THE IMPORTANCE OF COMMUNICATION WITH DEMENTIA PATIENTS & THEIR FAMILY MEMBERS
Tips for Healthcare Workers
Caring for people with dementia poses many challenges for caregivers and family members. It is demanding work-physically, mentally, and emotionally-that requires a substantial amount of patience, understanding, and empathy.
Yet, it can also be very rewarding. Healthcare staff caring for dementia patients, whether in a nursing home, assisted living facility, hospital, or in-home setting, have the opportunity to help those with dementia achieve a better quality of life and lead meaningful lives every day. They also have the responsibility of helping family members understand the disease and navigate the challenges of communicating with a loved one who has dementia.
DEMENTIA IN THE US: A GROWING EPIDEMIC
The number of people with dementia is growing in the U.S. (and around the world), in large partlargely due to the aging baby boom population of baby boomers. Consider these facts and figures:1
- 10 percent of people age ages 65 and older in the U.S. have Alzheimer’s disease.
- In 2018, an estimated 5.7 million Americans of all ages are living with Alzheimer’s disease; the majority (5.5 million) of these individuals are agesage 65 or older, while an estimated 200,000 are under age 65.
- Alzheimer’s disease is the 6th leading cause of death in the U.S.
- Alzheimer’s disproportionately affects women in the U.S.-nearly two-thirds of Americans with Alzheimer’s are women.
- Older African-Americans and Hispanics are also disproportionately affected by dementia; African-Americans have twice the rate of Alzheimer’s or other dementias as older whites, while Hispanics have one-and-a-half times the rate as older whites.
- Alzheimer’s and other dementias kill more seniors each year than breast and prostate cancers combined.
- Millions of people (family members, friends, and others) provide unpaid care for people with dementia. It is estimated that, collectively, these caregivers provide billions of hours of care valued at more than $230 billion.
- The cost to the nation of caring for patients with dementia is extraordinary-$277 billion in 2018; these costs are projected to rise as high as $1.1 trillion by mid-century.
As of today, there is no cure for dementia, and the demand for dementia care will only grow with our aging population. Given this, it’s especially important for healthcare facility administrators to ensure that nurses, certified nursing assistants (CNAs), home health aides, and other caregivers are trained to effectively communicate with dementia patients and their families.
WHAT DEMENTIA MEANS FOR PATIENTS
Dementia is an irreversible and progressive disease of the brain that leads to memory loss and cognitive decline. There are several types of dementia, including:
- Alzheimer’s disease-The most common form of dementia in people of advanced age.2
- Vascular dementia-The second most common form of dementia in the U.S.; it develops when vessels that supply blood to the brain become blocked or narrowed.3
- Lewy body dementia-A type of dementia associated with deposits in the brain known as Lewy bodies.
- Mixed dementia-A combination of two or more types of dementia.
- Frontotemporal disorders-Including Pick’s disease and frontal lobe dementia.
Dementia can impair a person’s thinking, memory, reasoning, and communication skills to the extent that they are no longer able to perform some or all the activities of daily living. Patients with dementia may have difficulty with short- and/or long-term memory, visual perception, problem-solving, attention, and focus.
They also may be unable to discern risk or danger, and they may wander, which presents additional challenges for healthcare workers in terms of patient safety.
WHAT DEMENTIA MEANS FOR FAMILIES
As the disease progresses, patients with dementia eventually may not remember or recognize their family members and others, and they may have difficulty controlling their emotions, leading to personality changes.
These changes can be difficult-if not devastating-for many family members, especially those closest to the patients.
IN THEIR SHOES: EMPATHIZING WITH DEMENTIA PATIENTS AND THEIR FAMILIES
Compassion and empathy are vital when working with dementia patients and their families.
It helps to imagine the situation from their perspective: New residents of an assisted living facility or nursing home are suddenly in an unfamiliar environment, with strange faces, sights, smells, sounds, and corridors, rooms, and passageways they don’t recognize. They must adapt to a new, unfamiliar routine. They may not understand why they’re in this new environment and why they can’t go home.
Family members often have tremendous guilt about not being able to care for their parents, siblings, or other loved ones with dementia. They may feel guilty about “abandoning” their loved ones and worry about whether the patients will be properly cared for in their new homes.
Official protocols and procedures aside, it’s in this context-one of empathy and compassion-that caregivers should approach patients with dementia and their family members.
STRATEGIES FOR CAREGIVERS: COMMUNICATING WITH DEMENTIA PATIENTS
Good communication is key to managing day-to-day interactions with dementia patients. Here are tips for effective communication:
- Get the person’s attention . Before attempting to speak with to a person with dementia, limit distractions and noise, such as a radio, TV, or commotion outside the room. Address the person by name, identify yourself by name and relation, and maintain eye contact. Use non-verbal cues (such as gestures, eye contact, or placing a hand on the patient’s shoulder) to redirect the person’s attention if he or she becomes distracted.
- Use positive body language and tone . Communicate with the person in a respectful, pleasant manner. Avoid raising your voice or using negative facial expressions and body language (e.g., scowling, crossing arms, or placing hands on hips).
- Use simple, concise language . State your message clearly in short sentences. Speak slowly in a reassuring tone. Use pictures, written words, gestures, and verbal cues if the person is having difficulty understanding.
- Ask simple questions . Resist asking open-ended questions or presenting the patient with too many choices, which can feel overwhelming. Don’t ask “What would like to wear today?” Ask “Would you like to wear your blue slacks or your black ones?” Use visual cues to help clarify your questions.
- Listen patiently . It may take the patient a few moments to process questions or new information and respond. Listen attentively and patiently. Suggest words if he or she is struggling to find the right one. If the patient is agitated or upset, always strive to understand the feelings/motivations behind the words.
- Break down an activity into a series of steps . This can make tasks and activities more manageable. Use visual cues to help signal what to do next during activities if the person is having challenges, and try to align activities with the person’s abilities, which are likely to change over time.
- Don’t argue . People with dementia sometimes confuse reality and may insist something happened that didn’t. Avoid arguing or trying to convince them they’re wrong. Stay focused on the feelings they are demonstrating and respond with reassuring statements, comfort, and support.
- Provide comfort and reassurance . Hold the patient’s hand, apologize if the person complains of pain or during a care activity, and listen attentively to the person’s concerns, providing verbal and non-verbal reassurance.
- Encourage the person to tell stories . Remembering the “good old days” can be very soothing for those with dementia. Ask them questions about their distant past, which they’re more likely to remember.
RESPONDING TO REPEATED QUESTIONS OR ACTIONS
One of the most frustrating aspects of caring for people with dementia is repeated questions and actions. A person with dementia patient may repeat the same question, statement, or action again and again in a short period of time.
When this happens, avoid responding with statements like “You just asked that” or “I’ve already told you three times,” which isn’t helpful and can feel belittling. Instead, try redirecting their attention with a snack or activity. If patients become agitated or frustrated, reassure them with comforting words or touches. Placing signs (such as “Dinner is at 6 p.m.”) can help address frequently repeated questions.
STRATEGIES FOR CAREGIVERS: COMMUNICATING WITH FAMILY MEMBERS
Care facilities should provide family members with written information about the specific types of dementia affecting their loved ones and counsel family members on what they might expect in the coming weeks and months, especially for new residents of a long-term care facility (however, family members should know that how quickly dementia progresses can vary dramatically from one person to the next). Care facilities should:
- Help family members understand that dementia is not a normal part of aging and that their loved ones require special care.
- Remind family members that their loved ones are not playing games, being contrary, or pretending, and that they have no control over their condition.
- Reassure family members that their loved ones will undergo a period of adjustment and that upsets are likely during this time.
- Explain ways family members can make the end-of-life stage more tolerable for their loved ones.
- Provide family members with information about self-care and stress management.
HELPING FAMILY MEMBERS EFFECTIVELY COMMUNICATE WITH THEIR LOVED ONES
Many of the same communication rules that apply to caregivers and residents of long-term care facility settings also apply to communication between family members and their loved ones with dementia. Healthcare workers should encourage family members to:
- Use simple language and short sentences.
- Ask simple, close-ended questions.
- Listen attentively.
- Avoid arguing with their loved ones.
- Provide comfort and reassurance through words, gestures, and body language.
- Use redirection tactics if their loved ones become confused or ask the same questions repeatedly.
Family members should be counseled on how to respond to physically and verbally aggressive behavior from their loved ones and how to respond to questions that indicate their loved ones are confused about where they are (very common among people with dementia).
EFFECTIVE COMMUNICATION IMPROVES RESIDENT OUTCOMES
Effective communication is essential not only for ensuring resident safety but also for ensuring optimal function and quality of life for patients with dementia.
As the U.S. population ages, the need for healthcare workers who are trained to effectively communicate and interact with dementia patients will grow. DVD videos and online medical courses, such as those offered by Medcom, are powerful cost-effective tools for educating nurses, CNAs, and other caregivers about dementia.
MEDCOM FEATURED SERIES: DEMENTIA CARE
Adults diagnosed with dementia are faced with a disease that is irreversible and progressive. Loss of judgment, reasoning, memory, and communication skills lead to an inability to discern risk and danger. Caregivers working with residents with dementia have a great responsibility in administering care that supports optimal function, maintains safety, and provides quality of life to those who have lost the ability to determine their own course in life.
Medcom offers a 7-part series designed to help long-term care facility workers provide quality care for residents with dementia. Topics covered include:
- Alzheimer’s Care
- Communicating with Persons with Dementia
- Dementia Behavior Management
- Dementia Care
- Elopement (leaving premises) Prevention
- Family Issues with Dementia
- Promoting Independence for Persons with Dementia
These carefully constructed courses enhance employee engagement, which, in turn, can improve resident satisfaction and outcomes. For more information about our 7-part series on dementia care and to set up a free preview, please contact Medcom at 800-541-0253, or email [email protected]. Dementia Care programs are also available on DVD in our Mental Health Nursing Series.
ABOUT MEDCOM
For over 50 years, Medcom has been a trusted education provider among healthcare professionals, students, patients and their loved ones. Our vast library of products is used nationwide by universities, hospitals, long-term care facilities, and mental/behavioral health areas.
Medcom offers a complete suite of online education, including nurse CE programs, to help ensure quality care. Our award-winning products not only meet regulatory compliance, but the Medcom solution is cost-effective, meets in-service and continuing education needs, and boosts employee retention. To ensure the highest level of quality, we have worked with leading healthcare and professional organizations such as the American Lung Association, Johns Hopkins Hospital, and Mayo Clinic.