person in care and consideration for their values.
Conclusion:
This article has reviewed some researches focused on building quality communication with people suffering from dementia. This complex process is comprised of many aspects and requires an in-depth study. It is not always sufficient to speak the same language with the person in care. It is also required to pay attention and use alternative methods of communication, as well as to employ efficient methods to implement those techniques into the patient’s life.
This all is necessary for providing the person in care with the communication he or she needs. It must be positive, long-term, with demonstration of patience and empathy. In this way, the interaction between a dementia patient and his or her carer will be most efficient from the point of view of the quality of communication and of the relations in general.
References:
- Inna Sidorova, Irina Shirocova “Dementia: problems and it’s solution”, 2014 “Remedium”.
- Lisa Strandroos and Eleonor Antelius “Interaction and common ground in dementia”, Health , September 2017, Vol. 21, No. 5 (September 2017), pp. 538-554 Published by: Sage Publications, Ltd.
- Emmelyne Vasse, Myrra Vernooij-Dassen, Anouk Spijker, Marcel Olde Rikkert and Raymond Koopmans “A systematic review of communication strategies for people with dementia in residential and nursing homes”. International Psychogeriatrics (2010), 22:2, 189–200 C International Psychogeriatric Association 2009
- Sarah Alsawy, Warren Mansell, Phil McEvoy and Sara Tai “What is good communication for people living with dementia? A mixed-methods systematic review” International Psychogeriatrics (2017), 29:11, 1785–1800 © International Psychogeriatric Association 2017