How to communicate with someone who has a cognitive impairment – Part 3
I would again like to thank Kate Smith from Memory Matters some of the information for this blog.
It is still important to note that no two people with a cognitive impairment will communicate or behave in the same way, but here are some more ideas that will hopefully help.
People with dementia can have problems initiating something, they just can’t seem to get started. A couple of years ago, I went on a dementia experience, when I had my hearing, vision and sensitivity affected by various pieces of equipment and was then told to do three things all at once, none of which I could hear properly. It was an information overload at a time when I had impaired senses and it became too much for me. I just sat down in the chair in the corner and waited for someone to come and tell me what to do next, as I had no idea what I was meant to do! This is apparently a common thing that people with dementia do, when they don’t know what to do. So, I sat waiting patiently and watched what was going on, as best as I could see. People with dementia might need help to get things started, as they might not know how to in that moment.
The next issue that they may have is called perseveration and this is when they do get started they cannot stop. I have had a few clients that walk, all the time in a care home. They cannot even sit down to have a meal for any length of time and often have food that they can carry with them and eat on the go. Even going to the loo can be challenging for these people that walk a lot, as they have trouble sitting for any length of time, which might not be the same time frame that they eliminate in! It can be repetition of any action though, including moving their hands, feet or arms in the manner that they did for work years ago, if their work tasks were repetitive.
People with dementia can become bewildered with choices, so keeping the choices down to very simple ones can help. Instead of asking if they want beef, chicken or fish for dinner, just start off my asking if they want beef, yes or no and if the answer is no, ask about chicken etc. In this circumstance it is useful to know what their general preference is, so as to ask them about what is likely to be a positive choice for them first. The person talking to them should keep the language simple, to ensure that they are as empowered as possible to make as many decisions for themselves as is possible.
People with dementia can have problems making good decisions, as they can have an impaired judgement. When faced with the choice about going into care, often they say that they don’t want to and believe that they are caring well for themselves, but are remembering a time in the past when that was true, which then affects their ability to make a good decision now. There are lots of different reasons for impaired judgement, this is just one example, however the person’s judgement might be impaired, so they might need support to make decisions. It is important not to interfere with an unwise decision, as people with dementia are allowed to make unwise decisions, like we call do from time to time. Impaired judgement is about exactly that, rather than about imposing on the person a different choice their loved one or family would rather they made.
The ability to make an unwise decisions is one of the five principles of the Mental Capacity Act 2005. The issue about protecting them from an unwise choice is around their right to life, when a decision is so unwise it puts their life at risk, then their other rights can be overreached, such as the right to a private and family life or the right to free association.
If nothing else, but the kind, safe smiling individual for the person with dementia.