Section 4
• Talking a lot about the past can foster success. Everything has potential to lead to a conversation about the past. Using this can be a way of engaging the person about their own wishes and preferences. • Be cautious of correcting a person with dementia – this can have a negative effect on a person’s self-esteem and be counterproductive. Do not argue over facts which the person presents to you which may be inaccurate. Accept this as their reality.
3. Consider the communication environment
The communication environment in which an interaction takes place can have a positive or negative impact on the person with dementia's ability to engage (54). Consider the following aspects of the communication environments you support people in: • Lighting: Good lighting in buildings can help people to see what is around them, to navigate, identify signs and spaces, see others’ faces and participate in activities. However, strong lighting can have a negative effect on people with dementia’s energy levels (55,56). • Noise: It is important to be aware of the level of noise in the environment. Background noises such as TV, music, people moving around, activities in the unit, chatting etc can make it very difficult for a person with dementia to concentrate. Try to reduce noise levels or move away from noise during an interaction as much as possible. • Seating: Ensure that where the person is seated maximizes their ability to engage in interactions (e.g. can they see and hear well in that position? Are they comfortable? Do they have a pen and paper/ photos or other supports they need for communication within reach?). • Resources: Ensure that there are resources to support communication available in the environment such as pens and paper/photos of relevant items for choice making etc. You could set up communication stations within units to have communication supports readily available as they are needed.
4. Be aware of your own communication style and approach
The importance placed upon nonverbal communication increases for people with dementia as they lose their ability to follow conversations. The person with dementia may struggle to find meaning in your words but take meaning from your tone of voice, your body language and your eye contact. Body language, posture, facial expression and eye contact are powerful in supporting a person to engage/disengage. The following tips should help you to engage with the person with dementia: • Approach the person from the front and make eye contact. 3 Sit at the person’s level – eye level is best. 3 Introduce yourself by name – do not expect the person to remember your name: asking them if they remember may be distressing. 3 Call the person by name and tell them what you are there for. • Be attentive to the person’s non-verbal communication. Use your observations of the person’s nonverbal signals to open up a conversation– if a person’s facial expression displays a particular emotion, label it (e.g. say " I see you look a bit happy/sad today").
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Facilitating discussions on future and end-of-life care with a person with dementia
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