Understanding

Dementia

Introduction
In February 2009 the Department of Health published the first ever
National Dementia Strategy. Within the strategy are 17 key
objectives designed to:
Make the lives of people with dementia, their carers and families
better and more fulfilled (DoH 2009).
Objective 13 calls for an informed workforce for people working with
dementia. This is to be achieved by effective basic training and
continuous professional and vocational development in dementia
care.
As part of SEPTs Workforce and Development strategy to support
this document, this e-Learning training has been created for all staff
involved in health and social care in older people services including
primary, secondary and tertiary care pathways providers.
DH UK Dementia
or you can order a copy from: Orderline UK

Key Points
This e learning training course should take learners up to 45 minutes to complete.
Learners will be able to stop and revisit at any given point.
On completion of this e learning training, learners should be able to:
Understand the definition of dementia
Gain an awareness of incident rates in the UK
Identify the most common types and causes of dementia
Gain an awareness of signs and symptoms of dementia
Recognise the difference between dementia, depression and confused states
Understand where behavioural interventions may be helpful
Identify different methods of communication
Understand why people with dementia may experience difficulties with
communication.
Identify communication skills and approaches which may be useful when working
with people with dementia.
Understand the need for a positive and effective communication with the person
experiencing dementia.

Prevalence
Key data for the UK as a whole includes the following:
More than 750,000 people in the UK are affected by dementia
It affects one person in six over 80 (late onset)
One in 14 over 65 (early onset)
Dementia is predominantly a disorder of later life, but there are at
least 15,000 people who have young onset dementia , click for more
information you may wish to view or download the following fact sheet:

Fact Sheet
Source: alzheimers.org.uk
Approximately two women for every man is affected
It is estimated that there are 11390 people from Black minority ethnic
groups (BME) with dementia. Its note worthy that 6.1% of all people
with dementia among BME groups is young onset, compared to 2.2%
for the UK population as a whole.

Projected Impact
The total number of people with
dementia in the UK is forecast to increase
to approximately 950,000 by 2021
Increasing to 1,735.000 by 2051
An increase of 38% over the next 15
years and 154% over the next 45 years
Information taken from Dementia UK: the
full report (Knapp, Albanese et al 2007)
To view copies of the full report go to:
Dementia UK Full Report

What is Dementia?
The Department of Health (2009) defines the term dementia as a
syndrome which may be caused by a number of illnesses in which
there is a progressive decline in multiple areas of function.
Dementia is not a part of the normal ageing process.
In essence dementia is a term used to describe a collection of
symptoms which for most people are progressive and irreversible.
This means the dementia usually gets worse slowly and often over
a period of years, meaning that in most cases, the person with
dementia can no longer live independently. This can have a
profound affect on both the person with dementia and their carers.
Additionally, there are different causes of dementia and this will
have a direct impact upon the experience of the illness which the
person with dementia has.
There are currently no cures for dementia but there are medications
and other psychosocial interventions/ treatments available. These
can improve symptoms in some people and optimise their
functioning level, thus increasing their quality of life.

Common Types and Causes of

Dementia
There are a hundred different forms of dementia, with the most
common being:
Alzheimers disease, affecting 62% of sufferers
Vascular dementia or Multi infarct dementia is attributed to 17%
Mixed Alzheimers disease and Vascular dementia account for 10%
Lewy bodies dementia accounts for another 4%
Fronto-temporal lobe dementia is responsible for another 2% and a
remaining 2% for Parkinsons disease
The remaining 3% of cases are related to other causes which may be
treatable.
Taken from:
A comprehensive free Tutorial for Dementia Management in
Primary care, a resource pack for GPs and patients. Funded by the
Department of Health. (Alzheimers Society 2009)

Common Types and Causes of

Dementia (continued)

Rarer, Less Treatable

Conditions
Fronto- temporal lobe dementia
Factsheet 404, Source: alzheimers.org.uk
Learning disabilities and dementia
Factsheet 430, Source: alzheimers.org.uk
Creutzfeldt Jakob Disease
Factsheet 427, Source: alzheimers.org.uk
AIDS related dementia
Factsheet 446, Source: alzheimers.org.uk

Other Conditions
Of which are caused by physical & psychological pathology include:
Depression (severe forms can mimic symptoms of dementia)
Factsheet 444, Source: alzheimers.org.uk
Acute Confusional State /Delirium
Delirium PDF, Source: NHS Library
Hypothyroidism
Factsheet 442, Source: alzheimers.org.uk
Vitamin B12 deficiency
Factsheet 442, Source: alzheimers.org.uk
Tumor
Brain tumor associated dementia, Source: find-healtharticles.com

It is of paramount importance that any underlying physical or

psychological causes are eliminated before someone is investigated for
suspected dementia.

Alzheimers Disease
For purpose of achieving the learning outcomes in this module we will
be concentrating on the three most common conditions. In addition
to these we will also explore depression which can be mistaken by
non-specialists as a dementia and Acute Confusional States as the
latter two conditions may be responsive to appropriate interventions.
Alzheimers Disease
Although the features of Alzheimers disease are not dissimilar to
other conditions, it is not an umbrella term for dementia as each
condition has distinct differences in their clinical and behavioural
presentations. No case of Alzheimers is the same as people react in
different ways. This fact sheet gives a simple overview of the
condition. You may wish to download this and use it as a resource.
What is Alzheimer's disease?
Source: Alzheimer's Society

Vascular / Multi Infarct

Dementia
Vascular dementia has a less predictable decline than Alzheimers disease.
The condition refers to a syndrome caused by different mechanisms all
resulting in vascular lesions in the brain. Early detection and accurate
diagnosis is of paramount importance as this type of dementia is partially
preventable. There can be relative stability if vascular disease is minimised,
but if left untreated there will be further deterioration in the condition after
subsequent vascular accidents.
There are a number of potentially modifiable risk factors that appear to
have an influence on the disease including common cardio-vascular risk
factors i.e. smoking, high cholesterol, alcohol abuse, hypertension and
obesity.
Initial symptoms are often physical in presentation, such as weakness in
limbs, slurred speech and dizziness with accompanying short term memory
impairment. If a person continues to have minor strokes or ischemic attacks
and they remain undetected, there will be an exacerbation of early
symptoms and less treatable physical and psychological presentations.
Types of Dementia
Source: dementiaweb.org.uk

Dementia with Lewy Bodies

Dementia with Lewy Bodies is caused by abnormal protein deposits which disrupt
the brains normal functioning. These proteins are also found in the brain stem of
people with Parkinsons disease hence they deplete the neurotransmitter
dopamine, which causes parkinsonian symptoms such as shuffling gait, stooped
posture, rigidity, rest tremor, slowness and balance problems which regularly lead
to numerous falls. For additional information on Parkinsons Disease, click here:
Parkinsons UK
Source: Parkinsons UK
These deposits also lead to disruption of perception and frequently cause recurrent
complex visual hallucinations, fluctuating variations in attention and alertness.
Prominent memory impairment may not be evident in the early stages. Other
common Alzheimers pathology may become apparent as the condition progresses.
LBDA Org
Source: LBDA Org
As with all other types of dementia, each persons experience is different with
varying levels of pathology.

Acute Confusional states

(Delirium)
Onset is often rapid over the preceding 24-48 hours.
Occurrence is due to underlying physical pathology. There are a number
of potential causes, some of the most common being: The following
mnemonic DELIRIUM, taken from the Merck manual of geriatrics, is a
useful way of checking possible causes of delirium.
Drug use, especially when the drug is first introduced or the dosage is
adjusted. It is therefore of paramount importance that medication is
reviewed at frequent intervals.
Electrolyte and physiologic abnormalities e.g., hyponatremia and
hypoxemia
Lack of Drugs commonly referred to as withdrawal.
Infection, especially urinary tract or respiratory infections.
Reduced sensory input e.g., blindness, deafness, darkness or a change
in surroundings.
Intracranial problems e.g., stroke, bleeding, meningitis, postictal state.
Urinary retention and faecal impaction
Myocardial problems e.g., myocardial infarction, arrhythmia and heart
failure.

Acute Confusional states

(Delerium) continued
The person is often confused and disorientated in time
and place and depending on severity, there may even
be clouding of consciousness. They may become
restless and agitated, with these behaviours possibly
being exacerbated by hallucinatory experiences. This
is where a person may see, feel, hear or taste things
which others around them do not. The condition is
usually transient once the person receives appropriate
treatment for the underlying pathology.
REMEMBER, delirium can occur in people with
dementia so it is extremely important that the
individuals ongoing physical health and well
being is continually monitored.

Depression
Depression in its severe form in older people can often be
mistaken for dementia by non specialists as the person
exhibits symptoms consistent with dementia, but the cause is
pre existing psychological illness rather than a degenerative
one.
It is often of short and abrupt onset where dementia is
insidious and cognitively debilitating in nature. As with clinical
depression the causes may be re-active and often linked to
some form of psychosocial stress or Endogenous pathology,
where there is no identifiable external factor. Endogenous
manifestations include persecutory delusions, where people
may present suspicion, often claiming that others are trying to
harm them. They also have negative, false fixed ideas of low
self worth and poor health. Sometimes they experience
nihilistic delusions where the person believes they are no
longer their self or parts of their bodies are missing i.e. I am
dead, I have no bowels.

Depression (continued)
The prominent cognitive symptom of depressive dementia is loss of
shortterm memory accompanied by reduced alertness and impaired
concentration. It isimportant to note that people with this condition
have an awareness ofcognitive impairment (Cummings and Benson
1992) on careful testing memory andlanguage functioning are intact:
http://alzheimers.about.com/od/glossary/g/pseudodementia.htm
Source: Alzheimers.com
Psychomotor retardation is also evident. This means the person may
be slow intheir movements and speech is often slow and monotonous.
Sometimes there isevidence of emotional blunting or agitation and
anxiety.
Once detected, this condition will respond favourably to
antidepressant therapyand other psychotherapeutic interventions.
It is therefore significantly important that a comprehensive
psychological& cognitive assessment is completed before a diagnosis
of dementia is explored.

Common Features
Dementia is an umbrella term for a collection of clinical
presentations which will vary according to the stage and
nature of the condition.

Impaired Cognitive
Functioning
This is the umbrella term for the disturbance or decline in all our intellectual
processes. It involves all aspects of thinking, reasoning and remembering things. This
will ultimately have a profound impact on a persons judgement and severely affect
all aspects of a persons ability to engage in everyday life. Anecdotal examples of
each of these experiences will follow.
Memory Problems
Memory problems are commonly seen as a key symptom of dementia. Initially it is
characterised by fluctuating short term memory (recent events). The person may
forget appointments or significant dates but during this period they will usually
remember past events related to their childhood or adult years (long term memory).
Problems with new learning and impaired working memory are evident i.e. the person
may not be able to repeat something you have just told them (new learning), or they
might appear to forget how to put their coat on for example (working memory). As
the condition progresses, their long term memory invariably becomes disrupted.
Last time I saw my sister was 2 years ago, granted she did seem a bit more forgetful
but we all become forgetful as we get older dont we? When I arrived at the care
home today she did not even recognise me and kept on saying her husband was
coming home for tea...but he died in the Second World War. Its so sad I wish l didnt
live on the other side of the world.

Disorientation to time, place

and person
During the early stages of dementia, a person may regularly forget recent events, names
and places but will often respond to prompting or reality orientation. However, as the
condition progresses they may have little or no recollection of self or others. This can be
extremely distressing for both the person with the condition and their loved ones.
The neighbours have brought mum home several times this week. She has been found
walking up and down the street claiming she cannot find her house. I am really worried
as a local taxi driver brought her home in the early hours of the morning. He told me she
could not recall any of her personal details.

Inability to carry out daily activities

As poor concentration and distraction becomes evident people start to neglect their
personal hygiene and dressing. They start to find it increasingly difficult to cater for their
everyday needs. At its worse it may be necessary to activate 24 hour care due to the risk
of self neglect.
Dad was found by a local shopkeeper wandering aimlessly up the high street. He was
only wearing his shirt and underpants and he looked so dishevelled, as he hadnt even
washed or shaved. When I visited today his cupboards were bare and he was eating his
meals on wheels lunch with his hands. He seems to have forgotten how to use a knife
and fork.

Problems with Speech and

understanding
People often forget common words used in everyday language. A person may start
to find it difficult to identify everyday objects and experience problems in
communicating the right terms or using the correct language.
Initially dad would forget what certain things were called; instead of asking for a
cup he would say something like can I have one of those things I drink tea out of?
Now I get really frustrated as he cannot identify many everyday objects. The other
day I asked him to put his watch on and he came back with a glove in his hand.he
couldnt remember what I had asked him to do.
Difficulty in completing familiar tasks
Tasks or activities which were automatically completed become impossible.
My sister used to forget sequential activities such as making a cup of tea but with
some gentle encouragement she would be able to complete the task. Everything is
so muddled now. Yesterday, I found her putting her washing in the fridge and she
got very agitated and angry when I told her what she was doing. She continued to
insist her washing machine had broken down and told me to get the hell out of
there.

Problems with Speech and

understanding (continued)
Misplacing things
Initially people will misplace and forget where they have left certain personal belongings but they
will eventually come across them. However, as the condition progresses they may become
suspicious and start accusing others of stealing things from them. This can be extremely
distressing for both the person with dementia and their carers or loved ones.
My brothers neighbour called me in a distressed state last night. Apparently he was shouting
and cursing at her claiming she had stolen his wallet. they have been neighbours for fifty
years, he even called the police!
Decline in personal ability to cater for themselves
As the condition reaches its latter stages, the person with dementia will become increasingly
dependent on others to meet their daily needs. At the most advanced stage mobility becomes
hindered and loss of bladder and bowel control is a common experience.
Last year dad managed to make himself a meal and drinks with visual written prompts around
the house, but he became so forgetful he just wasnt looking after himself. He ended up
dehydrated and was showing signs of malnutrition; he stopped going shopping and was in such a
muddle. His personal hygiene became poor and he has been dressing in clothes inappropriate to
prevailing weather conditions. We are now looking in to residential and care facilities because he
is at such a risk of accidental harm and self neglect.

Hallucinations
These are experiences which affect one or more of our five senses. People may
hear (auditory), see (visual), smell (olfactory) taste (gustatory) or feel (tactile)
something in the absence of any external stimuli.
I asked to see my mothers Community Mental Health Nurse today as I am
extremely worried. Mum seems to be picking at the air and dusting herself down,
she keeps saying insects are crawling all over her and its really upsetting for us.
Delusions
Delusions are false beliefs which are fixed and resistant to reason or argument, and
not in keeping with the persons cultural or religious background (Lyttle 1986).
Often the delusions are accompanied by hallucinations. In the following case it
would be an olfactory hallucination causing persecutory delusions.
My grandfather believes his neighbours are running gas through his air vents and
he thinks they are trying to kill him. I try to reassure him this isnt the case but he
becomes very angry and accuses me of being in on it.

Confusion
A person with dementias attention and behaviour appears to become detached from
people and events occurring around them. Concentration and judgement becomes
impaired. Initially carers say their loved ones seem to engage in a series of
purposeless activities.
I went to see Dad on the ward today and he appears increasingly confused, he did
not even recognise me. He kept wandering around picking up things along the way.
When I arrived today he was carrying someone elses shoes, a box of tissues and a
tablecloth. He became so angry when the staff attempted to take them from him.
Personality and Mood Alteration
Certain existing personality traits may become magnified or the person may behave
in a way that is increasingly out of character. This is a very troublesome experience
for both the sufferer and their loved ones. This can put immense strain on
relationships and the concerns expressed by others may exacerbate hostile reactions.
At the beginning we noticed mum was becoming short tempered but that was born
out of pure frustration. Now she uses obscenities and physical aggression for no
apparent reason. Her mood can change in an instant she can be shouting and cursing
one minute then switch back to her true soft and gentle self.

Confusion (continued)
Impaired Judgement
As the condition progresses, people with dementia may lack insight into potential
risks to health and safety. A person may unintentionally leave gases on or hot pans
unattended.
Last week a neighbour found dads door wide open during the early hours of the
morning. This week he left the gas on which caught light to his coat which he placed
on the counter next to the cooker. Thank god the home help had just arrived.
Behavioural changes
Behavioural changes can appear out of character or existing behavioural traits may
become exaggerated. Changes may be subtle at first but gradually increase as the
condition progresses.
I feel mortified when my father keeps undressing himself. He appears oblivious to
the staff and other residents and when anyone attempts to intervene he becomes
really angry.....he never used to swear.

Loss of interest and

initiative
People often lose interest and volition in previous activities or hobbies
they used to gain pleasure from.
The lady next door was always in the garden pottering about, she
would spend hours on it and it used to look so beautiful. Now she just
wanders out and stares at it, her expression is so blank and she
seems to have lost all interest in it.
Disturbed Sleep
Disorientation and confusion often leads to reversed or disrupted
sleep patterns.
I am so tired as my husband is sleeping periodically through the day,
but during the night he just wanders around the house saying Where
am I or Where is everybody?

Loss of interest and initiative

(continued)
Agitation and Restlessness
These symptoms are usually caused by one or many of the complex
experiences already explored in this section. However, it is important
that other potential underlying physical factors such as pain or
infection, for example, are eliminated. Consideration should also be
made to the persons underlying emotional and psychological well
being.
Dad is much more relaxed since he started to take the antibiotics. He
still has his moments but he is much more responsive to prompting and
reassurance. He is back to enjoying our afternoon walks now.
For more information go to:
Alzscot.org
Source: Alzscot ORG

Behavioural interventions
Behavioural interventions may typically involve working with those
individuals who provide care or support for someone with dementia.
Behavioural interventions may be helpful when working with
individuals who present with challenging behaviours and risk issues
(e.g. wandering, aggression, safety issues and sexually
inappropriate behaviour).
There are different ways of working with people who present with
behaviour that challenges. Here is one example:
Changing those events that happen before the behaviour
This can be considered to be the most important way to change
behaviour.
This involves changing or modifying the environment so that
behaviour is less likely to happen in the first place.
E.g. adapting a busy environment by reducing noise, modifying
lighting and the number of people present.

Communication disorder
Communication disorder becomes apparent during
the course of all types of dementia, varying
according to disease type, duration and other
factors such as pre-morbid skills, personality and
environment.
Research shows communication represents one of
the major problems for carers and families of the
person with dementia (Touzinksy 1998)
Communication is a basic part of human life. For
people with dementia their ability to communicate
can be significantly impaired (Bryan, Maxim 2006)

Communication disorder
(continued)
This in turn can have a profound affect on their
loved ones and carers abilities to communicate
effectively with them; ultimately it will impact
negatively upon the care process and the quality of
life for the person with Dementia. Communication
skills should be pivotal to the care planning process.
The Joseph Rowntree Foundation (2001) state that
communication skills are an essential element of
good care
This module has been designed to assist learners in
developing or refreshing their understanding of
communication skills and identify approaches which
may be useful in improving the quality of life and
care for the person with dementia.

What is Communication?
Communication involves the exchange
of thoughts, messages or information,
as by speech signals, writing or
behaviour:
http://www.thefreedictionary.com/communication
Source: The Free Dictionary

So how do we
communicate?
Where do you think each method of communication belongs?

Why do we communicate?
For the person with dementia the reasons are the same!!!

What are the benefits of Good

Communication?

Time to reflect
The following message was written by the
Author of Dancing with dementia and
Who will I be when I die five years
after her diagnosis of dementia.
Try to understand how hard it is for us
Its just that you cant see the missing bits
That we are having to cope without
Christine Bryden (2009)

Lets look a little deeper

Try to visualize yourself in a building with many rooms and
corridors, you cannot find yourself back to the starting
point because everywhere looks so unfamiliar, people are
approaching you that you have never met before but they
seem to know you. There are other people around you who
seem muddled and you cannot communicate with each
other. The people that seem to know you tell you that you
cannot go home to your spouse or partner because they are
no longer around. Sometimes these people want to take you
to the toilet, sometimes they want to bath you, and dress
you in clothes you do not like, they give you food you do
not like because when you try to tell them it comes out
disjointed and garbled, its almost like you are speaking an
alien language. They keep telling you to stop crying.
How would you feel...? TAKE A LITTLE TIME TO THINK ABOUT
THIS.

Socially inclusive
communications
The ability to relate to people
experiencing communication problems
can impact upon all areas of care, in
either a negative or positive way.
Lets now look at the possible
consequences of good and poor
communication

Possible consequences of good

and poor communication

Communication and the person

with dementia
For people experiencing dementia the area of the brain that deals with
understanding and interpreting what is said gradually dies. This in turn acts as a
barrier to verbal interaction and understanding. Dementia impairs a persons ability
to receive and understand information and the ability to express information is
often affected, these troublesome symptoms are exacerbated by loss of memory,
disorientation, impaired concentration and attention.
Some examples include:
Difficulty in saying words
Saying a related word not the right one
Not being able to understand what is being said to them
Grasping only parts of what is said to them
Deterioration in the ability to write and understand the written word
Able to talk about distance past but not recent events
Loss of social conventions of conversation e.g. taking turns
Difficulty in communicating emotions appropriately
Repetitive verbalisations
Confabulation where a person talks fluently but does not make any sense. Gaps in
memoryare filled by fabricated dialogue.

For communication to work

For communication to work it is necessary that everyone
can convey and understand the message. The key to
positive experiences is a clear and concise
understanding of an individuals unique communication
patterns
It is therefore of upmost importance that a clear
assessment of an individuals communication skills is
completed for all service users and incorporated into
their individual care plans. This will ensure their ability to
be understood is maximised and assist carers in
optimising the persons level of daily functioning,
independence and ultimately improve their quality of
life.

For communication to work

What information should be considered?
Information such as:
How much does the person understand?
Can they express their needs wants and wishes?
Situations the person finds distressing.
Hearing and visual impairments.
Primary language and cultural background.
Health problems, pain for example, this can often be an underlying cause of
challenging behaviour.
Existing speech impairments
An individuals unique communication patterns.
SEPT has a comprehensive therapeutic tool (My life story) for staff to use in order
to develop strong and meaningful relationships and interactions with the person
with dementia and their loved ones.
my life story folder
Source: SEPT
Staff handbook

Body language
It is important to recognise that for people
experiencing dementia non verbal language (Body
language) is often their only means of expressing
themselves
Also remember a person with communication
problems may pick up on your negative body
language such as sighs and raised eyebrows for
example.
An ability to be sensitive and responsive to non
verbal behaviour is a key skill for staff to develop
when working with people with dementia. This skill is
possessed by us all and is often based on instinct or
our primitive heritage, for some it may be more
developed than others.

What is non verbal

behaviour?
When you watch most people, you will see
they communicate non-verbally; how often
have you been in a social environment and
observed other peoples non verbal behaviours
which have revealed clues about the nature of
their relationships and interactions.
It is important to remember Non verbal
communication varies culturally. It is therefore
necessary to find out about a persons cultural
background to avoid misinterpretation.

Non verbal communication

Verbal Skills
The emphasis so far has been on non
verbal behaviours because as we have
already identified verbal memory and
language skills will be impaired to a lesser
or greater degree depending upon the
nature and course of the Dementia .This
does not however mean non verbal
communication is exclusive but should be
supplemented with verbal communication

Verbal Skills
(continued)

Verbal skills include:

Questioning
1. Using closed questions which elicit yes no answers will minimise over complication
i.e. Mrs B would you like a cup of tea with your breakfast?
2. An open ended question would sound something like this Mrs B would you like
tea, coffee, apple juice , toast or cereal for your breakfast? Too much information!!
Clarifying
This is where you try to break down complicated communications
I.e. Mrs B states I am sad . Breakfast, wheres my husband ..Its all too difficult?
Response
Mrs B am I right in thinking you are missing your husband? Are you saying you would
like your breakfast now? Are you saying you would like help you get your breakfast?
Your response should be broken down into closed questions and dealt with one by
one.
Reflection
This is where you try to identify the underlying emotions of feelings a person may be
feeling. I.e. Mrs B repeatedly says Its not good its not good I.wa.. Mrs B also
appears
slouched and has her arms folded tightly across her body.
Response
Mrs B you seem upset are you in pain?

Good practice
The way you deliver your verbal skills is important too:
Communicate a normal TONE of voice, loud or high pitched
verbalisations can be anxiety provoking.
Pace
Speaking slowly and clearly this will promote understanding.
Pauses
Will allow the person time to assimilate what information
they can
pacing communications will also help to minimise
further confusion
and agitation. Always wait for an answer, if
the person does not answer try again.
Diversion or Distraction
This is where you divert a persons attention away from
repetitive or preoccupying feelings for example.
Finally remain calm, show you are listening and smile when
appropriate.

Good practice (continued)

Regardless of the stage of dementia it is so important to focus on working creatively
with the person with dementia to find alternative ways of communicating. Remember
it is a two way process.
We have already identified the Trusts Life story books, the benefits of being aware of
our own non verbal communication and being sensitive to the individuals unique
communication patterns.
In recent years the use of talking mats as an aid to communication with the person
with dementia has been researched and found to have positive outcomes .The Social
Care institute of Clinical Excellence completed a research study which showed that
using talking mats improved communication for all people at all stages of dementia.
Using 'Talking Mats' to help people with dementia to communicate
Source: rf.org.uk
Talking mats offer a low cost tool which families and staff can use. Click here to view a
video of Talking Mats being used with a person with Dementia
http://www.talkingmats.com/news.htm
Source: talkingmats.com
For further information on talking mats and training go to
http://www.talkingmats.com/dementiatraining.htm
Source: talkingmats.com

Communication checklist

Ensure you have a full knowledge of the persons unique communication

patterns i.e. Mrs B tends to wander around a lot more when she needs the
toilet.
Position yourself in line with the persons vision and maintain balanced eye
contact, unwavering eye contact can be interpreted as confrontational.
Do not invade a persons personal spacedo not assume the person is hard of
hearing because they are old!!!
Always adopt a calm and approachable posture this will promote feelings of
safety and security.
Check for any sensory impairments i.e. hearing and eyesight.
Listen carefully and keep checking for understanding.
Keep sentences short and simple.
Give short, clear and precise instructions allow time for what you have said to
be interpreted and repeat if necessary.
Promote understanding by giving instructions such as you clean your teeth
with it
Always promote independence do not be tempted to complete activities of daily
living for someone who is able to respond to non verbal and verbal prompts
Modify gestures which may be distracting
Listen for and learn to recognise the feelings and emotions rather than the
words.

Communication checklist
(continued)

Always promote independence do not be tempted to complete activities of daily

living for someone who is able to respond to non verbal and verbal prompts
Modify gestures which may be distracting
Listen for and learn to recognise the feelings and emotions rather than the words.
Checklist - continued
Use non verbal behaviour such as tone of voice, touch and the way you move to
convey messages to the person with difficulty in understanding language.
Offer verbal prompting good and thats right
Non verbally demonstrate the activity you are helping the person to complete i.e.
mimic brushing your teeth or shaving.
If you are actively engaging in self care with someone less able to attend to their
needs independently give a commentary of exactly what you are going to do in
advance, as this will promote feelings of security.
Modify gestures which may be distracting
Use head nodding in agreement and shaking it to disagree
Supplement your speech with gestures such as thumbs up or ok.
Never shout this will only serve to distract and frighten the person. Caring can be
a stressful experience at times and may sub-consciously influence your pattern of
communication.
If you feel frustrated take time out and return a minute or two later (along as
persons safety is not compromised)

Communication checklist
(continued)

Never be Judgemental i.e. thats him hes a nasty aggressive man

Remember remain calm and be aware of your non verbal behaviour as the person
with dementia may recognise negative non verbal clues.
Do not patronise a person, conversation should be simple but remain on an adult
level to preserve dignity and self esteem.
Incorporate information in your conversation which tells the person where they
are, what is happening around them and who they are with, this will make them
feel more secure and less confused.
Avoid too many choices present only one at a time.
It may help to ask questions which require only yes no answers.
Be aware of environmental factors which may interfere with communication i.e.
competing noises such as TV or radio always make sure the environment is
conducive for communication.
Make sure glasses, hearing aids and dentures are correctly prescribed and well
fitting.
Ensure the environment has adequate signage.
To access a more comprehensive free downloadable fact sheet on communication
and Dementia (written by the Alzheimers Society) click on the link below
Communication and Dementia
Source: alzheimers.org.uk

Finally
It is important to remember that behaviour that might be seen as
challenging or difficult is often the persons way of trying to
communicate.
Such behaviour can develop out of sheer frustration of not being
able to understand what is being said to them or from not being
able to express themselves as they would wish. Other reasons may
include physical manifestations. It is important to always be
mindful of this and ensure steps are taken to identify and eliminate
such causes.
Always be respectful to the person with dementia and remember
communication is essential to all forms of quality of care. If you
continue to remain aware of your own communication skills and
sensitive to the persons unique communication patterns it will help
to reduce challenging behaviour and positively impact upon the
care process.

Valuing People with

Dementia

Conclusion
Each persons experience of dementia is different, but always has direct
consequences for their physical, social and mental health. The severity is
dependant upon the nature and pace of the illness. Although dementia is a terminal
condition, people can live up to 10 years after diagnosis.
People with dementia survive an average of four and a half years following their
diagnosis. However, age, sex and any existing disability can alter life expectancy,
according to the report in the Jan. 11 online issue of the British Medical Journal.
Article: Survival times in people with dementia
Source: BMJ
The study found a nearly seven-year difference in survival between the youngest
and oldest dementia patients - 10.7 years for those aged 65 to 69 and 3.8 years for
those aged 90 and older. The average survival time after dementia diagnosis was
4.6 years for women and 4.1 years for men.
Dementia must not be viewed as a living death as Woods (1989) quite crudely
describes the experience of Alzheimers disease. Dementia care is about building
upon each individuals strengths to maximise independence and continually work
towards maintaining a persons quality of life.

References
Knapp M Prince M, Albanese E et al (2007) Dementia UK: The
full report London: ALZHEIMERS society
Cummings.J.L. and Benson.D.F (1992) Dementia a Clinical
Approach. Boston Butterwork Heinemann
Lyttle, J. (1986).Mental Disorder.Bailliere Tindall, London
Woods, R. (1989) Alzheimers Disease coping with a living
death. Souvenir press ltd, London.
A comprehensive free Tutorial for Dementia Management in
Primary care, a resource pack for GPs and patients. Funded
by the Department of Health. (Alzheimers Society 2009)
Living Well with Dementia: A national Dementia strategy,
Department of health, 2009