Better Communication in Dementia Care

Hello everyone. Welcome to another new episode

of the truth, lies and Alzheimer's show. I'm Lisa

Skinner, your host. I'm genuinely excited today to have

you all here spending part of your day with me so I can share

some more insightful information with y'all that I believe can

help you communicate better with your loved ones living with

dementia. Today's episode is called common communication

challenges in dementia, caregiving and effective

solutions that I am going to share with you, as most of us

listening today are aware. We know Dementia is a progressive

decline in memory, in thinking, in behavior and the ability to

perform daily activities that are severe enough to interfere

with living an independent life. What happens in dementia? Well,

damage to brain cells affect not just short term memory, but

language, judgment, orientation, personality and behavior and

many, many other cognitive functions, some of the key

symptoms are, and this is just a couple of examples, because

there are many, many, many of them in the early stages,

forgetting recent events, misplacing items, difficulty

finding the right word to insert into a conversation or a

sentence, and getting lost in familiar places. Towards the mid

stage of dementia, we start to see confusion about time and

place, more difficulty with daily tasks, personality

changes, sometimes extreme and poor judgment. And then in the

latter stages, we will see severe memory loss, loss of

speech, the inability to recognize family members and

becoming fully dependent on others for our care. Now, some

of the red flags that you should be aware of that are not

considered part of the normal aging process is a rapid

decline, extreme personality changes.

You might notice somebody having a lot of difficulty managing

their finances or their medications, getting lost

frequently, and as a result of this continuation in cognitive

decline, communication between family members, care care

partners and the people living with dementia becomes

increasingly challenging. And I know a lot of you have already

experienced that. I'm going to tell you about a 92nd rule in

dementia care, and that is a communication strategy allowing

individuals 60 to 90 seconds to process information and respond

to the requests we're making of them, and this 92nd rule reduces

frustration and agitation, and the reason why is because

dementia impacts Our brain processing speed, so caregivers

should wait at least 90 seconds after asking question or giving

instructions before repeating them or acting upon them. So let

me, let me share with you the key aspects of this 92nd rule in

terms of the processing time, people with dementia often

experience significantly delayed cognitive processing, therefore

allowing them at least 60 to 90 seconds to process your words

can help them from feeling overwhelmed by having too many

words thrown at them all at once and too quickly. So what is what

does that do to help well, it reduces agitation, allowing this

pause prevents Re. Triggering or overwhelming the person which

can cause them to become extremely upset or even shut

down, it encourages their independence by giving them time

to understand and complete a task like, for example, putting

on a jacket themselves. Let them try it themselves first. If you

see them struggling, of course, that can cause frustration and

anxiety, but that is when you could step in and help but let

them try it first, rather than having the caregiver immediately

do it for them.

It offers better communication abilities. If no response occurs

after 90 seconds, we recommend using nonverbal cues, tac tile

prompts or break down the request into smaller steps. It's

really vital for caregivers to understand that dementia is a

physical breakdown affecting their comprehension, and it's

not just memory loss. So implementing this technique can

and will be extremely effective for you. As people living with

dementia continue to decline cognitively, and as they

progress through the stages of the disease, communication with

them does become increasingly challenging in dementia care,

you can expect that. So what I've done here is created a

variety of scenarios for you to illustrate some of the

situations that can and do arise in your daily dementia

caregiving journey, and they follow a consistent structure

that you can implement into your daily routines.

Each one of these scenarios includes what the issue is at

hand, a brief scenario, an effective solution and a

practical action, along with a takeaway for family members and

caregivers. So in this first group, I'm going to illustrate

scenarios that represent language decline and

understanding. So number one, the issue is progressive.

Language loss makes basic needs hard to express. Here's a

scenario for you, a 79 year old with Alzheimer's increasingly

struggles to name objects and express when he's thirsty,

hungry or experiencing pain. So what happened here is the

caregiver misinterprets his silence as agreement and misses

his cues. So an effective solution here is to use yes or

no questions with clear concrete choices, pair the questions with

nonverbal cues such as gestures and pictures, maintain a pain

symptom checklist that the person can point to, and the

takeaway for you all here Is when words fail, rely on simple

choices and observable signals, keep a calm patient tone to

reduce anxiety.

The second scenario, the issue is this person has word finding

troubles, causing her frustration, and if that results

in miscommunication between her and her caregiver, this person

has vascular dementia, and she often pauses mid sentence, then

becomes frustrated and her caregiver fills the situation in

with assumptions leading to mismatched actions, very common.

So here's an effective solution for you. Accept these pauses as

part of her processing the information give her extra

processing time and use broad non verbal prompts. So point to

an item, show her some options, validate her attempts, even when

her words are imperfect. So. And the takeaway here is patience

and validation, prevent misinterpretations and preserve

dignity during your conversations. Third issue,

repetition, we all know about that and script like speech. The

scenario here is that a parent repeats the same question about

when a doctor is going to visit despite being given repeated

reassurance about that appointment. Well, here's an

effective solution that you could try acknowledge the

underlying need like certainty and routine and provide

consistent script and a visible schedule. Offer a short,

concrete answer, plus a shift to a different task, get their mind

off of that one. So good takeaway for you here is

repetition often signals a need for reassurance and routine,

structured responses reduce frustration for both of you in

this group, we're going to address nonverbal communication

and cues. So let's discuss the first issue in this group,

misinterpreting nonverbal signals. A loved one becomes

agitated when the caregiver's body language appears rushed or

closed off. This happens daily, so an effective solution for

this situation use open posture, a soft voice. Slow your pace

down. Mirror their expressions of calm and avoid rushing or

interrupting them, accompany speech with a gentle touch, if

appropriate, make sure they're okay with being touched. And a

good takeaway here is that nonverbal, warmth and presence

convey safety and respect and often much more effectively than

words. Okay. Next issue, this one, deals with ambiguity

conveyed by tone rather than content. A caregiver's brisk

tone makes a simple instruction feel like a demand, triggering

resistance on the part of the person living with dementia. An

effective solution here is to use a warm tone and phrasing,

like, Would you like to blah, blah, blah, and pair it with a

gentle hand gesture or demonstration, a takeaway for

this is that your tone can override content. Soft,

collaborative language does support cooperation. Next issue

having difficulty interpreting sarcasm or jokes on the behalf

of the person living with dementia. So a person with

dementia, we've probably all been there done this, may often

misread humor and feels mocked, which can lead to extreme

withdrawal, you feel embarrassed like 50% know that they have

cognitive issues anyway, so it's just kind of rubbing salt into

the wound, if you will. So an effective solution for that

scenario is to stick to straightforward positive

statements and use humor carefully. And I'm not saying

don't use it, because everybody loves humor. It lights us up.

Just be careful in how you present it, ensuring that

they're gentle and clearly non, targeting their deficits,

monitor reactions and back off if misinterpretation does occur.

And the takeaway here is, humor is great, but it should be

simple, kind and clearly non threatening, to avoid their

confusion. So we're on Group C, which involves reading and

visual processing challenges. So this is the issue at hand,

difficulty following spoken directions. And here's the

scenario get little. Straighten this instructions like eat your

lunch before we go outside, become confusing because their

ability to process words slows down dramatically. So the

effective solution for this break those instructions into

single, sequential steps pair the verbal directions with

visual cues using pictures or checklists or colored arrows,

for example. And the takeaway for this scenario is that visual

cues support and complement spoken language, and as a

result, reduce cognitive overload. Next issue trouble

with multi step tasks, and eventually this will begin to

occur as they progress through the stages of the of dementia.

So let me give you an example. Getting dressed becomes

disorienting when asked to choose items or give them shirts

that need to be buttoned, tying shoes in one breath. So make it

simple an effective solution, just offer them one step choices

at a time, demonstrate each step to them, but let them do it. Use

labeled containers and labeled clothes arranged in order.

What's your takeaway here sequential prompts and

demonstrations preserve their autonomy while minimizing their

confusion. Okay, we have just a few more to get to now. This one

is having difficulty with abstract language or figurative

speech. And keep in mind that every one of these issues that

I'm going over with you today are real issues that show up

with dementia very commonly. So these are everyday occurrences

that you could be prepared for if and when they do occur. So

this scenario involves a person living with dementia. She may

misunderstand your expressions like, Oh, it's a piece of cake,

and that could cause confusion or embarrassment. There may have

been a time where she knew what that expression meant, but with

cognitive decline in malfunction, she's probably

going to think it's something literal, and will be very

confusing to her. So an effective solution is to use

literal language and avoid idioms and adages confirm

understanding with a simple recap. The takeaway, plain

language reduces misinterpretation and

embarrassment. And then Group D, we're going to cover behavioral

communication and de escalation. Here is the second to last

issue, or no, there's two more, and this one pertains to

communicating during agitation or aggression. And here's a

scenario to illustrate this situation, a person with

dementia all of a sudden becomes verbally aggressive because the

routine changed. They like routine because it represents

familiarity, safety and security to them. So the effective

solution, if they are feeling this way they just are at a loss

because something has changed that's not familiar. Acknowledge

their feelings first, because that's what they are going to

react on. First is emotion. All logic has pretty much gone by

the wayside. Validate that they're safe and calmly describe

what the upcoming plan is to reassure them, and then you can

offer two simple choices to regain their sense of control.

So take away for this one, calming language and actionable

choices do help de escalate tension. Next one, the issue

communicating with someone who's new to a care setting. So in

this scenario, a new memory care resident seems withdrawn and

misread. Needs the staff leading to fear and resistance to the

care. So here's an effective solution. Introduce staff by

their name and their role. Use a consistent daily routine. Assign

a friendly staff anchor for the resident and use familiar

objects from their home to ground, conversations once

again, and I've mentioned this several times already today.

Takeaway, familiarity, familiarity, consistency,

consistency, consistency and clear instructions, these will

ease transitions and build trust between you and our last

scenario is dealing with language barriers and cultural

considerations, a caregiver from a family with limited English

proficiency navigates medical questions and care instructions,

sometimes that can be difficult. What's the saying lost in the

translation? Yeah, something like that. So an effective

solution request an interpreter. There's a service by an

interpreter or bilingual staff translate essential documents.

You can use culturally relevant visual aids and plain language

materials in the home language takeaway for this, and this does

occur pretty regularly, because a lot of our care staff, English

is not their first language, and remember what we talked about

earlier. The farther along in the dementia that they are, the

more difficult they difficulty they have processing the

information, so you add an accent onto that and makes it

even more difficult for them, accessible care and cultural

respect, improve understanding and adherence. So that wraps up

today's episode for the truth lies and Alzheimer's show. I'm

Lisa Skinner, your host, and I want to thank you again. I

appreciate every one of you taking the time to be here with

me today to learn more insightful information about

living in the world of dementia and trying to make sense out of

it and create a harmonious environment for everybody

involved. So please come back next week. I will have another

new episode prepared for you then, and in the meantime, have

a great rest of your week, stay happy, be healthy, and I will

see you back here next week. Bye for now.