Short-term memory loss is associated with Alzheimer’s disease. Individuals affected with this disease may be unable to remember things that have just happened or ask the same questions repeatedly. Individuals suffering with it can also forget people this could be just forgetting their names and eventually just forgetting who they are. This itself can cause communication issues and the individual may not know who they are talking with and on top of that may repeat the same parts of the conversation over and over as they have forgotten what has already been said. Individuals may also struggle in finding the right words or can’t remember the right word for what they want to say so it can be hard to hold a conversation. If they can’t explain what they mean properly an individual with dementia may become frustrated and this can often be dismissed as agitation or aggression.
With Vascular Dementia although the causes are different to Alzheimer’s a lot of the symptoms are similar. For instance they may suffer memory loss, lose things and be disorientated. All these things can cause difficulties when communicating. There can be different symptoms of vascular dementia as different areas of the brain can be affected but most include slower thinking processes. Communication often becomes slow and the individual may find it hard to find the right word or forget what they were trying to say in the first place. This is very frustrating for them. People are often tempted to finish their sentences off for them which can lead to further frustration as its usually finished wrongly and not what they wanted to say.
Dementa with Lewy Bodies (DLB)
Again this does have some common symptoms with Alzheimer’s and Vascular dementia. For example memory loss and disorientation but it also has other symptoms that aren’t always found in other forms of dementia. Someone with DLB may experience visual hallucinations. This means they see things that aren’t really there. An individual experiencing hallucinations may be extremely frightened by them and be very afraid. They are very real to the individual and should be taken seriously. It can be difficult to comfort someone with hallucinations as it can cause them a lot of distress.
When the person is experiencing hallucinating it can cause communication difficulties as the person isn’t in touch with what is real and what is not as the hallucinations are very real to them. Non-verbal comfort and lots of reassurance are the best way to communicate with someone during hallucinations. Vivid dreams can also be experienced with this kind of dementia. Individuals with DLB may show different levels of alertness. There moods can change quickly from being chatty one minute to not knowing who you are the next. It is important to have flexible communication so you can respond to the individuals’ mood appropriately. An individual experiencing this form of dementia are also susceptible to falls and trips as there balance can be affected.
This form of dementia can be found in older people but is often found in younger people between 30 to 60. Early stage symptoms are similar to other forms of dementia. For instance communication issues such as forgetting or not understanding words or peoples’ names. There isn’t memory loss in the early stages but it seems like there is because of the communication problems. Personality changes are often common in this form of dementia. The may become extrovert when they weren’t before or vice versa, they may behaving inappropriately or lack empathy. They can behave inappropriately, for instance removing clothing in public or shouting loudly. It can seem like they are being selfish as they can lack warmth for others. The personality changes can make communication difficult. Especially for people that have known the person before they suffered with dementia. They may feel that they don’t know the person anymore and find it hard to interact with them. 1.2
Physical and mental health factors should always be considered when communicating with an individual that suffer with dementia. For instance they may have eye sight problems or not be able to hear well which can affect their ability to communicate. Hearing and vision problems should not be over looked. Regular eye and hearing tests should be performed as an individual with dementia may not be able to communicate that there is a problem. Glasses and hearing aid batteries should be checked regularly. Someone suffering with dementia may also have problems with pain. They may find it hard to communicate what the problem is or where the pain is coming from.
They may not be able to express or explain that they are in pain. Pain can cause other problems such as lack of concentration, increased memory loss, aggressive behaviour, sleeping problems and mood swings or a short temper. These are often mistaken for the persons dementia because of their lack of communication skills. It is important that people working with individuals that suffer from dementia are aware that pain could be a factor. Physical disability or illness needs to be taken into consideration. Someone who has had a stroke or has an illness like cerebral palsy may have difficulty with speech but not with memory problems. An individual with early stage dementia may understand perfectly what you are saying to them but may have difficulty communicating back. They may not be able to find the words are put the wrong words in the sentence.
This can be very frustrating for them. You have to patient and let them speak without trying to finish the sentence off for them. When dealing with an individual regularly you can become familiar with the way they communicate which can make it easy for both of you. An individual suffering with dementia may experience depression or anxiety. This too can cause communication problems as it can affect how they respond to others. They may not be interested in being involved in having a conversation which can make it hard for others trying to talk to them. It can also cause reduced concentration and problems with sleeping which then can lead to more confusion. This can make communication and other forms of interactions extremely difficult.
When communicating with an individual who has sensory impairment it is important to use hand gestures, body language, facial expressions and touch. Various aids or equipment can also be used such as flash cards, pictures or sign language to help understanding. If an individual suffers from hearing loss it is important to ensure that hearing aids are fitted correctly, working properly and batteries are changed regularly. When speaking to someone with hearing loss you need to be not too far away from them, speak clearly and don’t shout. Some individuals with hearing problems can lip read and some may be able to do sign language. Gestures and pointing to things can help and the use of flash cards could also be of use. As dementia progresses though, an individual may find it more difficult to use sign language or lip read as it becomes harder for them to remember how to do it. Glasses or contact lenses are the most common way of assisting someone who is visually impaired.
You should ensure that the lenses are clean and that the individual has regular eye tests to ensure that they are wearing the right prescription glasses. An individual suffering with dementia may forge to put there glasses on so it is important to remind them to put them on. If someone has severe visual impairment you should not just suddenly begin speaking as they may not have realised you were there. Make sure that you introduce yourself when speaking so they know who it is and you don’t shock them. You may need to use touch more than what you would when speaking to someone fully sighted as they will not see facial expressions, body language and gestures. It is important to maintain good communication and interaction as some with visuals impairment suffering with dementia can find the progression of the illness very frightening.
Individuals with dementia often demonstrate problem behaviour. There are many things that may contribute to such behaviours even something as simple as an uncomfortable, loud, or stressful environment. They could be experiencing pain, or be finding it hard to communicate or carry out simple tasks or perhaps there in unfamiliar surroundings. As a carer it is important that you pick up on these kinds of situations so you can ease the discomfort of the individual quickly so as little distress is caused as possible. It is important that you remain calm yourself. Offer reassurance to the individual and be patient and relaxed. Use body language and the tone of your voice to try and calm the situation. Sometimes distraction can help, perhaps try and engage them in a different topic of conversation so they then forget that they were angry or unhappy.
Sometimes carers can become stressed out or find it hard to cope with a particular individual, at these times it is best to take time out or get someone else to help you. Getting anxious or upset yourself can make their behaviour worse and it is important not to take aggressive or problem behaviour personally. If you do find yourself becoming stressed with a situation take time out to relax. Often other individuals need to be involved when supporting an individual with dementia. These could be family and friends, carers or other professionals. For example: GP – For medical advice and health problems, help with medications and side effects Speech Therapist – To help with communication issues
Social Worker – Can often provide useful background information, family history or situation Dementia Care Adviser – Offer advice and technique on ways to improve interactions Advocates – Provide information about the persons capacity and what is considered to be in there best interests and will be able to offer a view of the persons perspectives Family and friends – Can offer information about the person and tell you background information. Also may be able to offer advice about communication methods as they know the individual better
Dementia is a progressive illness and effects people suffering with it in different ways. A persons communication and interactions are most likely effected but with different levels of difficulty. People with dementia suffer different symptoms but most experience isolation due to increasing difficulty with communication. Often people assume that an individual with dementia cannot communicate and write them off if they do not get a response from them the first time instead of trying a different approach. The symptoms of dementia do often have a big impact on how a person communicates and they can often find it difficult to find the right word or repeat the same things several times. They may be confused about where they are or what time period there in which also can contribute to making communication difficult but there are different approaches that can be used. Picture cards or flash cards are a good way of finding out what an individual wants when they are unable to find the words. Also its important to watch their body language and gestures to pick up on things that they are trying to communicate.
Although dementia does cause huge problems with communication it is important for care staff to support and develop new ways to get around it. Carers and other peoples’ attitudes play a big part in the well-being of people with dementia. The best way to respond to the behaviour of an individual with dementia is by using creativity, flexibility, patience and compassion. Don’t take their behaviour personal, they have an illness that affects the way they behave. It is important to try and establish what is causing the behaviour to reduce the stress for everyone concerned. One of the following could be a factor: Medical problem, such as experiencing pain or side effects from medications – this needs to be resolved by a GP or a CPN Wandering around a lot – this is often caused by boredom or they may be trying to find something or someone.
Offering regular exercise and activities can help with this Repetitive behaviour – this can be caused because they need to or like to feel busy. Give them something to do ask if they would like to help with jobs around the home make them feel important and independent. Behaviour trigger – often it can be hard to find the trigger but sometimes a more calming environment can help and distraction techniques can be used. Repetition – People with dementia often repeat the same things over and over. This can be very frustrating for carers. They may ask the same questions or do the same activity over and over again. This can be triggered by boredom or environmental factors. Try and comfort them or distract them and look out for similar behaviours or signs. Certain behaviours could indicate that they need the bathroom or that they are hungry.
Incontinence – this is a common problem in people with dementia. They may not be able to find the bathroom in time and have an accident. An individual with dementia may find this very embarrassing and be upset with themselves. Be understanding and offer reassurance. This can be avoided by prompting regular trips to the toilet.
Insomnia – Restlessness, agitation, disorientation and other troubling behavior in people with dementia often get worse at the end of the day and sometimes continue throughout the night. A day full of activities and discouraging daytime napping can help.
With dementia trouble behaviour can simply just be part of the illness. Carers need to be flexible with how they act to try and address any issues. 4.1 Reality orientation is about trying to keep the person suffering with dementia in the here and now by making sure the person knows who and where they are. If they become confused about things then they are corrected about anything that isn’t reality.
Individuals are constantly reminded of the day, place, time and situation they are in. This approach is used as much today. Validation is part of a person centred approach. A persons confusion is accepted and carers do not tell them that their feelings are wrong or try to correct them. The approach focuses on the individuals feelings rather than what they are saying. Their expressed feelings are accepted as being valid and accepted. The idea of this approach is to build trust and increase well-being and is much more commonly used than the reality orientation approach.
Courtney from Study Moose
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