C is for communication. Communication is complicated.
Communication with the person with dementia. Communication with other professionals involved in care: nurses, doctors and other specialists and professional care partners. Communication with family.
Each of these requires a special set of skills, and probably, their own blog.
For today, we're going to look at communication with the person with dementia, because if you don't figure out how to communicate effectively with anyone else, it's important to get this one right. For both of you.
I've said it so often, but it applies again. "If you've met one person with dementia, you've met one person with dementia." Tom Kitwood 1
There are many different kinds of dementias, and although there are similarities, they all present differently. Then there is the personality of the person with dementia. Although likes and dislikes and abilities change, the person is still there, and who they are affects their communication. The progression of the disease, and even the time of day can change things. A secondary infection or illness (such as a urinary tract infection) can totally change a person until it is recognised and treated.
Given all that, how can we possibly get it right?
The good news is, it is possible. Even most of the time, with a little knowledge and experience.
Here are a few tips:
1) The basis of all things is knowledge.
a) Start with the kind of dementia the person has, and read as much as you can about communicating with a person with these challenges. What makes communication difficult for them? What is going on in their brains and their bodies that makes messages not get through? This is helpful, but only a start.
b) What other physical problems are there which affect communication? Do they have difficulty hearing? (Do you ever notice if you miss one key word in a sentence, none of it makes sense? If that happens to me, sometimes I try to keep listening and figure out what is being said rather than admit I didn't hear. If I haven't figured it out after a few sentences, I am totally lost in the conversation. Now, try that with dementia.)
Are they unable to see? We take for granted physical cues which we can see, and how much they add to our communication. What if the person has difficulty with both hearing and seeing? And dementia. Get the picture? It helps to realise what you are dealing with and compensate the best you can.
c) You know this person. There may be some days where you feel you don't, because they have changed so much, but you know many things about them. They love classical music. Hate gardening. Light up when children are in the room. Have a soft heart. Use what you know about them to reach through the other difficulties to their heart. Once you have reached the heart, communication is easy and incredibly satisfying.
2) Body language is key.
You know those social masks we wear so no one knows how we're really feeling? Who hasn't had a fight and then gone to church and looked like nothing is wrong? We all do it, but with people with dementia, the masks slip away early in the disease. They pick up on things quickly, and will often react with nervousness or anxiety. So watch your body language.
With many people, an effusive approach works well. (I am not an effusive person, so I have to work at this.) A big smile, an enthusiastic greeting often brings a responding smile and greeting. Often, but not always. If a person is angry, I immediately tone it down, and become concerned. (This is not put on. I am concerned. My friend is hurting.) I will encourage them to sit with me, and listen to what is bothering them. Sometimes, I have no idea what they are talking about, but I will make sympathetic noises ("That must have bothered you. What did you do about it?") If it seems appropriate, I may touch the person's arm. Sometimes I sense they aren 't open to touch. I don't always get it right.
Body language, even for a person with sight difficulties, is incredibly important. Many people have some sight, and are able to use other senses in combination to pick up the message. You want to communicate: you are a special person to me, and I am interested in what you are saying. If this is in your heart, body language will follow.
3) There are times to back off. If a person is angry and getting angrier no matter what you try, or even sleepy or interested in something else, back off. Give them some time. Often 15 minutes will change the climate entirely.
4) Food helps. Okay, this seems lame, but how often do you serve tea and cookies or coffee and donuts or whatever to someone who comes to visit. It's what we do and it doesn't change. Do you know their favourite treat? (You should.) Have a piece or two at the ready if things get difficult. Nothing works every time, but almost--.
5) Be flexible. Have no agenda, and no expectations. Ideas and possibilities are great, and can be stashed like the chocolate or homemade cookies you brought. Suggest and see what happens. The only agenda is to have a good visit together, and to communicate. How that happens may be different every time.
If it doesn't happen, don't get discouraged, or feel like it was a waste.
It's never a waste.