i'm a real person too” - alzheimer society of manitoba · 2017-06-16 · "i'm a real person...

"I'm a Real Person Too The Impact of Communication on

Behaviour for People with Dementia

Presented by T. Bowser RNBN Illustrations by Don Bellamy

Introducing Don Bellamy

Im 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 communication?

First Communications

What are our first communications? What do they mean?

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


Function Of Communication

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


Communication is a Process

Like an ocean Active Continuous Flowing Changing

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


PresenterPresentation NotesActivity:What does this mean?

Communication is a Transaction

Both individuals are affected by the other Complex interaction of skills

Listening Observing Speaking Questioning Analyzing Evaluating


Communication 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


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


Take a moment to introduce yourself to the person or 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 me introduce myself

Reflect:

What paralinguistic features do you use? What is your style?

What did you sound like, look like? What were your partners features?

This is normal communication

Non Verbal Communication

Communication is said to be 7% verbal, 93% non-verbal 38% tone 55% body language


Incongruence between verbal and non verbal


Non-Verbals and Dementia

With dementia, people live in the here and now May not remember the details May not be able to understand the details They know how they feel and they retain the

emotions from an interaction

Communication and Dementia


PresenterPresentation NotesShadow of your interaction is longOprah wisdom

What happens with communication in

dementia?


Dementia Deficits of Communication

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



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



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

nonverbal


Other Communication 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


Remember:

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


PresenterPresentation NotesThis includes isolation

Results of Impaired Communication

Unmet needs Frustration Anxiety Decreased self esteem Increased social isolation Interaction with individuals with dementia is often superficial and brief. o Not being understood increases isolation


Results of Impaired Communication

Responsive Behaviours Hostility Aggression Yelling Swearing Pushing Grabbing Refusing


What does this mean for me as care provider?

Telephone Game?

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


Telephone Game?

With increasing deficits, communication ceases to be 50/50 and becomes more 80/20


What do we do that may CAUSE responsive

behaviours?

What we do

What do we do?

How to we promote 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

Removing 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 ourselves and our surroundings

Feelings of helplessness and loss of control lead to reduced cooperation and acting out This is not unique to dementia

What we do

PresenterPresentation NotesEx: potty training, Christmas dinner, go in front of the car

https://fbcdn-video-n-a.akamaihd.net/hvideo-ak-xpf1/v/t42.1790-2/1053631_10152315890905881_1922148837_n.mp4?oh=3540c57890308614d5be2d25d020b6c2&oe=54A1B42B&__gda__=1419884671_79a64dc29a37d49e193ab55d734ada67

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 Emotion

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

Demeaning Names 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 dementia is so advanced that the words are

not understood, the feelings associated are perceived and retained

What we do

Elderspeak

Hi Sweetie. Its time for our exercise today. Lets get ready to walk down the hall.

Vs.

Hi Mrs. Smith. Its time for your exercise today. May I

walk down the hall with you?

What we do

Elderspeak

Effect on Person with Dementia: 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). Elderspeaks influence on resistiveness to care: focus on behavioural events. American Journal of Alzheimers 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 communication?

Strategies

Empathic 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 Remember: All communication has meaning

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 Maximize 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 with your neighbour


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


S Simple

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 time and ask them what they would like to drink consider pacing, spacing and clarity of choices.


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

o Find a balance between allowing time and causing distress Try it! Ask your partner about where they grew up if they dont reply, rephrase or repeat


A - Assist with Visual Aids

Gestures or actions Objects or pictures Show options


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

o Body language cues o Look for and respond to the emotion behind the message o What is the persons history?


G Get Their Message

Try it What is your first impression/reaction if faced with these

behaviours? What else might these behaviours mean? (3 ideas!) what

response might 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


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

Humour 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 - Humour

Humour 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 - Humour

Humour 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 - Humour

How Does Humour Stack up?

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

communication

Strategies - Humour

How to we promote responsive behaviours?

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

Freeman

OK but

Im no elderclown There are downsides to humour Im not funny Everyone can use humour

Strategies - Humour

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 Time Never during crisis

Communication, Dementia 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


PresenterPresentation NotesTake three minutes to discuss with neighbour

Two Stars and a Wish

Give yourself credit for your successes Two Stars to celebrate what went right

A wish for something that didnt

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 Communicating Effectively: Dementia with Dignity. Films On Demand. Films Media Group, 2006. Web. 14 Jan. 2015. . 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 Primary Health Care 21(10) :16-19 Gerontological Society of America (2012). Communicating With Older Adults: an evidence based review of what really works. Washington http://www.agingresources.com/cms/wp-content/uploads/2012/10/GSA_Communicating-with-Older-Adults-low- Final.pdf Herman, R & Williams, K. (2009). Elderspeaks influence on resistiveness to care: focus on behavioural events. American Journal of Alzheimers Disease and Other Dementias 24(5), 417-423 Low, L., Goodenough, B., Fletcher, J., Xu, K., Casey, A., Chenoweth, LBrodaty, H. (2014). The effects of humor therapy on nursing home residents measured using observational methods: the SMILE cluster randomized trial. Journal of the American Medical Directors Association 15, 564-569 McEvoy, P. (2014). Dementia communication using empathic curiosity Nursing Times 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 alzheimers 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 Pharmacotherapy 24, 414-426

http://www.agingresources.com/cms/wp-content/uploads/2012/10/GSA_Communicating-with-Older-Adults-low-Final.pdfhttp://www.agingresources.com/cms/wp-content/uploads/2012/10/GSA_Communicating-with-Older-Adults-low-Final.pdf

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. American Journal of Alzheimers Disease and Other Dementias 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

Slide Number 1Introducing Don BellamyOutlineSlide Number 4First CommunicationsFunction Of CommunicationCommunication is a ProcessCommunication is a TransactionCommunication and RelationshipsSlide Number 10What is communication?Reflect:Non Verbal Communication Slide Number 14Non-Verbals and DementiaSlide Number 16Slide Number 17Dementia Deficits of CommunicationDementia Deficits of CommunicationDementia Deficits of CommunicationOther Communication BarriersRemember:Results of Impaired CommunicationResults of Impaired CommunicationSlide Number 25Telephone Game?Telephone Game?Slide Number 28What do we do?Task Orientation/IsolationRemoving ControlSlide Number 32Not Engaging FullyNot Responding to the EmotionElderspeakElderspeakElderspeakElderspeakSlide Number 39ElderspeakStrategiesStrategiesStrategiesM Maximize AttentionE Expression and Body LanguageS SimpleS Support the ConversationA - Assist with Visual AidsG Get Their MessageG Get Their MessageE Encourage and Engage in ConversationOther StrategiesHumour TherapyHumour TherapyHumour TherapyHow Does Humour Stack up?OK but 5 RightsSlide Number 59Communication, Dementia and FrustrationTwo Stars and a WishReferencesSlide Number 63

i'm a real person too” - alzheimer society of manitoba · 2017-06-16 · "i'm a real person...

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