"I'm a Real Person Too The Im pact of Com m unication on - - PowerPoint PPT Presentation

"I'm a Real Person Too”

The Im pact of Com m unication on Behaviour for People with Dem entia

Presented by T. Bowser RNBN Illustrations by Don Bellamy

Introducing Don Bellam y

 “I’m a real person too.”

Outline

 What is communication?  How does dementia affect communication?  What does this mean for me as care provider?  What do we do that may cause responsive

behaviours?

 How can we reduce our contribution to responsive

behaviours through communication?

What is com m unication?

First Com m unications

 What are our first communications?  What do they mean?

Kit4na https:/ / www.flickr.com/ photos/ kit4na/ 6241060744/

What is com m unication?

Function Of Com m unication

 Fundamental requirement for all human beings  Essential for survival and growth and self-worth and

belonging, identity

 Expression of needs  Dignity  Control  Conveys meaning that goes beyond the spoken words

What is com m unication?

Com m unication is a Process

Like an ocean

• Active
• Continuous
• Flowing
• Changing

If you look at one bucket sample you don’t see the whole picture If you look at a sentence word or gesture in isolation you do not get the whole message (– jacket)

What is com m unication?

Com m unication is a Transaction

Both individuals are affected by the other Complex interaction of skills

• Listening
• Observing
• Speaking
• Questioning
• Analyzing
• Evaluating

What is com m unication?

Com m unication and Relationships

 A spoken sentence conveys much more than the

information in the sentence – it is a reflection of the relationship

 Communication changes based on who you are talking

to and in what situation

What is com m unication?

Consider the following paralinguistic features – what are your unique traits?

Volume Rate of speech Tone of voice Pitch Hand gestures Eye contact Vocabulary Body language Emphasis Conversational cues (hmmm) Proxemics

What is com m unication?

 Take a moment to introduce yourself to the person

• r people next to you

 Tell them your name, and a little bit about yourself

then let them tell you about themselves

 Ask each other one question to find out more  If you know the person beside you well, find

someone new to meet as well

Let m e introduce m yself…

Reflect:

 What paralinguistic features do you use? What is

your style?

 What did you sound like, look like?  What were your partner’s features?  This is normal communication

Non Verbal Com m unication

Communication is said to be 7% verbal, 93% non- verbal

 38% tone  55% body language

What is com m unication?

• Incongruence between verbal and non verbal

What is com m unication?

Non-Verbals and Dem entia

With dementia, people live in the here and now

• May not rem em ber the details
• May not be able to understand the details
• They know how they feel and they retain the

em otions from an interaction

Com m unication and Dem entia

Com m unication and Dem entia

What happens with com m unication in dem entia?

Com m unication and Dem entia

Dem entia Deficits of Com m unication

Early Stages:

• Tip of the tongue feeling
• Takes longer to process – 30-60 seconds
• Difficulty staying on track
• Aphasia (word finding difficulty)
• Repeating

Com m unication and Dem entia

Dem entia Deficits of Com m unication

Middle Stages

• Forget more complex words
• Neologisms
• Increased generalizations
• Greater reliance on social phrases
• Difficulty following instruction
• Less initiation of conversation

Com m unication and Dem entia

Dem entia Deficits of Com m unication

Late Stage

• Single words
• Limited initiation
• Nonverbal sounds
• Communication as a whole is predominantly

nonverbal

Com m unication and Dem entia

Other Com m unication Barriers

Hearing loss

• Loss of ability to hear higher pitches
• Substantial hearing loss not unusual

Vision loss

• Many visual cues are used in communication
• Conversational cueing
• Feedback
• Decoding

Dentures

Com m unication and Dem entia

Rem em ber:

Lack of initiation/ engagement of conversation does not imply a lack of desire for communication Ability to UNDERSTAND the spoken word long outlasts the ability to COMMUNICATE the spoken word Ability to understand and experience the emotions involved in communication long outlasts the ability to understand the spoken word

Com m unication and Dem entia

Results of Im paired Com m unication

 Unmet needs  Frustration  Anxiety  Decreased self esteem  Increased social isolation

 Interaction with individuals

with dementia is often superficial and brief.

• Not being understood increases

isolation

Com m unication and Dem entia

Results of Im paired Com m unication

Responsive Behaviours

Hostility Aggression Yelling Swearing Pushing Grabbing Refusing

Com m unication and Dem entia

What does this m ean for m e as care provider?

Telephone Gam e?

McGhee, J. (2011). Effective communication with people who have dementia Nursing Standard 25(25) 40-46

Com m unication and Dem entia

Telephone Gam e?

 With increasing deficits, communication ceases to

be 50/ 50 and becomes more 80/ 20

Com m unication and Dem entia

What do we do that m ay CAUSE responsive behaviours?

What we do…

What do we do?

How to we prom ote responsive behaviours?

• Task orientation/ isolation
• Removing control
• Not engaging fully
• Not responding to the emotion/ intended message
• Elderspeak

What we do…

Task Orientation/ Isolation

 Focusing on the task, not the person  Only engaging with them when there is a task to be

done

What we do…

Rem oving Control

• The desire to have control over ourselves and our lives

is fundamental to people of all ages

• We all want to feel as though we have influence over
• urselves and our surroundings
• Feelings of helplessness and loss
• f control lead to reduced

cooperation and acting out

• This is not unique to dementia…

What we do…

Control.

A life-long need.

Not Engaging Fully

 Multi-tasking  Being disconnected  Generic responses  Back to them  Talking to others as

though they are not there

What we do…

Not Responding to the Em otion

 Focusing only on the words  Looking at the bucket of water

Listening to reply rather than listening to understand

What we do…

Elderspeak

AVOID ELDERSPEAK

High Pitched Voice Dem eaning Nam es – Sweetie, Honey Baby Words – go potty Everything sounds like a question

What we do…

App store?

Elderspeak

• Greatly increases the likelihood of uncooperative

behaviour when doing tasks

• Demonstrates power imbalance and reinforces loss of

control

• Demonstrates lack of respect for individual and who they

are

• Increases depression and agitation
• May be interpreted as abusive

Even if dem entia is so advanced that the words are not understood, the feelings associated are perceived and retained

What we do…

Elderspeak

“Hi Sweetie. It’s time for our exercise today. Let’s get ready to walk down the hall.” Vs. “Hi Mrs. Smith. It’s time for your exercise today. May I walk down the hall with you?”

What we do…

Elderspeak

Effect on Person with Dem entia:

• Feel incompetent
• Feel discouraged
• Feel disrespected
• Alters self perception
• Reinforces and imposes dependency
• Insulting
• Depression
• Withdrawal

Greatly increased likelihood of resistance to care

What we do…

Herman, R & Williams, K. (2009). Elderspeak’s influence on resistiveness to care: focus on behavioural events. American Journal of Alzheimer’s Disease and Other Dementias 24(5) 417-423

What we do…

Elderspeak

Effect on perception of care provider by third party and care recipient:

• Disrespectful
• Patronizing
• Unprofessional
• Angry
• Frustrated
• Dislikable
• Unintelligent
• Poor communicator

What we do…

Strategies

How can we reduce our contribution to responsive behaviours through com m unication?

Strategies

Em pathic Curiosity

• A standpoint of trying to focus our attention on the

perceptual experiences of another as they are experiencing them here and now

• More than empathy – empathic listening with

maintaining a curious attitude toward nonverbal cues and behaviours Rem em ber: All com m unication has m eaning

Strategies

Strategies

MESSAGE

M – Maximize attention E – Expression and body language S – Simple S – Support the conversation A - Assist with visual aids G – Get their message (empathic listening) E – Encourage and engage in conversation

Strategies - MESSAGE

M – Maxim ize Attention

 Give cues before engaging them  Identify yourself  Use their name  Eye level and eye contact  Remove distractions – quiet environment  One person talking at a time  May use touch to aid concentration

Try it! – strike up a conversation w ith your neighbour

Strategies - MESSAGE

E – Expression and Body Language

 Stay calm and relaxed  Do not multi-task if you can help it  Smile – facial expressions  Lean forward  Eye contact  Even tone – do not over emphasize tone of voice

Try it! – talk to your neighbour about the forecast

Strategies - MESSAGE

S – Sim ple

 Keep messages familiar and short – but not infantilizing  One message at a time  Clear choices (Elvis or the Beatles?)  Fewer pronouns  Do not test – avoid factual questions that rely on recent

memory

 Present tense

Try it! – Tell your partner that it is lunch tim e and ask them w hat they w ould like to drink – consider pacing, spacing and clarity of choices.

Strategies - MESSAGE

S – Support the Conversation

 If interrupted, reintroduce the topic  Provide more time to process  Repeat and rephrase– maintain tone  Repeat part of what you heard to encourage them  Do not pressure  Help with word finding

• Find a balance between allowing time and causing distress

Try it! – Ask your partner about w here they grew up – if they don’t reply, rephrase or repeat

Strategies - MESSAGE

A - Assist with Visual Aids

 Gestures or actions  Objects or pictures  Show options

Strategies - MESSAGE

G – Get Their Message

 Start with the attitude that all behaviour and

communication has meaning

 Focus on feelings, not facts  Look for micro behavioural cues  Provide feedback – mmm hmm…

.

 Look at the big picture

• Body language cues
• Look for and respond to the

emotion behind the message

• What is the person’s history?

Strategies - MESSAGE

G – Get Their Message

Try it

• What is your first im pression/ reaction if faced w ith these

behaviours?

• What else m ight these behaviours m ean? (3 ideas!) – w hat

response m ight be required?

• Calling out for mother
• Pulling at your sweater
• Repeatedly wandering into the kitchen
• Refusing to sit at a meal
• A loud sigh

E – Encourage and Engage in Conversation

 Interesting and familiar topics  Do not test them – yes and no - statements  Avoid reality orientation  Alternative techniques to communicate – writing,

pictogram, gesturing

 Use positives rather than negatives when possible  Do not argue with them

Strategies - MESSAGE

Other Strategies

 Account for other communication barriers – hearing,

vision – and use available aids

 Support client control and self esteem  Do not be afraid to laugh  Share what works

Hum our Therapy

 A basic need throughout the life span  Humour and play have many benefits

 Cardiovascular  Respiratory  Immune  Pain  Stress relief  Diabetes  Connection  Distraction  Communication  Equality  Ability to try things without risk  Makes new connections

Strategies - Hum our

Hum our Therapy

 2011 SMILE study Sydney Australia  Cluster randomized controlled trial evaluating the

effect of humour on depression, agitation, social engagement and quality of life of nursing home residents

 Involved 398 residents  Involved humour therapy training for one staff and

9-12 visits by professional “elderclown”

Strategies - Hum our

Hum our Therapy

 No significant outcome change in depression found  Agitation outcome was a significant decrease  Equivalent to two agitated behaviours decreasing

from daily to once a week

 Similar outcome to risperidone – without the side

effects

Strategies - Hum our

How Does Hum our Stack up?

Hum our

• Enhances connection
• Removes power barriers
• Is fully engaging
• Is an emotional message
• Is a normal part of

communication

Strategies - Hum our

How to we prom ote responsive behaviours?

• Task orientation/ isolation
• Removing control
• Not engaging fully
• Not responding to the

emotion/ intended message

• Elderspeak

– Freem an

OK but…

 I’m no “elderclown”  There are downsides to humour  I’m not funny

Everyone can use hum our

Strategies - Hum our

5 Rights

Right Drug

 Right type of humour  Avoid sarcasm, gallows humour  Take cues from the other person - assess

Right Dose

 Could be just a smile

Right Route

• Where are you coming from?
• Laugh WITH not AT

Right Person

 Must know your audience  Must be trust established

Right Tim e

 Never during crisis

Com m unication, Dem entia and Frustration

 Communicating with someone with dementia can

be frustrating

 Constant reminder of loss  Fear  So what if you slip? What if you find yourself not

using your equality and respect voice?

 Regroup and try again  Forgive yourself  Self care

What is com m unication?

Two Stars and a Wish

 Give yourself credit for your successes  Two Stars to celebrate what went right  A wish for something that didn’t  All that you can do is take it one experience at a

time.be kind to yourself. Cherish the successes.

References

Balsis, S. & Carpenter, B. (2005). Evaluations of elderspeak in a caregiving context. Clinical Gerontologist 29(1), 79-96 Christienson, A., Buchanan, J. & Houlihan, D. (2011). Command use and compliance in staff communication with elderly residents of long term care facilities Behavior Therapy 42, 47-58 Com m unicating Effectively: Dem entia w ith Dignity. Film s On Dem and. Films Media Group, 2006. Web. 14 Jan. 2015. <http:/ / digital.films.com.proxy2.lib.umanitoba.ca/ PortalPlaylists.aspx?aid=36239&xtid=54521>. Eggenberger, E., Heimerl, K. & Bennett, M. (2013). Communication skills training in dementia care: a systematic review of effectiveness, training content, and didactic methods in different care settings International Psychogeriatrics 25(3),345-358 Elkins, Z. (2011). Communication bridges for people with dementia Prim ary Health Care 21(10) :16-19 Gerontological Society of America (2012). Com m unicating With Older Adults: an evidence based review of w hat really w orks. Washington http:/ / www.agingresources.com/ cms/ wp-content/ uploads/ 2012/ 10/ GSA_Communicating-with-Older-Adults-low- Final.pdf Herman, R & Williams, K. (2009). Elderspeak’s influence on resistiveness to care: focus on behavioural events. Am erican Journal of Alzheim er’s Disease and Other Dem entias 24(5), 417-423 Low, L., Goodenough, B., Fletcher, J., Xu, K., Casey, A., Chenoweth, L… Brodaty, H. (2014). The effects of humor therapy on nursing home residents measured using observational methods: the SMILE cluster randomized trial. Journal of the Am erican Medical Directors Association 15, 564-569 McEvoy, P. (2014). Dementia communication using empathic curiosity Nursing Tim es 110(24) ,12-15 McEvoy, P., baker, D., Plant, R., Hylton, K. & Mansell, W. (2013). Empathic curiosity: resolving goal conflics that generate emotional distress Journal of Psychiatric and Mental Health Nursing 20, 273-278 McEvoy, P. & Plant, R. (2014). Dementia care: using empathic curiosity to establish the common ground that is necessary for meaningful communication Journal of Psychiatric and Mental Health Nursing 21, 477-482 McGhee, J. (2011). Effective communication with people who have dementia Nursing Standard 25(25), 40-46 Moos, I. (2011). Humour, irony and sarcasm in severe alzheimer’s dementia – a corrective to retrogenisis? Ageing and Society 31, 328- 346 Nygard, H. (2010). Pain in people with dementia and impaired verbal communication. Journal of Pain and Palliative Care Pharm acotherapy 24, 414-426

Smith, E., Broughton, M., Baker, R.,Pachana, N., Angwin, A., Humphreys,M., … Cherney, H (2011). Memory and communication support in dementia: research based strategies for caregivers International Psychogeriatrics 23(2) , 256-263 Williams, K. & Herman, R. (2010). Linking resident behaviour to dementia care communication: Effects of emotional tone Behavior therapy 42, 42-46 Williams, K, Herman, R., Gejewski, B. & Wislon, K. (2009). Elderspeak communication: impact n dementia care. Am erican Journal

• f Alzheim er’s Disease and Other Dem entias 24(1), 11-20

Williams, K, Kemper, S & Hummert, M. (2003). Improving nursing home communication: An intervention to reduce elderspeak. The Gerontologist 43(2), 242-247 Wond, S., Anand, R., Chapman, S. Rackley, A. & Zientz, J. (2009). When nouns and verbs degrade: facilitating communication in semantic dementia Aphasiology 23(2), 286-301 Manitoba Health Enhanced Orientation for Nurses new to Long Term Care Clinical Workshop 2: Manitoba Health Young, T., Manthorp, C., Howells, D. & Tulla, E. (2011). Optimizing communication between medical professionals and people living with dementia international Psychogeriatrics 23(7), 1078-1085