Communication and Validation Strategies for Residents with Dementia

Presented by HomeCare Rehab and Nursing LLC

Communication
Overview of Abilities
Common problem is an increase in verbal conflicts as ability to communicate decreases; word finding problems and losing the thread of a story. Decrease in ability to censor self leads to more blunt, direct, and socially inappropriate comments. Argue to protect pride, act defensive and less cooperative; refuse often. Reading to follow directions is not reliable.
Copyright 2003

Communication
Strategies Get inside visual field (2-4 feet in front). Keep verbal directions clear and simple; avoid conservational speech while guiding patient through a task. Allow time to respond before asking question again- ask again exactly the same way. Limit choices and open ended questions: Dont ask: What do you want for breakfast? Ask: Would you like cereal or pancakes?
Copyright 2003

Communication
Strategies
DO NOT EVER ARGUE! Memory books may be effective with training if the resident values it. Can learn schedule of activities if caregivers consistently remind them to use it. Communication board may be effective to make choices- no more than 2 to 4 options. Dont hang a sign to improve safety or orientation.
Copyright 2003

Communication
Overview of Abilities
Can name familiar items, can state own name, can say you and I appropriately. Can speak in short phrases. Talks to self frequently. Repeats self, asks questions over and over. Phrases may have meaning only to the patient.
Copyright 2003

Communication

Strategies Get in visual field before speaking or touching (14 inches in front). Avoid asking questions that require more than yes or no. Show a positive response to all communication attempts. Stop what you are doing and make eye contact. Lower the pitch of your voice.
Copyright 2003

Communication

Strategies Use distraction to answer repetitive questions once you have determined there are no other needs. Reassure often. Responds best to demonstrated commands. Assume that the person understands everything you are saying- dont talk about them, talk to them. Scolding or lecturing is highly inappropriate and ineffective.
Copyright 2003

Communication

Overview of Abilities May speak incoherently but sing a full song without errors. Uses one or two random words to communicate. Able to say no. May be able to identify body parts when touched. Uses gestures to communicate until very late stages (claps, points, waves).
Copyright 2003

Communication

Strategies Keep cues limited to 2 or 3. Get in visual field (less than 12 inches directly in front of patient). Use all senses to engage patients attention. Lower your voice.
Copyright 2003

Validation
What is validation? 1. Letting the patient know that you accept and respect their feelings. 2. Standing in their shoes- empathy. 3. Making them feel important and intelligent.

Copyright 2003

Validation
1. 2. How do we validate a patient? Match the intensity of their emotions with your response. Do not lie or belittle, let them know you hear them. Do not try to orient a confused or frustrated patient. Take opportunity to redirect them if they offerdont come up with an unrelated distraction.
Yes: It sounds like your father was very caring. No: Your father is dead. Did you see the weather outside?
Copyright 2003

3.
4.

Communication
1. 2. 3. 4. 5.

Absolute No Nos No parenting, disciplining, scolding. No baby talk. No arguing. No negative body language (disgust, frustration, boredom, impatience). No talking about patients in front of patients.
Copyright 2003

Communication and Validation Strategies for Residents with Dementia

Presented by Sue Paul, OTR/L

Communication
Overview of Abilities
Common problem is an increase in verbal conflicts as ability to communicate decreases; word finding problems and losing the thread of a story. Decrease in ability to censor self leads to more blunt, direct, and socially inappropriate comments. Argue to protect pride, act defensive and less cooperative; refuse often. Reading to follow directions is not reliable.
Copyright 2003

Communication
Strategies Get inside visual field (2-4 feet in front). Keep verbal directions clear and simple; avoid conservational speech while guiding patient through a task. Allow time to respond before asking question again- ask again exactly the same way. Limit choices and open ended questions: Dont ask: What do you want for breakfast? Ask: Would you like cereal or pancakes?
Copyright 2003

Communication
Strategies
DO NOT EVER ARGUE! Memory books may be effective with training if the resident values it. Can learn schedule of activities if caregivers consistently remind them to use it. Communication board may be effective to make choices- no more than 2 to 4 options. Dont hang a sign to improve safety or orientation.
Copyright 2003

Communication
Overview of Abilities
Can name familiar items, can state own name, can say you and I appropriately. Can speak in short phrases. Talks to self frequently. Repeats self, asks questions over and over. Phrases may have meaning only to the patient.
Copyright 2003

Communication

Strategies Get in visual field before speaking or touching (14 inches in front). Avoid asking questions that require more than yes or no. Show a positive response to all communication attempts. Stop what you are doing and make eye contact. Lower the pitch of your voice.
Copyright 2003

Communication

Strategies Use distraction to answer repetitive questions once you have determined there are no other needs. Reassure often. Responds best to demonstrated commands. Assume that the person understands everything you are saying- dont talk about them, talk to them. Scolding or lecturing is highly inappropriate and ineffective.
Copyright 2003

Communication

Overview of Abilities May speak incoherently but sing a full song without errors. Uses one or two random words to communicate. Able to say no. May be able to identify body parts when touched. Uses gestures to communicate until very late stages (claps, points, waves).
Copyright 2003

Communication

Strategies Keep cues limited to 2 or 3. Get in visual field (less than 12 inches directly in front of patient). Use all senses to engage patients attention. Lower your voice.
Copyright 2003

Validation
What is validation? 1. Letting the patient know that you accept and respect their feelings. 2. Standing in their shoes- empathy. 3. Making them feel important and intelligent.

Copyright 2003

Validation
1. 2. How do we validate a patient? Match the intensity of their emotions with your response. Do not lie or belittle, let them know you hear them. Do not try to orient a confused or frustrated patient. Take opportunity to redirect them if they offerdont come up with an unrelated distraction.
Yes: It sounds like your father was very caring. No: Your father is dead. Did you see the weather outside?
Copyright 2003

3.
4.

Communication
Overview of Abilities
Common problem is an increase in verbal conflicts as ability to communicate decreases; word finding problems and losing the thread of a story. Decrease in ability to censor self leads to more blunt, direct, and socially inappropriate comments. Argue to protect pride, act defensive and less cooperative; refuse often. Reading to follow directions is not reliable.
Copyright 2003

Communication
Strategies Get inside visual field (2-4 feet in front). Keep verbal directions clear and simple; avoid conservational speech while guiding patient through a task. Allow time to respond before asking question again- ask again exactly the same way. Limit choices and open ended questions: Dont ask: What do you want for breakfast? Ask: Would you like cereal or pancakes?
Copyright 2003

Communication
Strategies
DO NOT EVER ARGUE! Memory books may be effective with training if the resident values it. Can learn schedule of activities if caregivers consistently remind them to use it. Communication board may be effective to make choices- no more than 2 to 4 options. Dont hang a sign to improve safety or orientation.
Copyright 2003

Communication
Overview of Abilities
Can name familiar items, can state own name, can say you and I appropriately. Can speak in short phrases. Talks to self frequently. Repeats self, asks questions over and over. Phrases may have meaning only to the patient.
Copyright 2003

Communication

Strategies Get in visual field before speaking or touching (14 inches in front). Avoid asking questions that require more than yes or no. Show a positive response to all communication attempts. Stop what you are doing and make eye contact. Lower the pitch of your voice.
Copyright 2003

Communication

Strategies Use distraction to answer repetitive questions once you have determined there are no other needs. Reassure often. Responds best to demonstrated commands. Assume that the person understands everything you are saying- dont talk about them, talk to them. Scolding or lecturing is highly inappropriate and ineffective.
Copyright 2003

Communication

Overview of Abilities May speak incoherently but sing a full song without errors. Uses one or two random words to communicate. Able to say no. May be able to identify body parts when touched. Uses gestures to communicate until very late stages (claps, points, waves).
Copyright 2003

Communication

Strategies Keep cues limited to 2 or 3. Get in visual field (less than 12 inches directly in front of patient). Use all senses to engage patients attention. Lower your voice.
Copyright 2003

Validation
What is validation? 1. Letting the patient know that you accept and respect their feelings. 2. Standing in their shoes- empathy. 3. Making them feel important and intelligent.

Copyright 2003

Validation
1. 2. How do we validate a patient? Match the intensity of their emotions with your response. Do not lie or belittle, let them know you hear them. Do not try to orient a confused or frustrated patient. Take opportunity to redirect them if they offerdont come up with an unrelated distraction.
Yes: It sounds like your father was very caring. No: Your father is dead. Did you see the weather outside?
Copyright 2003

3.
4.

Communication
1. 2. 3. 4. 5.

Absolute No Nos No parenting, disciplining, scolding. No baby talk. No arguing. No negative body language (disgust, frustration, boredom, impatience). No talking about patients in front of patients.
Copyright 2003