Communication

What is Communication?

The Oxford English dictionary definition of communication is “The imparting or exchanging of information by speaking, writing or using some other medium, the successful conveying or sharing of ideas and feelings”.

All communication requires as a minimum a sender of information and a recipient. The information can be sent via either verbal (oral communication) or non-verbal methods (writing graphics, signs and behaviours). Feedback signals can also be verbal or non-verbal. Accurate and effective communication is complex and can be affected by a number of external factors as well as a reliance on both the sender and recipients sensory processing skills.

Good communication and effective communication skills are essential in everyday living. For people with dementia, as the condition progresses communication can become challenging and so for family and care givers these skills are even more important.  Understanding the language difficulties that may arise and strategies to overcome these is crucial to supporting people to live well with dementia.

How might dementia impact a person’s ability to communicate?

The specific symptoms experienced by a person with dementia will depend on which disease they are diagnosed with and which area of the brain has been damaged. A diagnosis of any form of dementia is unique to that person and everyone will have a different experience. Other factors such as additional illnesses, and the environment can affect how a person may respond to their symptoms.

For people with a diagnosis of dementia and the people who care for them communication can be challenging, Language difficulties are common and are a result of damage in the areas of the brain that control language. As with all dementia symptoms each person is unique but they may experience problems with understanding, expression, repetition, word-finding, reading, writing and semantic abilities. The degree of difficulty experienced with language and communication is dependent on the type of dementia, how the dementia has progressed and how both the person with dementia and the carer’s are able to adapt their communication.

The brain is divided into 4 lobes, each responsible for different functions and it is also split into left and right hemispheres. For good communication we rely on multiple parts of the brain to function at an optimal level to be able to send and receive accurate signals. The Broca’s area in the frontal lobe, mainly in the left hemisphere is the centre for production of language and speech. Wernicke’s area, closely linked to the Broca’s area via neural pathways, is mainly responsible for comprehension and processing of spoken and written language. In addition, we rely on the parietal lobe for sensory information, the occipital lobe for visual processing, and the temporal lobe for auditory processing and for making sense of meaning in language. Since communication is reliant on so many areas of the brain, a language impairment is common in dementia. It can be a presenting symptom, especially in Alzheimer’s disease or primary progressive aphasia (PPA) and as the disease progresses it can become one of the more challenging aspects of dementia. One of the earliest signs of communication difficulties might include word finding struggles, particularly with names, choosing a wrong word or putting sentences in an incorrect order. A decline in communicative ability does not only prevent a person from expressing their needs and wishes. It can also cause lead to increased stress, depression and isolation as people withdraw from social interactions as a consequence of these difficulties.

Nonverbal communication is mostly preserved, an understanding of gestures or facial expression. However, some of the language challenges a person may face are:

• Word-finding & naming problems.

• Slower and more hesitant speech due to inability to retrieve correct word, name or number

• Replacing words with incorrect ones or be unable to substitute word at all. This may lead to forgetting names and in later stages no longer recognizing people.

• Difficulty with repetition of phrases or sentences

• Difficulty with long or complex information, but single word comprehension may be ok

• Loss of understanding of familiar words

• May use less words and more incomplete fragmented sentences.

A language impairment may be referred to as ‘Aphasia’ which can be split into sub-types of either expressive, receptive or anomia, each with their own symptoms as described below.

Expressive aphasia or Broca’s  (non-fluent) Aphasia

• Speech is reduced

• Vocabulary access limited

• Sound formation difficult

• May still understand speech and retain reading ability but limited ability in writing.

Receptive aphasia or Wernicke’s (fluent) aphasia

• Reduced ability to understand speech

• Speech may not be affected but may not be ‘normal’.

• May include irrelevant words in sentence and sentences may not connect.

• Reading and writing may be impaired.

Anomic aphasia

• Word-finding difficulty

• Nouns and verbs are particularly hard

• Speech may be grammatically fluent has a vagueness as missing words are circumnavigated.

• Person may express frustration.

• Comprehension and reading is less affected

• Word finding difficulty also evident in writing

How can we support a person with dementia to communicate?

Good communication is a key aspect in the provision of care to maintain quality of life and well-being for people with dementia. It is therefore important to identify when someone may be starting to struggle and perhaps need family and caregivers to adapt their own communication to support them. Speech and Language therapists can also be approached to assist a person to maintain their communication skills for as long as possible or look at adaptive strategies to keep communication channels open.

“Treatment strategies aimed at increasing attention and understanding and simplifying conversation will improve communication skills between people with dementia and care providers”

(Ross, Cummings and Benson, 1990).

Top tips for effective communication with a person with dementia

Tip 1: Language

• Use simple language

• Short sentences

• Speak slowly

• Avoid too many open-ended questions.

• Use direct language for tasks e.g., “Wash your hands” not “Do you want to or can you wash your hands”.

• Only give one instruction at a time.

• Talk to person as an adult.

• Do not exclude the person or speak for them.

Tip 2: Non-verbal

• Use touch to help concentration & to encourage and support.

• Use a sign, (touch hand) at start of conversation.

• Use facial expression & body language.

• Use gesture, writing, images.

• Cue cards or communication apps.

Tip 3: Position

• Access the person from the front.

• Look at the person when talking.

• Maintain eye contact

• In groups position person at end of table so all the noise is coming from the same direction.

• Sit at edge of a room ideally back against a wall

Tip 4: Environment

• Reduce distractions

• Calm & quiet.

• Avoid background noise.

• Limit how many people are in a conversation.

Tip 5: Time

• Allow processing & response time.

• If there is no response repeat using the same language. If still no response try again rephrasing the question.

• Let them complete thoughts and choose their own words.

• Be aware time of day can affect the person.

• Attention span may be reduced so time limit conversations if needed.

Tip 6: Support

• Start the conversation with their name or a touch so they engage.

• Avoid guessing what they are trying to say & don’t correct mistakes.

• Encourage the person to write a word down then say it out loud.

• Repeat what you understand back to the person to ensure you have understood correctly.

• Use images to support conversation or questions.

• Allow a person to describe or talk around a word if they can’t recall it.

• Avoid confrontation or conflict.

• Use humour to reduce anxiety if conversation is difficult.

Tip 7: Sensory needs

• If the person is experiencing sensory loss and relies on aids to support them make sure they use them.

• Ensuring hearing aids batteries are working and they are correctly fitted. Check that glasses are clean and are worn. Keep up to date with audiology or visual appointments.

• Speak clearly and slowly but don’t shout.

• Make sure your mouth is visible to the person so lip movements can be seen if they have impaired hearing.

• With hearing loss try visual aids to support conversation

• When talking to someone with visual impairment ensure you have explained who you are and what you are doing.

• Make sure the environment is well lit and that shadows are minimised

Further support & Take-away Tasks

• With the correct support, future planning and an understanding of dementia it is possible to live well. A diagnosis is the start of a new & different journey but not the end.

• Family and friends can all access support from Sage House to improve their understanding of dementia and enabling you to have a better quality of life

• Whilst finding out about the different types of dementia is likely the start of your journey, it is important to remember that you’re not alone.

DISCLAIMER: This information sheet has been produced by Dementia Support as general advice. It should not be relied on as a basis for any decision or action and cannot be used as a substitute for medical advice. Dementia Support and Sage House do not accept any liability arising drom its use and it is the readers sole responsibility to ensure any information is up to date and accurate.

Published October 2023 – Peer reviewed by carers, people living with dementia and expert reviewers