Memory and intellect deteriorate as dementia progresses, yet people with dementia continue to interact. How staff respond can have profound effects on a person’s wellbeing.

Barriers

Barriers to communication may relate to individual issues or to social and physical environments. Personal barriers may include:

  • health status
  • physical ability
  • cognitive and sensory ability
  • emotional wellbeing
  • personality and mood
  • culture and knowledge of English.
  • A facility’s institutional values and philosophy affect the social environment through policies on:
  • staff recruitment and training
  • staff-to-staff communication
  • routines
  • rosters
  • staff–resident ratios
  • staff encouragement and support.

In the physical environment, communication is affected by:

  • building design and layout
  • size of rooms
  • size and placement of furniture
  • width and length of corridors
  • extent of private space
  • lighting
  • ambient noise.

Principles

Change: As dementia progresses adjust how you communicate to suit a person’s changing needs.

Context: Guide a person through any task, activity or request by explaining or describing what is happening or about to happen.

No expectations: Make it clear verbally and non-verbally that a person may respond or not as they wish; that nothing is required of them.

Reassurance: Communicate verbally and non-verbally to reassure a person they are accepted.

Consistency: Verbal responses and non-verbal communication should not contradict each other.

Strategies

  • Talk to a person, rather than about them to others.
  • Address a person by their preferred name, not ‘dear’ or ‘love’.
  • Tell a person what you are doing or going to do.
  • Focus your full attention on the person and make eye contact.
  • Use words and sounds of encouragement.
  • Do not use a demeaning or condescending tone of voice or hostile gestures or stance.
  • Do not invade a person’s personal space.
  • Speak at a slower pace.
  • Pause between one topic and the next.
  • Use prompts such as pictures, photographs and simple signs.
  • Accept a person’s feelings.
  • Use non-threatening physical contact.
  • Do not make abrupt changes to routines.
  • Get to know a person’s life story so you have a store of background information for questions and conversations.
  • Use individualised memory books to improve and keep communication skills.
  • Use written and pictorial signs in significant places around the facility.
  • Place memory charts containing photographs, brief statements about the person and conversation topics on bedroom walls and other appropriate places to aid communication.
  • Use other techniques and therapies that help communication like aromatherapy, attention focusing, bright light therapy, massage, music therapy, pet therapy, reminiscence sessions and walking.