Section 4
7. Focus on one question at a time.
Be aware that reasoning, logic and time requires complex thought processes that a person with dementia may struggle with (33,58,60,61,64). Open ended questions (e.g. what do you feel about?) or choice based questions (would you like tea or coffee?) can be very difficult to retain and to process for some people with dementia. These tips may help: • Reframe open-ended questions. If the person is struggling to answer a question, it may be beneficial to rephrase it as a closed question which involves a yes/no answer (e.g. would you like a cup of tea?). • Asking a series of short closed questions which focus on one key idea at a time can be of benefit. • Try not to ask the person to give you lots of facts as this information is difficult for a person with dementia to access and can make conversations feel like a test rather than a two way interaction. It can be useful to ask questions related to feelings rather than facts (e.g. say “Do you like children?” or “Tell me about your children” rather than “How many children do you have?”.) • If the person does not appear to understand what you have said, repeating and/or rephrasing the question can help.
8. Clarify information and check for understanding
• If you have difficulty understanding what the person is saying, ask some questions to help clarify what the person wishes to communicate. • Do not pretend to understand if you do not. Share responsibility (e.g. say “I’m sorry we are getting a bit stuck” or “I didn't get that”.) • Check the person has understood what you are saying. The person may demonstrate this through nonverbal means. • Ensure you have heard and understood the person correctly by repeating back the information to them to allow them to clarify their meaning (e.g. “you’ve told me that you wish to get more help with getting dressed, is that right”).
Additional Resources
1. The National Dementia Training Programme (65) has a session on communicating with the person with dementia which enables staff to develop skills and knowledge in this area. 2. The Social Care Institute for Excellence has a module on positive communication as part of its e-learning “Dementia Gateway” (66). This is available free of charge to the public. 3. The Alzheimers Soceity of Ireland have produced two factsheets relating to communication. These are as follows:
• Communication: Understanding changes in behaviour (67) • Understanding and respecting the person with dementia (68).
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Facilitating discussions on future and end-of-life care with a person with dementia
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