Understand and enable positive interaction and Communication with individuals who have dementia
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Understand and enable positive interaction and Communication with individuals who have dementia.
1.1 Losing the ability to communicate can be one of the most frustrating and difficult problems for people with dementia, their families and carers. As the illness progresses, a person with dementia experiences a gradual lessening of their ability to communicate. They find it more and more difficult to express themselves clearly and to understand what others say. Each person with dementia is unique and difficulties in communicating thoughts and feelings are very individual. There are many causes of dementia, each affecting the brain in different ways. Some changes include: Difficulty in finding a word. A related word might be given instead of one they cannot remember They may speak fluently, but not make sense
They may not be able to understand what you are saying or only be able to grasp part of it Writing and reading skills may also deteriorate .They may lose the normal social conventions of conversations and interrupt or ignore a speaker, or fail to respond when spoken to They may have difficulty expressing emotions appropriately. A person with later stages of dementia will have increasing difficulty in understanding what is said or what is going on around them. They may gradually lose their speech, or repeat a few words or cry out from time to time.
1.2 People with dementia may have physical health difficulties too, like loss of hearing, make sure that the hearing aids are working well and that you speak to them in a loud clear voice so they can understand you. The person could also be in pain or discomfort; they could be having side effects from medication which will affect the way they communicate with you. Other problems would be eyesight, make sure they are wearing the correct prescription of glasses. Dentures are important as well, if the dentures are loose fitting then this will affect the person’s speech and this will be frustrating for them. Mental health factors need to be considered when communicating with an individual with dementia as they may be suffering from hallucinations or paranoia, which make it more difficult for them to concentrate on what you are saying, speaking clearly and slowly and asking them if they understand will help them.
1.3 If a person’s hearing or sight is impaired, body language and tone of voice will become more important. They may also need to learn new skills such as sign language or lip reading in order to be able to communicate. Making sure the person’s glasses is the correct prescription, that their hearing aids are working properly, that they are looking at your face when you speak so that they can lip read, keeping your communication simple and clear, using visual prompts, light touches to their arms to gain attention etc. If a condition or impairment develops suddenly, you’ll need to re-evaluate your methods of communication with that person. It might feel strange at first, but you might need to consider your tone of voice, how quickly you speak and how you use body language and gestures to emphasise what you are saying. It’s a good idea to express this to the person you care for and find out what helps them or makes your communication clearer.
1.4 The impact the behaviours of carers and others may have on an individual with dementia include becoming more confused and frustrated as they do not understand what you are telling, are using body language that suggests something different to what you are saying. They may feel you are telling them off or are angry with them if you cannot get your point across and change the tone in which you are speaking to them. Speaking clearly, and rephrasing questions or instructions they do not understand may put the individual at ease.
2.1 As dementia develops, it can cause behaviour changes that can be confusing, irritating or difficult for others to deal with, leaving carers, partners and family members feeling stressed, irritable or helpless. By learning to understand the meaning behind the actions, it can be easier to stay calm and deal effectively with the challenges that arise. Remembering that the individual is not being deliberately difficult, their sense of reality may be very different to yours but very real to them. Dementia can affect a person’s ability to use logic and reason so things that may seem obvious to you might appear to be very different for the person with dementia. Ask yourself whether the behaviour is really a problem. If the behaviour is linked to a particular activity such as washing or dressing, ask yourself if this task really needs to be done right now or if you could leave it for a while until the person has calmed down. Try to put yourself in the person’s situation. Imagine how they might be feeling and what they might be trying to express. Offer as much reassurance as you can.
Remember that all behaviour is a means of communication. If you can establish what the person is trying to communicate, you will resolve the problem much more quickly. Distract the person with calming activities such as a hand massage, stroking a pet, a drive in the country or by playing their favourite music. Try to make sure that you have support for yourself and breaks when you need them. Some people find unusual behaviours, particularly a repetitive behaviour, very irritating. If you feel you can’t contain your irritation, make an excuse to leave the room for a while. If you find the person’s behaviour really difficult to deal with, ask for advice from professionals or other carers before you become too stressed. Medication may sometimes be used for these behaviours, but this should be monitored and reviewed very carefully.
Ask about the possible side-effects of any drugs so that if they appear you do not automatically assume that the dementia has become worse. Remember that it is possible to be the cause of the behaviour through a lack of understanding of what the person is trying to communicate. Try stepping away from the situation, look at the person’s body language and try to understand what they might be feeling at that time. Give the person space to calm down and offer reassurance. 4.1 The difference between a reality orientation approach to interactions and a validation approach is that reality orientation appeals to still existing functions and helps people to get oriented toward the reality, reminding the individual of the day, place, time and situation they are in. Validation goes with people into their inner world, where feelings dominate and facts are no longer important, using non-judgmental acceptance and empathy to show the individual that their expressed feelings are valid.