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Communication Strategies for Patient's with Dementia

Megan L. Malone, MA, CCC-SLP, Jennifer Loehr, MA, CCC-SLP

February 15, 2024

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Question

As health care professionals, should we alter our communication depending on the stage of dementia a patient is in?

Answer

In healthcare, adapting our communication approaches in accordance with the varying stages of dementia is pivotal. The effectiveness of our strategies hinges on a nuanced understanding of the patient's condition.

During the early stages, it is imperative not to make assumptions about a person's communicative abilities. Memory impairment doesn't equate to a decline in intellectual capacity. Instead of automatically adjusting our tone, volume, or withholding information, we should include them in conversations. Speaking directly to the individual, allowing time for responses, and avoiding premature assumptions are crucial elements.

As the disease progresses into the middle stages, one-on-one communication proves most effective. Clear, deliberate speech, sustained eye contact, and providing ample response time remain essential. Visual supports, such as written instructions, can aid in comprehension, enhancing the individual's ability to perform tasks.

In the late stages, a respectful and dignified approach becomes even more paramount. Approaching the individual from the front, identifying oneself, and clearly stating intentions are crucial. They may not remember who you are. Reading nonverbal cues, such as tone of voice and facial expressions, becomes increasingly important. Inferring the individual's emotions and responding accordingly fosters a more meaningful connection.

Regardless of the stage, condescension is never appropriate. Recognizing the person's identity and avoiding assumptions about their capabilities is vital.

Compensatory strategies, both verbal and written, can be employed to support communication.

Verbal compensatory strategies can include describing or spelling out words and asking clarifying questions to help improve understanding.   Non-verbal compensatory strategies can include pointing, gesturing,or facial expressions to help a patient communicate their wants, needs, and pain if unable to do so verbally.  

Written compensatory strategies can include alternative methods, such as writing or finger spelling, which can assist individuals in overcoming word retrieval challenges. When someone struggles to find a specific word, guiding them through a focused thought process, asking about relevant details, and narrowing down options can be effective. For instance, if they can't recall the word "salt" while asking for it, prompting them to think about its purpose, where it's found, or the starting sound can aid in word recall. Employing strategies that structure conversations with choices, rather than broad inquiries, can simplify communication. Instead of asking a general question like "What do you want for dinner tonight?" offering specific options like "Spaghetti or pot roast?" facilitates easier responses.

Enhancing engagement in conversations involves crafting questions that are specific and offer choices. Simple yes/no inquiries empower individuals to respond easily. Open-ended questions that encourage sharing opinions are effective in fostering meaningful communication. For instance, instead of asking about a challenging recall like breakfast, inquire about preferences or opinions on food. Seeking advice is a valuable approach, prompting individuals to share their thoughts and experiences. By asking for advice on topics like choosing a hostess gift or holiday food, you stimulate memory and encourage discussion. It's crucial to respect opinions, especially for those with dementia or Alzheimer's, as it fosters confidence in communication and allows them to share without judgment.

Ultimately, the goal is to adapt our communication strategies with sensitivity, ensuring that individuals with dementia are consistently treated with respect and afforded the opportunity to express themselves throughout the progression of the disease.

This Ask the Expert is an edited excerpt from the course Alzheimer's and Other Dementias: Overview for Healthcare Professionals by Megan L. Malone, MA, CCC-SLP 


megan l malone

Megan L. Malone, MA, CCC-SLP

Megan Malone is a speech-language pathologist working as a clinical faculty member in Kent State University's Department of Speech Pathology & Audiology and as a clinician and consultant in home health care. She previously worked for 9 years as a senior research associate and lead trainer at Myers Research Institute, in Cleveland, OH where she oversaw federally/privately funded grants focused on implementing interventions with older adults with dementia. She is the co-author of the book, Here's How to Treat Dementia (Plural Publishing, 2013), has spoken numerous times at the annual conventions of the American Speech and Hearing Association, Gerontological Society of America, American Society on Aging, and the Alzheimer's Association, along with several state speech and hearing conventions. She has published articles in the Journal of Communication Disorders, Alzheimer's Care Quarterly, The Gerontologist, and Dementia.


jennifer loehr

Jennifer Loehr, MA, CCC-SLP

Jenny Loehr is a speech language pathologist with over 25 years experience working with adult neurology. She has presented at over 20 state and national conferences and online continuing education programs on the topic of dementia. She is the co-author of the book, Here's How to Treat Dementia (Plural Publishing 2013) and is an LSVT certified clinician. She currently works in development and implementation of the Memory Care Program with Encompass home health training and mentoring physical, occupational and speech language pathologists working with the dementia population in the independent and assisted living communities. 


Related Courses

Alzheimer’s 101: An Overview for Healthcare Professionals
Presented by Megan L. Malone, MA, CCC-SLP, Jennifer Loehr, MA, CCC-SLP
Recorded Webinar

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Megan L. Malone, MA, CCC-SLPJennifer Loehr, MA, CCC-SLP
Course: #4823Level: Introductory2 Hours
  'How the material was presented with slides'   Read Reviews
An overview of dementia, Alzheimer's disease and related disorders for healthcare professionals. Strategies for assessment and diagnosis, improving communication with patients, understanding and managing behavioral challenges, care planning and promoting independence are discussed. Methods for supporting family and caregivers are also described.

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This course will provide an overview for the healthcare professional about Alzheimer’s disease and related disorders. Participants will learn strategies related to improving communication with patients and families, understanding and managing behavioral challenges, and promoting independence.

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This course will provide an overview of the spaced retrieval technique, which is a cognitive intervention that can improve recall of functional information. Participants will learn the evidence behind this technique as well as how to implement it in therapy sessions. This course is directly related to the practice of physical therapy and is therefore appropriate for the PT/PTA.

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