I'm a Real Person Too” - Alzheimer Society of Manitoba · 2017-06-16 · "I'm a Real Person...
Transcript of I'm a Real Person Too” - Alzheimer Society of Manitoba · 2017-06-16 · "I'm a Real Person...
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"I'm a Real Person Too The Impact of Communication on
Behaviour for People with Dementia
Presented by T. Bowser RNBN Illustrations by Don Bellamy
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Introducing Don Bellamy
Im a real person too.
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Outline
What is communication? How does dementia affect communication? What does this mean for me as care provider? What do we do that may cause responsive
behaviours? How can we reduce our contribution to responsive
behaviours through communication?
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What is communication?
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First Communications
What are our first communications? What do they mean?
Kit4na https://www.flickr.com/photos/kit4na/6241060744/
What is communication?
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Function Of Communication
Fundamental requirement for all human beings Essential for survival and growth and self-worth and
belonging, identity Expression of needs Dignity Control
Conveys meaning that goes beyond the spoken words
What is communication?
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Communication is a Process
Like an ocean Active Continuous Flowing Changing
If you look at one bucket sample you dont see the whole picture If you look at a sentence word or gesture in isolation you do not get the whole message ( jacket)
What is communication?
PresenterPresentation NotesActivity:What does this mean?
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Communication is a Transaction
Both individuals are affected by the other Complex interaction of skills
Listening Observing Speaking Questioning Analyzing Evaluating
What is communication?
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Communication and Relationships
A spoken sentence conveys much more than the information in the sentence it is a reflection of the relationship
Communication changes based on who you are talking to and in what situation
What is communication?
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Consider the following paralinguistic features what are your unique traits? Volume Rate of speech Tone of voice Pitch Hand gestures Eye contact Vocabulary Body language Emphasis Conversational cues (hmmm) Proxemics
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What is communication?
Take a moment to introduce yourself to the person or people next to you
Tell them your name, and a little bit about yourself then let them tell you about themselves
Ask each other one question to find out more If you know the person beside you well, find
someone new to meet as well
Let me introduce myself
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Reflect:
What paralinguistic features do you use? What is your style?
What did you sound like, look like? What were your partners features?
This is normal communication
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Non Verbal Communication
Communication is said to be 7% verbal, 93% non-verbal 38% tone 55% body language
What is communication?
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Incongruence between verbal and non verbal
What is communication?
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Non-Verbals and Dementia
With dementia, people live in the here and now May not remember the details May not be able to understand the details They know how they feel and they retain the
emotions from an interaction
Communication and Dementia
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Communication and Dementia
PresenterPresentation NotesShadow of your interaction is longOprah wisdom
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What happens with communication in
dementia?
Communication and Dementia
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Dementia Deficits of Communication
Early Stages: Tip of the tongue feeling Takes longer to process 30-60 seconds Difficulty staying on track Aphasia (word finding difficulty) Repeating
Communication and Dementia
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Dementia Deficits of Communication
Middle Stages Forget more complex words Neologisms Increased generalizations Greater reliance on social phrases Difficulty following instruction Less initiation of conversation
Communication and Dementia
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Dementia Deficits of Communication
Late Stage Single words Limited initiation Nonverbal sounds Communication as a whole is predominantly
nonverbal
Communication and Dementia
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Other Communication Barriers
Hearing loss Loss of ability to hear higher pitches Substantial hearing loss not unusual
Vision loss Many visual cues are used in communication Conversational cueing Feedback Decoding
Dentures
Communication and Dementia
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Remember:
Lack of initiation/engagement of conversation does not imply a lack of desire for communication Ability to UNDERSTAND the spoken word long outlasts the ability to COMMUNICATE the spoken word Ability to understand and experience the emotions involved in communication long outlasts the ability to understand the spoken word
Communication and Dementia
PresenterPresentation NotesThis includes isolation
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Results of Impaired Communication
Unmet needs Frustration Anxiety Decreased self esteem Increased social isolation Interaction with individuals with dementia is often superficial and brief. o Not being understood increases isolation
Communication and Dementia
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Results of Impaired Communication
Responsive Behaviours Hostility Aggression Yelling Swearing Pushing Grabbing Refusing
Communication and Dementia
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What does this mean for me as care provider?
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Telephone Game?
McGhee, J. (2011). Effective communication with people who have dementia Nursing Standard 25(25) 40-46
Communication and Dementia
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Telephone Game?
With increasing deficits, communication ceases to be 50/50 and becomes more 80/20
Communication and Dementia
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What do we do that may CAUSE responsive
behaviours?
What we do
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What do we do?
How to we promote responsive behaviours? Task orientation/isolation Removing control Not engaging fully Not responding to the emotion/intended message Elderspeak
What we do
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Task Orientation/Isolation
Focusing on the task, not the person Only engaging with them when there is a task to be
done
What we do
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Removing Control
The desire to have control over ourselves and our lives is fundamental to people of all ages
We all want to feel as though we have influence over ourselves and our surroundings
Feelings of helplessness and loss of control lead to reduced cooperation and acting out This is not unique to dementia
What we do
PresenterPresentation NotesEx: potty training, Christmas dinner, go in front of the car
https://fbcdn-video-n-a.akamaihd.net/hvideo-ak-xpf1/v/t42.1790-2/1053631_10152315890905881_1922148837_n.mp4?oh=3540c57890308614d5be2d25d020b6c2&oe=54A1B42B&__gda__=1419884671_79a64dc29a37d49e193ab55d734ada67
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Control. A life-long need.
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Not Engaging Fully
Multi-tasking Being disconnected Generic responses Back to them Talking to others as though they are not there
What we do
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Not Responding to the Emotion
Focusing only on the words Looking at the bucket of water Listening to reply rather than listening to understand
What we do
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Elderspeak
AVOID ELDERSPEAK
High Pitched Voice
Demeaning Names Sweetie,
Honey
Baby Words go potty
Everything sounds like a
question
What we do
App store?
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Elderspeak
Greatly increases the likelihood of uncooperative behaviour when doing tasks
Demonstrates power imbalance and reinforces loss of control
Demonstrates lack of respect for individual and who they are
Increases depression and agitation May be interpreted as abusive
Even if dementia is so advanced that the words are
not understood, the feelings associated are perceived and retained
What we do
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Elderspeak
Hi Sweetie. Its time for our exercise today. Lets get ready to walk down the hall.
Vs.
Hi Mrs. Smith. Its time for your exercise today. May I
walk down the hall with you?
What we do
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Elderspeak
Effect on Person with Dementia: Feel incompetent Feel discouraged Feel disrespected Alters self perception Reinforces and imposes dependency Insulting Depression Withdrawal Greatly increased likelihood of resistance to care
What we do
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Herman, R & Williams, K. (2009). Elderspeaks influence on resistiveness to care: focus on behavioural events. American Journal of Alzheimers Disease and Other Dementias 24(5) 417-423
What we do
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Elderspeak
Effect on perception of care provider by third party and care recipient:
Disrespectful Patronizing Unprofessional Angry Frustrated Dislikable Unintelligent Poor communicator
What we do
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Strategies
How can we reduce our contribution to responsive
behaviours through communication?
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Strategies
Empathic Curiosity A standpoint of trying to focus our attention on the
perceptual experiences of another as they are experiencing them here and now
More than empathy empathic listening with maintaining a curious attitude toward nonverbal cues and behaviours Remember: All communication has meaning
Strategies
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Strategies
MESSAGE M Maximize attention E Expression and body language S Simple S Support the conversation A - Assist with visual aids G Get their message (empathic listening) E Encourage and engage in conversation
Strategies - MESSAGE
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M Maximize Attention
Give cues before engaging them Identify yourself Use their name Eye level and eye contact Remove distractions quiet environment One person talking at a time May use touch to aid concentration
Try it! strike up a conversation with your neighbour
Strategies - MESSAGE
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E Expression and Body Language
Stay calm and relaxed Do not multi-task if you can help it Smile facial expressions Lean forward Eye contact Even tone do not over emphasize tone of voice
Try it! talk to your neighbour about the forecast
Strategies - MESSAGE
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S Simple
Keep messages familiar and short but not infantilizing One message at a time Clear choices (Elvis or the Beatles?) Fewer pronouns Do not test avoid factual questions that rely on recent
memory Present tense Try it! Tell your partner that it is lunch time and ask them what they would like to drink consider pacing, spacing and clarity of choices.
Strategies - MESSAGE
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S Support the Conversation
If interrupted, reintroduce the topic Provide more time to process Repeat and rephrase maintain tone Repeat part of what you heard to encourage them Do not pressure Help with word finding
o Find a balance between allowing time and causing distress Try it! Ask your partner about where they grew up if they dont reply, rephrase or repeat
Strategies - MESSAGE
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A - Assist with Visual Aids
Gestures or actions Objects or pictures Show options
Strategies - MESSAGE
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G Get Their Message
Start with the attitude that all behaviour and communication has meaning
Focus on feelings, not facts Look for micro behavioural cues Provide feedback mmm hmm. Look at the big picture
o Body language cues o Look for and respond to the emotion behind the message o What is the persons history?
Strategies - MESSAGE
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G Get Their Message
Try it What is your first impression/reaction if faced with these
behaviours? What else might these behaviours mean? (3 ideas!) what
response might be required?
Calling out for mother Pulling at your sweater Repeatedly wandering into the kitchen Refusing to sit at a meal A loud sigh
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E Encourage and Engage in Conversation
Interesting and familiar topics Do not test them yes and no - statements Avoid reality orientation Alternative techniques to communicate writing,
pictogram, gesturing Use positives rather than negatives when possible Do not argue with them
Strategies - MESSAGE
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Other Strategies
Account for other communication barriers hearing, vision and use available aids
Support client control and self esteem Do not be afraid to laugh Share what works
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Humour Therapy
A basic need throughout the life span Humour and play have many benefits Cardiovascular Respiratory Immune Pain Stress relief Diabetes Connection Distraction Communication Equality Ability to try things without risk Makes new connections
Strategies - Humour
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Humour Therapy
2011 SMILE study Sydney Australia Cluster randomized controlled trial evaluating the
effect of humour on depression, agitation, social engagement and quality of life of nursing home residents
Involved 398 residents Involved humour therapy training for one staff and
9-12 visits by professional elderclown
Strategies - Humour
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Humour Therapy
No significant outcome change in depression found Agitation outcome was a significant decrease Equivalent to two agitated behaviours decreasing
from daily to once a week Similar outcome to risperidone without the side
effects
Strategies - Humour
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How Does Humour Stack up?
Humour Enhances connection Removes power barriers Is fully engaging Is an emotional message Is a normal part of
communication
Strategies - Humour
How to we promote responsive behaviours?
Task orientation/isolation Removing control Not engaging fully Not responding to the emotion/intended message Elderspeak
Freeman
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OK but
Im no elderclown There are downsides to humour Im not funny Everyone can use humour
Strategies - Humour
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5 Rights
Right Drug Right type of humour Avoid sarcasm, gallows humour Take cues from the other person - assess
Right Dose Could be just a smile
Right Route Where are you coming from? Laugh WITH not AT Right Person Must know your audience Must be trust established
Right Time Never during crisis
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Communication, Dementia and Frustration
Communicating with someone with dementia can be frustrating
Constant reminder of loss Fear So what if you slip? What if you find yourself not
using your equality and respect voice? Regroup and try again Forgive yourself Self care
What is communication?
PresenterPresentation NotesTake three minutes to discuss with neighbour
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Two Stars and a Wish
Give yourself credit for your successes Two Stars to celebrate what went right
A wish for something that didnt
All that you can do is take it one experience at a time.be kind to yourself. Cherish the successes.
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References Balsis, S. & Carpenter, B. (2005). Evaluations of elderspeak in a caregiving context. Clinical Gerontologist 29(1), 79-96 Christienson, A., Buchanan, J. & Houlihan, D. (2011). Command use and compliance in staff communication with elderly residents of long term care facilities Behavior Therapy 42, 47-58 Communicating Effectively: Dementia with Dignity. Films On Demand. Films Media Group, 2006. Web. 14 Jan. 2015. . Eggenberger, E., Heimerl, K. & Bennett, M. (2013). Communication skills training in dementia care: a systematic review of effectiveness, training content, and didactic methods in different care settings International Psychogeriatrics 25(3),345-358 Elkins, Z. (2011). Communication bridges for people with dementia Primary Health Care 21(10) :16-19 Gerontological Society of America (2012). Communicating With Older Adults: an evidence based review of what really works. Washington http://www.agingresources.com/cms/wp-content/uploads/2012/10/GSA_Communicating-with-Older-Adults-low- Final.pdf Herman, R & Williams, K. (2009). Elderspeaks influence on resistiveness to care: focus on behavioural events. American Journal of Alzheimers Disease and Other Dementias 24(5), 417-423 Low, L., Goodenough, B., Fletcher, J., Xu, K., Casey, A., Chenoweth, LBrodaty, H. (2014). The effects of humor therapy on nursing home residents measured using observational methods: the SMILE cluster randomized trial. Journal of the American Medical Directors Association 15, 564-569 McEvoy, P. (2014). Dementia communication using empathic curiosity Nursing Times 110(24) ,12-15 McEvoy, P., baker, D., Plant, R., Hylton, K. & Mansell, W. (2013). Empathic curiosity: resolving goal conflics that generate emotional distress Journal of Psychiatric and Mental Health Nursing 20, 273-278 McEvoy, P. & Plant, R. (2014). Dementia care: using empathic curiosity to establish the common ground that is necessary for meaningful communication Journal of Psychiatric and Mental Health Nursing 21, 477-482 McGhee, J. (2011). Effective communication with people who have dementia Nursing Standard 25(25), 40-46 Moos, I. (2011). Humour, irony and sarcasm in severe alzheimers dementia a corrective to retrogenisis? Ageing and Society 31, 328- 346 Nygard, H. (2010). Pain in people with dementia and impaired verbal communication. Journal of Pain and Palliative Care Pharmacotherapy 24, 414-426
http://www.agingresources.com/cms/wp-content/uploads/2012/10/GSA_Communicating-with-Older-Adults-low-Final.pdfhttp://www.agingresources.com/cms/wp-content/uploads/2012/10/GSA_Communicating-with-Older-Adults-low-Final.pdf
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Smith, E., Broughton, M., Baker, R.,Pachana, N., Angwin, A., Humphreys,M., Cherney, H (2011). Memory and communication support in dementia: research based strategies for caregivers International Psychogeriatrics 23(2) , 256-263 Williams, K. & Herman, R. (2010). Linking resident behaviour to dementia care communication: Effects of emotional tone Behavior therapy 42, 42-46 Williams, K, Herman, R., Gejewski, B. & Wislon, K. (2009). Elderspeak communication: impact n dementia care. American Journal of Alzheimers Disease and Other Dementias 24(1), 11-20 Williams, K, Kemper, S & Hummert, M. (2003). Improving nursing home communication: An intervention to reduce elderspeak. The Gerontologist 43(2), 242-247 Wond, S., Anand, R., Chapman, S. Rackley, A. & Zientz, J. (2009). When nouns and verbs degrade: facilitating communication in semantic dementia Aphasiology 23(2), 286-301 Manitoba Health Enhanced Orientation for Nurses new to Long Term Care Clinical Workshop 2: Manitoba Health Young, T., Manthorp, C., Howells, D. & Tulla, E. (2011). Optimizing communication between medical professionals and people living with dementia international Psychogeriatrics 23(7), 1078-1085
Slide Number 1Introducing Don BellamyOutlineSlide Number 4First CommunicationsFunction Of CommunicationCommunication is a ProcessCommunication is a TransactionCommunication and RelationshipsSlide Number 10What is communication?Reflect:Non Verbal Communication Slide Number 14Non-Verbals and DementiaSlide Number 16Slide Number 17Dementia Deficits of CommunicationDementia Deficits of CommunicationDementia Deficits of CommunicationOther Communication BarriersRemember:Results of Impaired CommunicationResults of Impaired CommunicationSlide Number 25Telephone Game?Telephone Game?Slide Number 28What do we do?Task Orientation/IsolationRemoving ControlSlide Number 32Not Engaging FullyNot Responding to the EmotionElderspeakElderspeakElderspeakElderspeakSlide Number 39ElderspeakStrategiesStrategiesStrategiesM Maximize AttentionE Expression and Body LanguageS SimpleS Support the ConversationA - Assist with Visual AidsG Get Their MessageG Get Their MessageE Encourage and Engage in ConversationOther StrategiesHumour TherapyHumour TherapyHumour TherapyHow Does Humour Stack up?OK but 5 RightsSlide Number 59Communication, Dementia and FrustrationTwo Stars and a WishReferencesSlide Number 63