Person-Centered Care: 5 Basics of Communication in the Early Stages of Dementia

In the beginning, caregivers have a fairly easy time communicating with the person in their care living with dementia. Yes, there are hiccups and challenges in the early stages of Alzheimer’s and other dementias but there is also a lot of lucid communication happening/possible too. Caregivers are usually unpaid family members who know the person quite well in this phase. The rough-going is mostly in the middle stages. Use this time – when the person living with dementia has the greatest mental capacity for communication they will ever have again – to hone your approach and skills in communication as a caregiver.

Based on my professional and personal experience, the following concepts are essential to developing the skills and tools you will need to communicate effectively and peacefully with the person in your care.

  1. FACT: With dementia, at least two parts of the brain are dying. No matter which of the 70+ diseases that cause a specific individual’s dementia, no matter how the brain changes associated with that disease manifest in your unique person, all share this fact in common.The changes you see today began ten years ago. All those annoying and unexplained behaviors, different from the person you used to know before, were/are the disease creeping up on the one you love, neuron by neuron. TAKEAWAY: The only aspect of this disease within your control is your own behavior. As the one with healthy cognitive function, it falls on the caregiver to be attentive to what they themselves are doing to either foster or foul effective communications with the person in their care and make adjustments real-time. Similarly, what other factors may be causing communication breakdowns? Is there too much environmental stimuli? Is the person tired, hungry or thirsty? Is the person in physical discomfort? Make note of influencing variables and alter those within your control before attempting to re-start the conversation or activity.
  2. FACT: Dementia does not attack someone’s person-hood. Even after caregivers attend to a person’s basic physical safety and comfort, people living with dementia need more to be whole. All humans need to experience a sense of connection with and worth in their community to enjoy maximum well-being. A sense of connection is a combination of feeling welcome, understood and valued. With dementia, the sense of connection will become more important even though the ability to verbally express that need will deteriorate. TAKEAWAY: Now is the time to practice validation strategies. Validation strategies support a sense of connection by partnering with the person in your care rather than trying to get them to join your reality. So instead of correcting them, learn to understand how they see the world. The changes caused by dementia erode a person’s own sense of physical and emotional safety. Their sense of security is now tied to whether they feel understood by you.
  3. FACT: It’s not a hearing problem. It’s a processing problem. Seniors in general, and those with dementia in particular, process information more slowly and need more time to interpret what you said and to get their response together before sharing. TAKEAWAY: Don’t raise your volume, slow your pace. Pause between sentences. Allow the person time to respond. The meaning of some words may become elusive. Simplify your vocabulary unless using words long familiar to the person through vocation, hobby or family history.
  4. FACT: Dementia increasingly constricts a person’s peripheral vision. With dementia a person will lose peripheral vision more so than a typical senior but this condition will persist so that progressively, the person’s vision will be as if looking through first a scuba mask, then binoculars and eventually a monocle. TAKEAWAY: Start now to practice how you will approach the person in the center of their field of vision. Having confirmed you have eye contact, speak clearly and make sure your mouth is in clear view when you talk.
  5. FACT: As language skills decline, reliance on non-verbal communication will increase.  This works in both directions. The non-verbal aspects of communication have always been more important, in terms of interpreting meaning, than what one actually says. In the early stages of dementia, a person still has a fairly good vocabulary and conversation skills. But now is a good time to begin thinking about the roles that body language, facial expression, lip movement, gesture, tone, volume, speed and inflection play in communication. TAKEAWAY: Start to practice how you will incorporate multi-modal communication cues into your daily interactions.

Person-centered care is a philosophy that has, rightly, gained a lot of traction in the aging services and dementia care communities. The basic thesis is that the person living with dementia retains their identity even though they may be different from before. To honor and respect their personhood and protect their dignity, caregivers must learn to meet the person in their care where they are and to work with the skills their person still has. This approach is essential to protecting quality of life and well-being for both the person and their caregivers. The 5 basic concepts for effective communications with those in the early stages of dementia rest on the concept of person-centered care and can help you to foster and promote joyful exchanges and peaceful relationships with your loved one.

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