Nonverbal Communication

&

Quality of Life in Dementia

Zunera Khan10/03/2020

Background - Dementia

Fifty million people with dementia. Likely to almost double

every 20 years, reaching 74.7 million in 2030 and 131.5 million

in 2050.

In the UK, 1/3 of people with dementia live in care homes. The

majority of these individuals have moderate or severe dementia

and have highly complex care needs.

PM Dementia Challenge 2020: Importance of improving quality

of life and meaningful care of people with dementia.

Non-drug approaches to address major drivers of QoL,

particularly through social interaction and pleasant activities for

both agitation and antipsychotic use.

Care Needs Food

Medication

Falls

Activities of Daily Living

Mental health

Anxiety

Depression

Agitation

Social Interaction

Input by Multidisciplinary Teams

Hancock et al., 2006

When interacting with one another

Communication can be either verbal or

non verbal.

Only 7 % of what we communicate is

through spoken words.

Rest is through how words are spoken

and other Nonverbal indices

Communication

Forms of Nonverbal

Communication

Eye contact

Shows: personal interest, affection, hostility, or attraction

Helps with the flow of conversation

Engage and elicit the other person’s response

How Words are Spoken

• When we speak, other people “read” our tone in

addition to listening to our words

• Pitch (how louder you speak), your tone

• Timing and pace, and inflection

• Someone's tone of voice, for example, can indicate

anger, happiness, affection, fear, or confidence; these

behaviours help to convey the message stronger.

Forms of Nonverbal Communication

Forms of Nonverbal Communication

Facial Expressions

• Human face is extremely expressive, able to express countless

emotions without saying a word.

• Facial expressions are universal.

• The facial expressions for happiness, sadness, anger, surprise,

fear, and disgust are the same across cultures.

Gestures

• Movement of part of the body, especially a hand head, to express

an idea or meaning

• We wave, point, sign, and use our hands while we are arguing or

speaking animatedly; expressing ourselves often without thinking

with gestures.

Touch

• Touch is an integral part of nursing care, especially for

building relationship and rapport

• A light touch on the arm can bring comfort and enrich

the communication.

• Instrumental touch Vs. affective expressive touch

• Found to be effective method of interacting with limited

cognitive function

Forms of Nonverbal Communication

Forms of Nonverbal Communication

Posture & Spacing

Space and position can communicate many different nonverbal

cue; e.g. interest, intimacy, affection & aggression or dominance

Body positioning may indicate if one is listening, attending and

involved (Von Cranach 1971, Gross 1990)

One may feel uncomfortable during a conversation because the

other person was standing too close and invading our space?

DANVA – Facial Expressions (Nowicki et al 1994)

DANVA – Facial Expressions

DANVA – Facial Expressions

Importance of Nonverbal communication

1. Reinforces or modifies what is said in words. People may

vigorously nod their head when saying yes to emphasis

that they are agreeing with the other person

2. Where NVC plays an important role in conveying

information about their emotional state.

3. NVC not only Defines BUT Reinforces relationships

between people.

Person living with dementia may

show symptoms with

Nonverbal cues

Aggression

Facialexpression loss

of interest

Anxiety

Change in Appetite

Reduced social interaction

Change in sleep

Low mood

Agitation

Nonverbal Communication &

Quality of Life In Dementia - Study

Study Sample

&

Study Participants

100 People with dementia in care homes.

Average age - 85 years old (SD 1.8)

69% female Vs. 31% - male.

Participants with Dementia (n =100)

– 21 Care homes across London / Essex

Quality of Life – AD (Logsdon, 1999) (QoL-AD) - Proxy and

Self reported

Camberwell Assessment of Need in Elderly (CANE) (Orrell et

al., 2004)

Emory Dyssemia Index (EDI) – Impairment of NVC (Nowicki

and Duke, 1992) (Baseline – 12 weeks – 24 weeks)

Sheffield Screening Test for Acquired Language Disorders

(STALD) (Baseline – 12 weeks – 24 weeks)

Neuropsychiatric Inventory (NPI) (Cummings, 1994)

Functional Assessment Staging Tool (FAST) (Reisberg,1988)

Verbal Fluency – (FAS) (Benton 1976)

Study Assessments

Emory Dyssemia Index

➢ Greater impairment in people living with severe dementia

as compared to people with moderate to severe dementia

Care Needs and Communication

Impairment in Nonverbal communication

impacted number of care needs

As the level of impairment went up, number of

care needs increased..

Impairment in Nonverbal

Communication and Quality of Life

(QoL)

Impairment in Nonverbal communication impacted QoL

As the level of impairment went up there was a decline in people’s QoL

Communication and Neuropsychiatric Symptoms

Impairment in Nonverbal communication

impacted Behavioural Symptoms..

As the level of impairment increased,

behavioural symptoms also increased…

Follow up time points – Message

Nonverbal Communication was still

associated with behavioural symptoms, QoL

and Caregiver distress at the follow up visits

at 3 months and 6 months..

EDI total score Baseline

EDI total score 12 weeks

EDI total score 24 weeks

NPI total items A-J .410** p < .001(n= 100)

.416**p < .001(n = 78)

.301*p = 0.011(n = 70)

NPI Baseline Agitation Cluster

Score

.284**p =. 004(n = 100)

.413**p < .001(n = 77)

.271*p = .023(n = 70)

Occupational disruptiveness score NPI–NH

.330**p < .001

(n= 100)

.444**p < .001(n = 78)

.275*p = .021(n = 70)

Proxy-reported QoL-AD

- 0.351**p<.001

(n= 100)

-.245*0.031(n=77)

-.434**p< .001(n = 70)

Impairment in Nonverbal Skills in

Moderate - Severe Stages of Dementia

Lower scores indicate less impairment

20.00

16.00

14.00

12.00

10.00

10.00

10.00

9.00

8.00

7.00

0.00 5.00 10.00 15.00 20.00 25.00

Objectics

Nonverbal Receptivity

Conversational Skills

Social Rules

Chronemics and Use of Time

Space Touch

Facial Expression

Paralanguage

Gaze & Eye Contact

Hands Gesture

Median

ED

I S

ub

scale

s

Nonverbal Communication in People with Moderate/Severe AD

Impairment in Nonverbal Skills in Severe

Stages of Dementia

Lower scores indicate less impairment

28.00

25.00

20.00

15.00

13.00

12.00

12.00

12.00

10.50

7.00

0.00 5.00 10.00 15.00 20.00 25.00 30.00

Objectics

Nonverbal Receptivity

Social Rules

Conversational Skills

Paralanguage

Facial Expression

Gaze & Eye Contact

Space Touch

Chronemics and Use of Time

Hands Gesture

Median

ED

I S

ub

scale

s

Nonverbal Communication in People with Severe AD

Conclusion

Importance of nonverbal communication in the delivery care for people with dementia living in nursing homes

Impairment in nonverbal communication is also associated with more agitation and aggression

Two way Communication is important

Training care on using nonverbal skills that are least impaired for people with dementia

Use of gestures and Gaze when interacting with people with dementia

Further psychosocial intervention models for this population should incorporate nonverbal communication as a base therapeutic target.

Thank you…