NAVIGATING THE
DIVIDE:
How to Communicate
Effectively
with Dementia Patients
OBJECTIVES
Understand the behaviors associated with
dementia and their causes
 Identify techniques to manage such behaviors
 Identify unspoken cues by dementia and
Alzheimer’s disease patients
 Provide techniques to help engage patients
suffering from dementia and Alzheimer’s disease

WE CAME HERE FOR A REASON
Nonna
 Mel
 Grams

THE DIVIDE
Gaps in cognition
make it unable to
communicate
 Meaningful
connections
 Quality of life
 Burnout

DEMENTIA
The Disorders of Loss
DEFINITION AND CRITERION

Dementia is characterized by loss
Loss of ability to understand spoken or written
language
 Loss of ability to identify or remember objects
 Loss of ability to perform motor activities
 Loss of ability to think abstractly


These manifest as a loss of autonomy, control and
oneself.
Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition
COMMON CAUSES OF DEMENTIA
Over 70 types of dementia
 Often comorbid or “mixed”
 Alzheimer’s Disease
 Vascular Dementia
 Lewy Body Dementia
 Frontotemporal Degeneration
 Hydrocephalus

BASICS OF ALZHEIMER’S
Understanding the disease
 Progressive
 Degenerative
 Ultimately fatal

BARRIERS TO COMMUNICATION
As a Result of Dementia and Related Diseases
METHODS OF MANAGEMENT
Reorientation
Short term memory is
effect them
 Honest with patients
 Relive painful trauma
 Death

Joining Patient’s Reality
Patients physically
cannot retain
information
 Follow along with
what the patient
believes is true

MEL VS. AUGUSTE
DEMENTIA’S ROLE IN BEHAVIOR
Keep in mind how far reaching the grasp of
dementia can be
 What if our brains couldn’t complete the
command or message
 What would happen if you couldn’t recognize
what normal functions of the body feel like

Urination
 Hunger
 Pain


Imagine the anxiety and behavior you would
exhibit if you didn’t know that these feelings
could be resolved
RECOGNIZING BARRIERS TO
COMMUNICATION
Identify underlying causes
 Question
 Overcome
 Assess
 Repeat if necessary

BEHAVIOR AS A BARRIER
As the ability to communicate wanes, behavior is
the main way patients can communicate
 Problem Behavior Vs. Nuisance Behavior
 Must choose which behaviors are necessary to
manage
 Some may not need management
 “Pick your battles”

BEHAVIOR BARRIERS

Nuisance behavior – Behaviors which do not put
the patient or staff at risk; these may just be
behaviors which are odd or socially unacceptable.
Singing
 Repetitive speech
 “Babies”
 Word Salad

BEHAVIOR BARRIERS

Problem behaviors – Behaviors that could result
in emotional or physical harm to the patient or
staff.





Delusions
Hallucinations
Wandering
Sexual Inappropriateness
Lack of Interest in Cleanliness
QUESTION THE BEHAVIOR

Discern if the behavior is in fact needing to be
managed
Singing may be a nuisance behavior at 3pm, but it may
be a problem behavior at 3am

If it needs managed, what could the behavior
mean
Consider what the client is not saying
 Are there non verbal cues
 Is this a common behavior
 Is the patient more disoriented than normal

OVERCOME THE BEHAVIOR

Use cues from the client’s history to redirect to
another activity


Not wanting to bathe
Overstimulation
Modify the environment or remove items that could
be causing an issue
 Notify other staff if you remove or replace something
 Simplify a task
 Questions

Open ended
 Closed ended

ENGAGE THE PATIENT
Assure the patient that they are safe
 Use a reassuring touch


Which is commensurate with relationship
Tell them what you plan to do
 Have confidence in your ability to manage the
situation
 Use cues from your relationship with them to let
them know you have had contact previously
 These will help to find the root cause of the
problem, which may then be addressed

WHAT ARE THEY NOT SAYING

Use nonverbal cues to read into what the patient
is unable to tell you
Pacing- worried, anticipating someone’s arrival
 Aggression- frustration at loss of control
 Wandering- confusion to place
 Sexual Inappropriateness- confusion to person

REASSESS THE PATIENT
After the root of the behavior is found and tended
to, the patient needs to be reassessed
 Is the behavior still occurring?
 If it is, look for an additional meaning

Physical
 Emotional

NOT ONE SIZE FITS ALL
There is no one universal answer
 One solution may work, until it doesn’t any
longer
 Not every behavior will be resolved
 Regain perspective

IDEAS FROM FAMILY
Memory people
 Give time to answer
 Listen
 Be patient
 Respect patients as people


Still have intelligence
TREMENDOUS OPPORTUNITY
It all comes down to
perspective
 You are my sunshine
