Being able to communicate means far more than just being able to talk to someone. Telling people how we feel, making our wishes known and feeling understood, even without speaking (e.g. through our body language, facial expressions, behaviour etc.) strengthens our ability to cope with the all the practical and emotional challenges that we encounter in our day-to-day lives. It is an essential part of our self-identity.
When we think of dementia, the symptom of memory loss may be one of the first things we associate with getting a diagnosis. However, people living with dementia may experience changes in the way that they are able to communicate in a number of different ways including:
- Following a conversation.
- The ability to name everyday objects.
- Facial recognition.
- Recognising familiar surroundings.
- Being unable to think clearly and quickly.
- Problem-solving and decision-making becoming more difficult.
All the senses are vital to the way in which we communicate but hearing and/or sight impairment makes it doubly challenging. Dementia can affect the way in which people perceive sound, are able to cope with loud noise and can also cause problems with their peripheral vision.
People living with dementia may also be coping with changes in perception (e.g. how their minds are interpreting the information around them; double vision; colour and distance distortion etc.) and possibly also hallucinations.
Health and wellbeing
The way in which we communicate is also determined by how we feel physically and emotionally. Physical factors may include:
- Being in pain (e.g. arthritis, stiffness and being sore from siting for long periods, healing wounds, headaches, toothache, constipation, chest or urinary tract infections).
- Feeling unwell (e.g. colds and flu, feeling dizzy or sick).
- Hunger, thirst or dehydration.
- Body clock changes (e.g. late day confusion and increasing unease as night time approaches; asking to ‘go home’ because of rising anxiety).
Emotionally, the challenge of coping with constant communication problems can really impact on a person’s sense of self-belief (e.g. making them feel like a failure or unworthy and even unloveable).
Some people may be able to manage these feelings more easily than others. This is because we have all experienced life differently, we all have unique personality types and we all have different support networks (e.g. families, friends, communities) around us. Therefore, some people may adapt well and willingly accept that they need more help and support as their dementia progresses.
However, for others, this process can feel very uncomfortable. Being unable to make someone understand what you need or how you feel can be both frustrating and isolating – especially if this is something that you experience time and time again. Feeling like this can lead to anger and despair which, left untreated, may lead to depression.
Techniques that can help to support better communication
To be able to communicate effectively with someone living with dementia, it may help to consider:
- Your tone of voice – how fast or loudly you may be talking; your facial expressions and body language and how easily any of those may be misunderstood.
- That a person living with dementia may interpret your own anxieties as impatience or, as being treated discourteously on purpose. They may feel that you are distancing yourself from them (rejecting them) because they have done something wrong to upset you.
- That many people living with dementia remain highly perceptive to changes in mood and atmosphere. Perhaps even more so than before their diagnosis.
- That sometimes, by simply explaining that you’re feeling tired or unwell, rather than trying put on a ‘brave face’, it can help to reassure someone that nothing bad is about to happen.
- That if someone does feel under threat, their response is likely to be defensive (e.g. shouting or not willing to do something that you want them to).
We may often be the cause of someone’s distress by undermining their sense of dignity. For example:
- Publicly correcting mistakes and misunderstandings.
- Talking about them within earshot.
- Brow-raising/mocking them, if their behaviour is difficult for us to understand.
- Publicly brushing away crumbs as they eat, straightening their clothes, smoothing their hair etc.
- Imposing physical contact without their agreement or, without being sure that they understand what’s intended (e.g. a loving stroke on the face, gently wiping away saliva or food from their mouth); even well intended actions such as these may be perceived as humiliating or even threatening.