Dementia Care: Communicating with People Living with Dementia Who are Struggling to Express Their Needs

By Dr Rachel Daly, Practice Development Admiral Nurse Consultant at Dementia UK (www.dementiauk.org)

Some people living with dementia may have problems communicating and expressing their needs which can leave them feeling very frustrated.

For anyone providing support to a person living with dementia, thinking about ways to help the person communicate with you could be beneficial. Are there picture cards to hand to help the person recognise a picture of what they need (for example the toilet) and point to it, even if they cannot say the words? This helps them to express their needs and wants to their carer.

Some people can write fluently long after their speech has gone. Others may communicate through touch, facial expressions or body language. Taking the time to be with a person who is struggling to communicate is one of the greatest gifts to give them. Remember that all behaviour is communication, and it is our job as professional carers to TRY HARD to understand and help them. If you have a question on helping someone living with dementia, you can always contact Dementia UK’s Admiral Nurse Dementia Helpline on 0800 888 6678 or email helpline@dementiauk.org

T Take a moment. Look around, what might be wrong? What might that person want or need? Give them your time.
R Reactions – is the person reacting to you, another resident, the temperature, a noise or something else in the environment?  
Y Yearning – is the person yearning for something? Are they hungry or thirsty? Are they bored? Do they miss their family? Do they need a hug?
H How can you find out their needs and emotions? Are they sad, stressed, anxious, fearful, confused, happy, or in pain?
A Activities and meaningful occupation – how can you engage the person in a way that gives them some sense of choice, control or fun? What did they like doing when they were younger? Would they like to plant some bulbs, go for a walk, or visit other residents? If the person is walking, consider why -are they looking for something or someone? Maybe they have a sore bottom from sitting too long.
R Repetition – restate and use their words. Reassurance – take the time to calm them down and remember they might feel frightened. 
D Dos, Don’ts and Distractions – Do: Smile, be kind and get on their level. Use more non-verbal communication like touch, gestures, pictures, smells, and show objects (like the juice box) to enhance understanding.
  
Don’t: be too loud, too fast, or use too many words. Don’t argue and remember that it is not important to correct them if they believe something to be true (like they need to go home to their mum). Distraction techniques can work well. Ask them to tell you about their mum, look at pictures or have a cup of tea together, give a hand massage or play some music, and dance with them if they are able.  

Music can be a wonderful therapy for people living with dementia and for it to be most effective it needs to be tailored to the individual. Find out as much as you can about the person through ‘Life Story Work’ which helps to ensure that our care always honours the person as an individual. For example, what job did they do? Did they have children? Do they have a religion? What are their hobbies? This is often called ‘Person-Centred Care’ or ‘Person-Centred Practice.’ Ask the person (if they can communicate), ask their family, check their records, and note it in the care plan so you can share it with all your colleagues.

Think about how the music you like might differ from your friends, your partner or your family. How can it affect your mood? That will be the same for your residents. Some might like jazz or classical music, whilst others might prefer music related to their religion. If you find a favourite or something that calms them, then make a note and use it in situations that they might find stressful. If you find a tune that distresses them, make a note of that too to help your colleagues to remember not to play it when they are around. Music can be used passively (to listen to) or actively (for singing and dancing) – try it out, always remembering to keep it personal to the individual.

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