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Understand the Role of Communication

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1. Understand that individuals with dementia may communicate in different ways 1.1 Explain how individuals with dementia may communicate through their behaviour The way a person is behaving is usually a good indicator of what they are trying to communicate, especially if they have difficulty expressing their feelings with words. Body language will also provide clues. People wish to be heard and validated and the way they behave may indicate how they are feeling. so a person presenting as angry may be feeling frustrated. People presenting as sad may be experiencing vivid memories of a past event that seems very real and current to them. Someone with dementia may feel they are losing control of their world so they may come across as cantankerous or even aggressive when you enter their home.

1.2 Give examples of how carers and others may misinterpret communication Initially people experiencing memory losses may feel frustrated or angry with themselves and this may come across as being angry with someone else. An inability to have empathy could make the person appear selfish and a loss of social etiquette could result in the client making thoughtless comments, being rude or exhibiting sexual behaviours in public. Asking the same question in a short space of time or repeating conversations may appear as if the client isn’t listening. 1.3 Explain the importance of effective communication to an individual with dementia A person with dementia lives in a very frightening world where things that have just happened are immediately lost.

The person may also forget where they live, what age they are or where their loved ones are. A carer or anyone else can help to make the world a little easier to understand by remaining patient and reassuring the person by telling them the facts that they are missing. It may be necessary to repeat the information such as “Your daughter is at work at the moment” or “This is your house, you have lived here for ten years.” 1.4 Describe how different forms of dementia may affect the way an individual communicates Alzheimers disease is a degenerative brain disease that causes chemical and structural changes to the brain which destroys the ability to remember, reason or relate to others. This means that the person may lose empathetic feelings towards others and may not recognise someone from one day to the next. Alzheimers can affect speech and language.

A person may lose words gradually or get the order of their words muddled which makes conversation very difficult. Vascular dementia is caused by a series of mini strokes or by a gradual failure of brain cells. This can result in the person being unable to understand what is being said to them and cannot therefore respond. Dementia with Lewy Bodies disease affects the cerebellum part of the brain. This can cause difficulties with balance, co-ordination and visual recognition. The person may have hallucinations which are very real to them. A person with this illness will eventually not recognise their loved ones which makes intimate interaction impossible, and the person Is unable to act with the familiarity towards people that they used to.

2. Understand the importance of positive interactions with individuals with dementia 2.1 Give examples of positive interactions with individuals who have dementia In my role I deal with clients who present many different behaviours associated with dementia. One lady likes to talk for the entire visit about her role working for the police in her past. It is more important to the client that she is listened to and that she has your attention as this makes her feel validated. A gentleman who is still quite active enjoys visiting places locally that hold a meaning from his past. I take him to the church where he was married or to a garden centre and this allows him to talk fondly about and remember his deceased wife who he misses greatly.

Another lady never leaves her flat and has a very short memory span. It is important to her that I keep reminding her of the time of day, day of the week etc. and also she needs constant reassurance about where her daughter is. This helps to keep the client from feeling lost in her day. 2.2 Explain how positive interactions with individuals who have dementia can contribute to their wellbeing Positive interactions can help reduce agitation caused by frustration and give a person a feeling that they do matter. By lending an understanding ear to someone with Alzheimer’s to verbalize their frustrations, worries and fears, the negative emotions can diminish. This will contribute to better cognitive functioning and behaviour. Dementia can be a lonely illness and giving someone you time and undivided attention can help them to remain centred and calm.

2.3 Explain the importance of involving individuals with dementia in a range of activities Cognitive stimulation can help to slow the decline of dementia in the early stages. Stimulation helps to keep the processes of the brain functioning. Boredom and frustration are the two most common causes of challenging behaviour in with dementia. Taking part in a physical or mental activity can provide a welcome distraction from the stresses of the illness and can help to focus them on the positive and fun aspects of life. Activity can be as simple as holding a conversation, singing or going for a walk and discussing what is seen.

2.4 Compare a reality orientation approach to interactions with a validation approach Reality Orientation helps confusion and memory loss by reminding the client of basic facts such as the day of the week, the time of day or about where they are. A white board may be used with the date written on it reminding clients of what has already happened and what will happen next. This may assist with reducing anxiety and uncertainty about anticipated events. Photos can be put up of family and a newspaper can provide daily stimulation. For example, one client benefits greatly from a white board which reminds her that a carer called at breakfast and another carer will visit at lunchtime etc. This stops the client from spending all day believing they have not seen anybody. Validation Therapy works by entering the client’s reality rather than trying to bring them back to our reality.

Some dementia clients can no longer make sense of the present so the validation method helps to understand and empathize with the needs the person is trying to express. Validating their words and actions is a way of encouraging them to keep communication open with the rest of the world. In this way empathy is developed with the person, building a sense of trust and security. For example, a client who believes her soft toys are her babies would be distressed to be told that it is not true, so it is better to talk to the client about her babies which are very real to her. 3. Understand the factors which can affect interactions and communication of individuals with dementia

3.1 List the physical and mental needs that may need to be considered when communicating with an individual with dementia Dementia can result in the brain not producing enough of the chemicals needed for certain processes:- The chemical dopamine is critical for controlling the body’s movements and can produce symptoms similar to Parkinson’s disease. The chemical serotonin is known as the ‘feel-good’ neurotransmitter. It has a profound effect on mood, anxiety and can cause aggression. ACh controls activity in the areas of the brain that are connected with attention, learning and memory. People with Alzheimer’s tend to have low levels of ACh in their brain. 3.2 Describe how the sensory impairment of an individual with dementia may affect their communication skills Our senses help us to make sense of the world.

For someone with dementia the world gradually makes less and less sense. Therefore a double loss makes things very difficult. Someone with poor eyesight and poor memory may find it difficult orientating themselves even in their own home. I had a client with this issue and each day when he woke up in a bungalow he didn’t know where he was as he had no visual clues and his memory told him that he should be living in a different style of house with an upstairs. A person with poor hearing who is also losing their language skills will find it very difficult to hold a conversation as they may struggle to process words that they have misheard anyway. It is also tricky to persuade someone with dementia to wear hearing aids which may cause them irritation, and the person may not understand how to turn them on or put them in. Some dementia clients develop hand and face tremors which can affect their body language and therefore some communication signs may be misinterpreted.

People who have damage to the neurons on the left side of the brain tend to be affected by depression. They will have more organisational problems and will have problems using language. 3.3 Describe how the environment might affect an individual with dementia If a person with dementia is doing something that is familiar to them, they may appear very confident and able to do it with ease. However, take the person out of their familiar surroundings and out of their routine, and their confusion will grow, causing their symptoms to be more obvious. Keeping a person with dementia in their own home gives them a point of reference and allows them to orientate themselves each morning. In a similar way, as carers we all wear the same uniform which gives a client with dementia a feeling of recognition, even if they cannot recognise us individually.

3.4 Describe how the behaviours of carers or others might affect an individual with dementia One of the main triggers resulting in somebody with dementia becoming agitated and confused is a change in their routine. Any changes to the person’s life or daily routine can cause them to become unsettled, which could lead to inappropriate behaviours. To This can cause their stress levels to rise, resulting in added memory difficulties, frustration and confusion. In these earlier stages it is important for you as a care worker to give the person emotional support. Do not be tempted to take over what they are having difficulty with. Help them to calm down and think about what they are doing. The more the person becomes agitated, the greater their difficulties will become. If the person asks you a question and repeats it several times within a short space of time, answer it as though it is the first time you have heard the question.

Do not show your frustrations as this will only cause them to become upset when they see how their behaviour is affecting you. In the later stages, the person will become You can help reduce episodes of agitation by reducing the intake of caffeine, sugar and processed foods. The reduction of noise or crowds can also help, as does the maintenance of the person’s routines. One way of reducing this is to provide them with reassurance. Alternative strategies could include displaying reminders of activities around their home such as ‘Dinner is at 6:30pm’ or ‘Dave comes home at 5pm.’

This may assist with reducing anxiety and uncertainty about anticipated events. 3.5 Explain how the use of language can hinder positive interactions and communications As a care worker, you should identify the specific needs of the person with dementia. These needs could arise from their gender, ethnicity, age, religion and personal care. Other needs could also arise from their physical health or physical disability, any sensory impairment, communication difficulties, problems resulting from poor nutrition, poor oral health or learning disabilities.

The person’s needs should be identified with input from the person, their family, friends and any other persons that may be important in that person’s life. A person’s physical condition can be affected by their dementia. Their mobility may be reduced as may the person’s ability to maintain their own personal care or diet. Combining these factors can increase the person’s susceptibility to other illnesses such as chest infections or physical conditions such as pressure sores.

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