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Part 2 Compassionate Communication

In part 1 on compassionate communication, I spoke about the impact of verbal, non-verbal and the external environment on communication.  I picked out 4 tips for improving communication:

  1. Recognise that process speed slows so allow time for the individual to answer. Considerable time.
  2. Holding information becomes harder so speak slower, clearer and offer less information per speech.
  3. Recognise that non-verbal communication is the principle form of communication.  Make sure your non-verbal signals suggest positivity & safety.
  4. A loud, busy external environment can increase confusion and make any conversation difficult.

In this 2nd part on communication, I want to expand on a couple of these topics.

Old Styles No Longer Work

Old communication styles no longer work.  This is something I discuss with families regularly.  Many couples have over decades built up a pattern of communication which is the default process.  This may involve bickering, logical discussion, sarcasm or teasing.  However, as someone’s cognitive decline increases their ability to pick up on sarcasm or to follow a logical argument and retaliate in bickering decreases.  The common response will often be to say no, to refuse or an argument may begin to escalate.

Dementia is an invisible illness and so easy (particularly at the start) to forget or underestimate the damage it has done to the person’s brain.  They now struggle to retain new information, often can struggle to follow conversation or unpick complex language.  It requires the carer or family member to build a new way of communicating and to not become frustrated when old communication patterns end in frustrated arguments.

If someone living with dementia doesn’t agree or want to do something they don’t have the complex communication skills to reason or argue logically and will often just refuse.  Equally if what they do say is inaccurate or out of sequence that is no longer important.  For happy communication I teach two things:

  •       * First avoid disagreement at all times or as much as you can.  They can’t argue so agree with them and move around the subject.
  •       * Second recognise their pleasure in communication (even inaccurate unusual communication).  Even if the information is incorrect or makes no sense we all like communicating so take pleasure in all forms of communication.

Non-Verbal Communication

As I mentioned in part 1 this is the principle form of communication and should be a focus for successful happy communication.  In most situations, our non-verbal communication is seeking to either connect or seek a sense of safety.  As social animals we co-regulate in small groups or communicating 1:1. This means that our physical reactions subconsciously mimic or mirror each other’s emotions.  This occurs down to the speed and beat of our hearts, the speed of our breathing and the matching of emotions.

Someone living with short term memory loss can be (not always) in a constant state of anxiety or slight confusion.  Scared of a world they can no longer fully understand and socially unconfident.  They look around the world seeking connection, security and certainty and this is why our non-verbal language is so important.

Some examples of positive non-verbal communication:

  •      * Eye contact that includes a smile through the eyes and in the mouth.
  •      * Big smile, genuine laugh.
  •      * Tone of voice that is happy, positive and gentle
  •      * Calm sound to the voice and a comfort in silence
  •      * To be on the same eye line either sitting or standing.
  •      * Touch – gentle, non-intimate (if not family) on hand, shoulder, knee
  •      * Agreement sounds – hmmm, yes, I agree (regardless of truth)
  •      * Create a feeling that they are in control and what is happening is correct.
  •      * Hand gestures that are open, stance and body form that is open, face that is wide and open.

All non-verbal actions are seeking to co-regulate emotion.  However, occasionally you may need to actively consciously regulate and there are actions you can take.  There are small exercises to boost mood, these include:

  •     * Looking in the mirror (or at each other) and opening our arms and creating the biggest smile we can.  The wider the arms and sillier and bigger the smile the better.  By watching someone do that we will do it ourselves and feel better.
  •     * Equally fake laughing, with a big smile will turn into real laughter.
  •     * Or there is a simple tapping exercise that can help to wake up and reduce fight and flight response.
  •     * Deep humming coming from our tummies and through our chests feels silly but helps to improve emotions.
  •     * Finally breathing exercises like the 5-7 Breathing Technique (shown in all Google searches).

In Conclusion

There is so much more to say about communication and The Ness Care Group do courses and teaching around validation therapy and how to communicate well with those living with memory loss so please do get in touch.

However, at the core of everything is to recognise that this individual living with dementia has a brain that has been irrevocably damaged they can no longer communicate in the same way and will often feel incredibly scared, confused and anxious.  We must therefore change for them and enable the world so they can feel safe and loved.

Part 1 Compassionate Communication

In this blog we explore what it means to communicate well with someone living with dementia. What you can do to ensure compassionate enabling communication. It is a topic close to my heart as kind good communication can unlock the secret to enabling someone to live fully and reduce the stress, anxiety and pressure on those that care. This blog is directed to those that care for someone living with memory loss. I will dedicate 2 blogs to this topic, in the first blog I concentrate on what is communication and how the disease erodes our ability to communicate at each stage of this journey. In blog 2 we will drill a little deeper into a couple of the key themes to find safety & connection in good communication.

What is communication?

I like to see communication like a game of table tennis. Each participant is reading the actions, verbal & non-verbal, of their partner, reading the environment and tuning out the unnecessary in order to hit the ball back to their partner and continue the rally. Let’s break that down into 3 separate elements: the verbal words, the non-verbal actions and the environment surrounding us.

Verbal words:

This is the hardest element in communication. We have to understand the words, the context of those words and the sequence of the words at immense speed in order to make sense and reply correctly. Most researchers now believe that normal conversation is predictive you are guessing what will be said before the person speaks and forming a response even as the person states those words. This ability to predict the next word or action and act before it occurs is based on memory. Social memory that over your lifetime you pick up and box into associations and societal norms until you are mature enough to accurately guess what is mostly likely to be said or the next action to occur. Your mind gathers all this data instinctively and correctly applies it 98% of the time.

If your memory is damaged then this predictive function fails to work or makes a guess based on social conformity. Like “Hmm yes dear, how lovely.” A universal response to lots of questions or comments. The individual may still understand the words and the question but they now need to wait several seconds for those words to enter the brain, be interpreted and then use previous knowledge to respond appropriately. This can take anything from 5 to 20 seconds longer than you or I which within a normal conversation can feel like a lifetime.

That’s why on occasion someone living with dementia may respond to a previous question, which makes no sense to a conversation that has moved on in the usual rapid pace.

So the first point is recognising that processing speed is much slower for someone with memory loss.

The second challenge is the need to hold the other person’s spoken words in your mind and then respond using your short-term memory. If someone talks for 10-20 seconds and then asks a question you will have had to hold the meaning and context of that monologue for more than 20 seconds to then answer correctly. For many people with moderate dementia who have almost no short-term memory this is incredibly difficult.

So the second point is that conversation needs to be simpler with less information in any one question. We’ll come back to this in the next blog.

Non-Verbal Communication:

Have you ever been introduced to someone and looked at their face, shook their hand and completely forgotten their name instantly? That’s because our brains deal with small detail and big picture in two distinct parts of the brain. Presented with both small details (their name) and the bigger picture (what they look like, is the person happy/angry) our brains will ignore the detail and check the non-verbal expression for danger.

Non-verbal communication is the transfer of information from one person to another without the use of words or spoken language. This can occur in a variety of ways, including through facial expressions, gestures, body posture, the reading of tone of voice, position of person, their clothes, their actions, their wrinkles, their expression.

Non-verbal communication accounts for 60 or 70% of all communication between 2 people, but for those living with dementia non-verbal communication accounts for more than 80% of communication. It is incredibly important and feeds directly
instinctively into our vasal vagal nerve (our fight or flight response).

This needs to be your primary form of communication and needs to always be emotionally positive to elude a sense of safety.

Environment:

Finally the environment in which a conversation takes place becomes important for those with memory loss. One of the many skills our normal brains develop is something called “The Cocktail Party effect”. This is the ability for the brain to
filter out all external stimulation and focus on what is being said by 1 person. In a busy cocktail party we ignore colour, noise, people, conversations to focus our laser attention on the person speaking to us.

This ability deteriorates or is lost completely for those living with dementia. They can no longer filter out background movement, noise, people and become easily distracted. Even worse if there are too many people, or music/TV sounds, or lots of people moving around it can cause hyper-arousal in an individual resulting in increased confusion and acute anxiety.

To have a good conversation the TV/music needs to be off and the carer or relative should be aware of the wider environment creating a space that is calm, quiet, with minimal distractions. A pub or restaurant might be a socially engaging space, helpful for the carer and engaging for the person with memory loss, however, there should be no expectation that the person with memory loss should speak.

In summary recognise why language is so difficult and adapt your speech, focus on non-verbal communication and be aware of the environment and it’s impact on someone’s ability to comprehend and speak.

The Ness do courses and teaching around validation therapy and how to communicate well with those living with memory loss so please do get in touch.

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