1. Clients with Dementia Communication Skills and Dealing with Difficult People

2. What is Dementia ? Dementia is a general term for a decline in mental ability severe enough to interfere with daily life. There are multiple causes of dementia The commonest cause in the elderly is Alzheimer’s disease.

3. Person-Centered Care Care that respects the dignity of the care recipient and treats him/her as an individual with needs, feelings, opinions, preferences, and desires, rather than focusing on narrowly on the recipient’s illness or the abilities that they do not have. In Person-Centered Care, the recipient is ideally an active participant and decision-maker in his/her own care.

4. Respectful Communication Always ask the care recipient how he/she would like to be addressed, then learn to say the name correctly. Never use terms such as “sweetie” or “honey” Treat adults as adults. A care recipient may have communication difficulties, but this is not a reason to speak to him or her like a child. Some examples: No “baby talk” Don’t patronize or talk down to adults. Use adult words.. For example: say “briefs” rather than “diapers”) Use books and TV programs for adults Try whenever possible to let care recipients make choices about their care and life. Don’t r

5. Good Listening Skills “Active Listening” means making a conscious effort to really hear and understand what the other person is saying, and responding appropriately. Active listening skills: Be quiet. Make a habit of focusing mindfully and intently on understanding the other person’s feelings and needs. Stop all other activities Focus on the speaker. Look and sound interested. Do not interrupt Clarify what the speaker has said. Paraphrase it back to the person. Try to avoid closed-end questions (eg. Yes/no) and instead use open-ended questions (Could you tell me what you how your are feeling ?, what you heard ?, what you saw ? what you mean ?)

6. Messages Use “I” messages instead of “you” messages. “You” messages put the blame on the other person, but “I messages are assertive. They show that you are taking responsibility for your own feelings. A “you” message: You make me worry when you don’t talk to me. An “I” message: I feel worried when I cannot communicate with you.

7. Managing Your Own Feelings Stick to the point at hand. Don’t add. “And another thing…” Understand that people respond with different emotions to the same situation. Do not react when you feel you’re your own emotions rising. Listen first Own your own feelings Never argue with the care recipient. Feelings are neither right or wrong.

8. Some Cases CASE 1: Mr S says that he sees bugs all over ther walls. Feels itchy. Wants to spray all the walls with bug spray. CASE 2 Mrs B says she is really late for work. Her boss will be mad. She cant find the car keys and wants you to let her out so that she can take the bus. CASE 3: Mr. D sees a man in the street outside. Thinks the man is going to kill him. Says his neighbor has been stealing his money and have plans to burn his house down. Need to call the police today. CASE 4: Mr M has always taken a shower twice a week. His wife now finds that he screams, hits her and bites if she even tries to get him into the shower, yet he continues to ask her to bathe each day.

9. Communicating with Individuals with Dementia Dementia is not a mental health issue. The diseases that cause dementia produce damage to the structures and/or functioning of the brain. Symptoms of dementia may include Difficulty remembering names and recent events Disorientation/getting lost Difficulty speaking or understanding Impaired decision-making and judgement Changes in behavior Apathy or withdrawal depression Memory problems in old age do not inevitably = dementia.

10. Some Tips on Communicating with Individuals with Dementia Try to remember that their behavior is beyond their control. Don’t take their behavior personally. Use appropriate non-verbal and verbal communication ! Your actions and reactions are the most important factors you can use to be effective in caring for an individual who has difficult/challenging behaviors !

11. Being Effective… Never Argue. Do not try to bring a care recipient into your own reality. Rather let them be in ther own time and place. Try to distract a care recipient who has become upset or anxious. Distraction is a great tool to help someone calm down. For example: Ask you to tell them stories from their youth. Look at and discuss old photos together. Play board games, card games, do crafts, paint with watercolor,draw pictures with crayons if possible. Use Humor !

12. More Tips for Handling Difficult/Challenging Behaviors Always try to perform one task at a time. Keep things simple, perform one task at a time and avoid making any changes. Focus on assets ( “good job”, “wow”) and goals. Always remember the “Four “R’s” Repeating Repetition Reinforcement Reassuring (over and over and over….)

13. If a Difficult Behavior is Escalating… Back Off. Step Back Evaluate Be Flexible

14. If a Difficult Behavior is Escalating… Instead of saying “no” tell the care recipient what he or she CAN do. Talk and move slowly so a care recipient does not feel threatened. Never rush or grab them. Try soothing touch. For example, a gentle arm around the shoulders or holding hands can be reassuring and soothing. Be sure that this is appropriate for the care recipient, however. Reassure the care recipient that everything is alright.

15. If a Difficult Behavior is Escalating… Try to respond to the recipient’s emotions. Regardless of what causes the the agitation, the person is upset. Try to focus on what they are feeling instead the actual words they use. Breathe deeply. Try to calm your own feelings and reactions. Remember that when the care recipient is angry and aggressive that it comes from fear and from wanting to be understood and be be cared for. You cannot control the recipient’s emotions/reactions. Always try to Step back, control your own reactions and emotions, assess the situation and use your nonverbal and verbal responses effectively.

16. Some Things to Remember Changes in behavior may signal an underlying medical issue that the care recipient may not be able to express verbally. Some key examples: Pain Acute urinary tract infection Bothersome medication side effects or drug-drug interactions Overstimultion

17. The 4 R’s REPEATING REDIRECTING REINFORCEMENT REDIRECTION

18. 5 D’s DESCRIBE IT DECODE IT DESIGN INTERVENTION DO IT DETERMINE IF INTERVENTION WORKS

19. Some Cases CASE 1: Mr S says that he sees bugs all over ther walls. Feels itchy. Wants to spray all the walls with bug spray. CASE 2 Mrs B says she is really late for work. Her boss will be mad. She cant find the car keys and wants you to let her out so that she can take the bus. CASE 3: Mr. D sees a man in the street outside. Thinks the man is going to kill him. Says his neighbor has been stealing his money and have plans to burn his house down. Need to call the police today. CASE 4: Mr M has always taken a shower twice a week. His wife now finds that he screams, hits her and bites if she even tries to get him into the shower, yet he continues to ask her to bathe each day.