People can have problems with language, either understanding words or saying words, but sometimes it does not mean that they don’t understand more about what is going on than their lack of communication might indicate. Sometimes the situation a little more complicated than mere forgetting or confusion and it will all depend on which areas of the brain are damaged and how that damage affects the person. Damage to the brain that affects language can be caused by dementia, but there are other causes for it, stroke being a very common one.
Generally language issues are divided into two parts, the first part is known as “expressive dysphasia”, it is about the ability to speak and express yourself. This is often summarised as “word finding difficulties”, people just cannot remember the right words for things. If people have partial damage to the communication areas of the brain, then the person might remember an associated word, but not the actual word that they are looking for. So when asking for chicken for lunch, they might say “bird” or when discussion their illness, they might say “medication”. These change in language ability takes time and patience to tune into what people are really saying and to try to interpret their communication beyond the words they are using.
People can also have very severe word finding problems and still communicate using tools, including pointing at words or pictures. When some complex issue needs to be discussed, this can involve the making of a special set of word books or pictures in order to allow the person the tools that they need to respond to what is being discussed with them. There are various standard picture / words books available for everyday living, which can be very helpful.
As well as having speaking problems, people can have “receptive dysphasia”, which is the inability to understand what is being said to them. It is about receiving language, which can include hearing issues or vision issues if the person lip reads or problems with understanding. When the issue is hearing, it is helpful to sit in front of the person without any other distractions, so they can focus only on the person speaking and see their body and facial expression. If hearing aids help, then ensure that they are in and working.
When the issue is understanding what is being said to them, then it is helpful to take the ideas slowly and one at a time, in simple language. If there is a complex matter to discuss, it is helpful to take the person slowly through the steps of what they need to consider. If there are too many ideas coming to them at once, this will confuse them, they just need one idea / concept at a time. Then once they have grasped that, move to the next part of the issue. It will take time and patience to get anything resolved, but the person should not be disempowered from being involved in decisions about them because it take a bit more time and patience.
People can also have more global “Aphasia”, which is where they have both expressive and receptive dysphasia. This is much more likely to be a cognitive issue than just a communication issue, but it might not be and again, someone should always be involved in decisions about themselves to the extent that they are able.
I have had a number of clients with communication issues, including just hearing problems, where I sat in front of them and bellowed, we now have a portable hearing loop to help with that problem. I have had a client with no language at all, but facial expression, this took some preparation, so that I could ask her closed yes/no questions and she could nod or shake her head. I have also had a client with very limited language, who was perfectly functional, so she could not tell you that she wanted a cup of tea, but could go to the kitchen and make it.
Kindness and patience are always the appropriate response. See the person and not just their failings in their abilities. Information about their past can inform their choices as well as observing how they respond to situations. There will be errors made in caring for someone with major communication difficulties, giving them tea instead of coffee, but that doesn’t mean that the carer has to give up and feel defeated, there will be lots more opportunities to get things right.