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Section 3
FIVE KEY CONSIDERATIONS TO INFORM GOOD PRACTICE
This section explores five key considerations which inform good practice in communicating with a person with dementia. They should be applied as foundation knowledge for all staff supporting the person with dementia. They are as follows:
1. Recognise that communication with a person with dementia is always possible. 2. Develop knowledge about the progression of dementia and key
triggers for end-of-life care discussions. 3. Plan future care to optimise comfort. 4. Promote personhood throughout the person’s journey. 5. Record future wishes when they are expressed.
3.1 Recognise that communication is always possible with a person with dementia
“Relationships cannot develop without communication and quality care is impossible without relationships” (38) As outlined in the statement above, communication is core to forming meaningful relationships and underpins all elements of quality care (39). A person centred approach to communication and to care involves taking the time to get to know each person, their fears and anxieties, listening to their wishes and dreams, and finding out about the things that bring them comfort and joy which enables staff to care for each person in a way that is right for them. This relationship will support staff to talk to people about their wishes for their future care, finding out how much they would like to know if their health begins to decline, or asking them what arrangements they would like to make for after their death (31). Dementia is accompanied by a decline in the ability to communicate using speech. This reduced ability to talk is often misinterpreted as signifying that a person with dementia has nothing to say or, more significantly that they have lost the ability to communicate altogether. As dementia progresses and speech becomes less and less useful as a way of engaging or making contact, staff can easily give up because their attempts at communication are unsuccessful (40). It is always possible to communicate with a person with dementia but the manner in which the person can express themselves will change as their condition progresses, demanding increasingly sensitive communication from those supporting the person (17). Staff need to be creative and open to trying out different approaches to interact, connect with and support the person with dementia to communicate. This belief and willingness to be creative is key to delivering good person-centred end- of-life care. Further guidance on communication skills is provided in section 4.
Facilitating discussions on future and end-of-life care with a person with dementia
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