On the 15th April I hopped onto a train down to Theale for a long day of training with the Alzheimer’s Society. The training comprised of workshops on vocal warm-ups, health & hygiene, songs and rhythm, group composition, a song-share and an excellent presentation on ‘Communicating with People with Dementia’ by Marielle Kay, Specialist Speech and Language Therapist.
More of the rest in another post, but here are some of my learning points from Marielle’s presentation:
- “When you’ve met one person with dementia, you’ve met one person with dementia”
- Saying ‘lovely to see you again‘ can be unhelpful as the person may not remember and this can cause uncertainty.
- Watch for someone’s non-verbal communication – laughter can sometimes be a sign of uncertainty, a deflection of not understanding something – how might you react if I asked in all seriousness ‘have you seen the squarg?’
- When speaking, put things in chronological order – for example, do say ‘we will collect in the books and then we will finish our session with a song’, don’t say ‘before we finish our session with a song, we’re going to collect in the books’
- Idioms can be difficult to understand, and wordplay can exclude – but humour can be a gift.
- Don’t ask questions that require short term memory, or specific details
- Sometimes questions such as ‘would you like a cup of tea’ can be difficult – the person may not remember if they have recently had a cup already, or they may not want you to go to the trouble for them. Instead saying ‘I’m having a cup of tea, would you like one?’ gives permission.
- Pace – speak slowly with a clear vocabulary.
- Infantilisation – this can happen because often our main experience of caring is with and around small children, when we naturally speak in a higher-pitched voice. It’s important to reject the notion of dementia as a second childhood and recognise the person with dementia is an adult with a life-time’s worth of experiences.
- Look for the meanings behind the words: ‘I’m going to work now’ might mean I need something to do – ‘where’s my mother’ or ‘I want to go home’ might indicate feelings of insecurity.
- When these difficult questions arise through disinhibition or confabulation there are various options: 1. To correct 2. To distract 3. To validate 4. To fabricate
- When talking to someone who is becoming less lucid it is best to let them take the lead – listen to them and give them the full attention – read the non-verbal signs and repeat back key words that might prompt a memory.
Marielle’s presentation was incredibly rich, full of really practical tips about communicating with someone living with dementia. She finished by talking about Tom Kitwood’s book Dementia Reconsidered (1997). Tom Kitwood was a proponent of person-centred care for people living with dementia, and examined a variety of ways in which this could be undermined, including: outpacing, disempowerment, infantilisation, invalidation, imposition, ignoring… the list goes on.
This presentation really helped me reflect on how the Singing for the Brain is such an effective model for empowering and building the confidence of people with dementia, but also how easy it can be to fall into the traps of not always listening to someone, by not making an effort to be with someone who is less communicative, or by not taking the time to s-l-o-w d-o-w-n when speaking to someone with dementia.