Lecture 3 - Effective Strategies Supporting Communication in Dementia

give examples of ways to support communication

• eliminate distractions

• approach the person slowly and from the front

• use short simple sentences

• speak slowly

• ask one question and give one instruction at a time

• avoid interrupting and give plenty of time to respond

• 
  

describe strategy: eliminate distractions

• reduce distractions by simplifying surroundings (e.g. TV, radio)

• associated with fewer breakdowns in communication

describe strategy: approach slowly and from the front

• establish and maintain eye contact

• ensure well lit space to minimize startling the patient

• introduce yourself each time you speak to the same client with dementia

describe the benefits of using short simple sentences

• ensures minimal demands on working memory

• associated with fewer breakdowns in communication with a caregiver

• improves auditory comprehension

• fewer errors with simple sentences than complex sentences during a sentence-picture matching task

describe a downside of using short simple sentences

using this strategy over time may actually lead to a faster decline in ability to understand complex sentences

describe the benefits to speaking slowly

• compensates for slower information processing speed by allowing additional processing time

describe the downsides to speaking slowly

• more breakdowns in communication with a caregiver, though caregivers reported that it helped “quite a bit”

• no difference in sentence comprehension at slow and normal speech rates

• may place more demands on working memory which overrides the benefits of additional processing time

what is “elderspeak”

systematic speech accommodations directed towards older adults

what are strategies used in elderspeak

• simplistic vocabulary and grammar

• shortened sentences

• slowed speech

• exaggerated prosody

what are the consequences to using elderspeak

• older adults, with and without dementia, react negatively to many aspects of elderspeak

• decreased successful task performance

• negative assessments of their own and the speaker’s communicative competence

• resistance to care

why is it important to ask one question and give one instruction at a time

people with AD have more difficulties with multi-propositional sentences due to greater demands on their working memory

communication is more successful when relied on … > … memory

relied on semantic > episodic memory (i.e. what they know vs what they remember)

communicative success is highest with what type of question? lowest with what type of question?

highest with yes/no questions

lower with choice questions

lowest with open-ended questions

use of what type of question was associated with fewer communication breakdowns

use of yes/no questions

when might choice and open-ended questions be effective?

choice/closed-ended better for questions regarding everyday living tasks

open-ended to encourage emotional responses

in a sentence-picture matching task, when was comprehension of complex sentences improved?

when they were repeated verbatim or paraphrased in a sentence-picture matching task

avoiding interrupting is important to who?

caregivers consider it important not interrupting their loved ones and they frequently employed this strategy in interacting with their spouse

describe the patient’s response when caregivers avoided interrupting them

no clear differences in patient’s response between caregivers who used or did not use this strategy

for patients that have trouble labeling words, what is a strategy to encourage them to use

encourage them to “talk around” or describe the words they are searching for

what are other common strategies

• not all communication has to be verbal

• stay in the conversation

• don’t forget to have fun

what do the 4 C’s refer to

do not:

confront (e.g. “did you put sugar in the fridge again!”)

contradict (e.g. “no! your doctor never said that”)

correct (e.g. “today is tuesday, not sunday”)

criticize (e.g. “as usual, you didn’t take your pills on time”)

what % of communication is non-verbal

80%

what is the focused program?

addresses different aspects of communication, often used in nursing homes

what is the most effective communication technique in dementia

memory aids combined with specific caregiver training programs

describe environmental memory/cognitive strategies

• strategically placed items

• note board

describe environmental orientation strategies

location:

• visually distinct entrances

• signage

• presence of familiar objects

time:

• clocks

• calendars

describe environmental strategies that prevent wandering

• points with high visual appeal

• safe wandering space

• non-glass doors

• safety locks/alarms

• camouflage exits

describe environmental strategies that support visuo-spatial processing

• lighting

• floor surfaces

• visible handrails

• reducing window glare

• removing clutter

• contrasted colours (ability to see contrast diminishes in AD)

describe environmental strategies that reduce depressive mood

• increasing visual/tactile appeal

• including familiar objects

• reducing noise, offensive odours

• gentle light

• playing soft music

describe environmental strategies that may reduce agitation

• window treatments

• reducing noise levels/distractors

• reducing # of people present

• personal space

• ambient music

• minimizing strong odours

• covering/removing mirrors

• non-institutional features

describe environmental strategies that foster communication

• smaller tables

• centrally placed items (e.g. magazines, photos)

• furniture arrangement

• room assignments (pairing residents with similar abilities)

describe feeding strategies

• separate dining area

• non-institutional features

• seating at tables (PT)

• positioning closer to the table

• removing non-essential items from the table

• raising height of seat

• placing napkin in hand

• presenting one food item at a time

• using specialized utensils, if necessary (OT)

• sufficient lighting

describe what the research says about placing patients around tables vs along the walls with centrally placed food

results in increased communication and improvements in mealtime behaviours (e.g. using utensils properly)

describe what the research says about patients dining in a separate dining area vs their room, and those who had non-institutional features (e.g. tablecloths, dishes, napkins)

were more likely to have higher food/fluid intake

describe what the research says about implementing several environmental strategies for feeding issues

reductions in problem behaviours (e.g. confusion, verbal aggression, restlessness)