People living with Dementia experience changes in their ability to comprehend and process language. Dementia may also interfere with how they understand words; which can pose challenges with daily activities and accepting assistance with routine.
Comprehension versus Hearing Loss
As seniors age, many times they experience a decrease in their ability to hear spoken words. This can lead to the common misconception that people with hearing loss have Dementia as they will frequently ask you to repeat what you said over and over again. This can cause frustration for staff and loved ones. Residents living with Dementia may also experience diminished hearing; however, that isn’t usually the reason they ask “what” and “can you say that again”. In the mid-stage of Dementia, residents will only hear/comprehend one out of every four words spoken to them so don’t raise the volume of your voice; but rather, break the statement down to simplify your communication and speak slowly. Repeat your statement several times until the resident has had a chance to fully understand what is being said to them. Remember, they don’t necessarily have hearing loss but rather the inability to comprehend the words.
Another common misconception with Dementia is that the resident is being defiant or stubborn, when in actuality, they can’t remember what you asked them to do. Instead of telling them all the steps in the process, provide step-by-step directions, giving one step at a time. Once the resident completes the first step, slowly provide the next step and use as few words as possible. Cue cards may help the resident to understand what your expectation is as it will give them a visual of the task.
Resistance to Care
Residents living with Dementia often become resistant to care for many reasons. One reason was discussed above and that is that they are not understanding what caregivers are trying to do; this can be due to missing spoken words. Train caregivers to speak slowly to the resident; use short phrases, cue cards and other visual cues to assist the resident in understanding what the caregiver is trying to do. The resident may have missed spoken words so it is important to take it slowly as they may not understand why the caregiver is reaching for their face or trying to assist in getting dressed etc. These situations can cause fear in the resident and can result in combative behaviors.
Noise and busy environments pose a challenge for those living with Dementia. When providing instruction to these residents, ensure that the environment is quiet and calm. Try walking to an empty day room, the resident’s room or another area in the building where you can sit and talk quietly with the resident. In doing this, the resident may be able to communicate better; with less distraction.
Lastly, when entering a resident room or apartment, if you notice that the television and/or radio volume is loud, ask the resident if you can turn the volume down. Once the environment is quiet, observe what program the resident is watching. If the resident also has hearing loss combined with “missing words in the spoken language”, the resident may understand the program better if the volume is turned up. Work with resident to determine if a music channel is a better option than a talk show. Again, due to missing words, the resident may become frustrated or anxious because they cannot keep up with the spoken language in the program.
This population can be challenging at times, so it is important to remember that they are not doing things purposely to frustrate and/or challenge the care team. Instead, it is their disease process that is interfering with their day-to-day activities. Keep their schedules as similar as possible, the environment as calm and inviting as you can, and remember to be patient. For more tips, check out this blog written by Teepa Snow sharing some suggestions on how to handle challenging dementia behaviors in a productive way.