[2] Horizons: Communication Changes

Dementia Horizons | Workshop 2 | Communication Changes

Video Module 2 Transcript

Welcome. It's no surprise that your brain controls how and what you say and understand, but did you know that an area deep within the brain, the amygdala, is responsible for first sensing who is safe to communicate with, and who is not? From the beginning of time, this has been a skill required for survival.

Imagine for a moment that someone suddenly walks into the room with a scowl on their face or a look of anger, disgust, or frustration. What is your first reaction? Without them saying a word, you may feel fearful and defensive, not wanting to engage immediately. This core part of your brain is working to protect you without effort on your part. Your brain quickly decides if this person is a friend or foe. Then, if the person starts to talk, your brain tries to figure out the meaning of the person's tone of voice. Do they sound angry, frustrated, kind, respectful, or inviting?

People living with Dementia will respond to or believe what they see and hear. First words have less of an impact. In fact, this is true for all of us. Research indicates that we communicate mostly through our body language. Next comes our tone of voice and lastly, our words. So the first critical lesson is for you to look and sound safe, caring, loving, and respectful. That said, it is also important to be reminded that you are human, and it is not always easy to be loving 24 hours a day. It helps to take at least four slow deep breaths if you become frustrated.

This heightened self-awareness of your communication style is particularly impactful as Dementia progresses towards the end of life. It is also essential to understand that the diseases and disorders that manifest as the progressive symptoms which we call Dementia, bring anatomical and cellular changes to various parts of the brain that affect communication differently over time.

As the individual enters each stage of their Dementia journey, you may notice some or all of the following changes:

• Difficulty starting or following conversations, therefore, withdrawing from situations that require social interactions.

• Repeating the same questions, not having processed your answers.

• Struggling to find or retrieve words or names of people, places, and common objects.

• Difficulty juggling a conversation with multiple people in the room.

• Hearing sounds and talking to people that don't exist.

• Mixing fragments of words, an inability to follow written or verbal directions, and towards the end of life, language may be limited to just a few responses.

  
  

So what can you do to help communicate more effectively? There are several guidelines that we recommend. Please note that some may not be intuitive. You are learning a new skill. Now, let's look at a few of the guidelines.

• First, keep in mind that the individual's brain is changing. Do not take their responses to you personally, if they are accusatory, do not make sense to you, or seem irrational.

• Pay attention to the environment. Excessive background noise and clutter can interrupt the person's ability to focus and pay attention. So turn off or lower the TV or radio, if possible.

• Keep the room or space uncluttered.

• Position yourself at eye level so that the person can see your eyes. It's been said that they are the window to the soul, and they greatly impact our ability to connect with one another.

• Speak calmly, more slowly, and at an audio level the person can hear. Remember that your tone of voice plays a big part in how your communications are perceived.

• Avoid stacking questions one on top of the other in rapid succession. Wait for the person to respond to one question at a time.

• When the individual needs to decide on something, provide simple choices. Instead of saying, what do you want for lunch? Say, would you like a ham and cheese sandwich or a bowl of soup? If there is difficulty understanding your words, then show them the slice of ham, a piece of cheese or a can of soup. The idea is to support their dignity and choice, because the part of the brain that controls rational thinking can become impaired.

• Avoid trying to convince or argue your point, when their reality is altered in their mind. What they think or believe is very true to them. Arguing will only cause frustration, anger, and more anxiety.

  
  
  
  

For both of you, pause and think. Are these issues we are discussing really that important? Consider going with the flow. Here's an example. A wife who is a retired art teacher and is living with Dementia looks at the sky and says, "What a beautiful purple sky." The husband in return sees the sky as brilliant blue, and corrects her saying, "Honey, don't you see it's blue, not purple? How could you say that, you are an art teacher for gosh sakes?" After that, the wife stops talking. She feels embarrassed and afraid to make a mistake. Mistake. Instead, it would've been more supportive and loving to say, "Yes, it's a beautiful day."

Here are a few other ways to foster good communications.

• Introduce yourself first by name. Don't quiz the person, forcing them to try and come up with your name. That causes frustration.

• Just like you and me, people living with Dementia don't always perform at their best when they are hungry or tired, memory and communication worsen with these circumstances. Recognize when this is happening so you can respond appropriately.

• If the person asks the same question repeatedly, respond like it's the first time. You can also shift to another activity or topic or another room to potentially alter their questions and redirect the conversation.

• Use words that show respect and dignity. For example, use adult words like a napkin instead of a bib, toilet instead of the potty, et cetera.

• Smile more frequently, and say thank you.

• Don't focus on what the person may do as wrong. Compliment them for trying. Even if the laundry was folded up in a ball, say, "Thank you so much for helping me."

  
  

Overall, the main point is to interact and communicate with compassion and empathy. So what is empathy? Empathy is the ability to understand and recognize how someone is feeling. It's your ability to set aside your own thoughts and feelings to see things from someone else's point of view. Understanding how people living with Dementia perceive their world allows you to be more empathetic. Empathy conveys safety and an effort to comprehend. This allows for real connection and trust. And trust encourages cooperation. Without empathy, people may experience increased resistance, and may be less willing to work with you.

You can practice using empathy by slowing down and observing the person's feelings through their body language, facial gestures, and tone of voice. Pay attention to see if you can identify confusion, anger, pain, unmet need, or even better, joy or contentment. This practice will give you a deeper, more meaningful connection with others.

Empathy is also a statement of reassurance and validation. It says, "I hear you. I recognize how you may be feeling." It may sound like "I sense that you are scared, but you are safe with me", or "You seem upset. I'm so sorry that this is happening to you." As Dementia progresses, rational thoughts and spoken or written words become less effective. When this happens, look for things to do together, that don't require conversation or a right or wrong answer. For example, engage in sensory experiences like listening to or singing to music, drawing or painting, reading poetry, or getting outside for a breath of fresh air.

Recognize that your relationship with your loved one is not over. It's just changing. Look for new ways to connect and enjoy your time together. To quote author and family therapist, Virginia Satir, "Life's not the way it's supposed to be. It's the way it is, and the way you respond to life that makes the difference."

As you reflect on what was covered in this video, plan to put the following into practice. Focus, take at least four slow, deep breaths to help you keep calm. If the conversation becomes difficult, pay attention to your words, what you may be saying through your physical actions and tone of voice. Ask, what and how am I communicating? Do I appear and sound loving and trustworthy or frustrated and angry? Complete a so-called self scan. Look at your entire being. Your thoughts and feelings influence how you see the situation.

In conclusion, I hope you feel more equipped with practical tips to enhance your communication style. By prioritizing how we communicate, we cultivate deeper relationships and build stronger connections with the people that matter most to us. You have taken a great step forward to help yourself and others. Thank you for joining me today.