Academic journal article Research and Theory for Nursing Practice

Increasing Social Communication in Persons with Dementia

Academic journal article Research and Theory for Nursing Practice

Increasing Social Communication in Persons with Dementia

Article excerpt

Communication difficulties between caregivers and persons with dementia (PWDs) may increase stress, resulting in behavior problems. Kitwood's theory of dementia care suggests that successful collaborative communication increases well-being and quality of life in PWDs. This study aimed to determine if individualized communication prescriptions (ways interviewers might facilitate collaborative communication) are effective for doing so. Ten PWDs were interviewed; individualized communication prescriptions developed then implemented in a second interview. No increase in number of words used by PWDs occurred in interview 2; however, PWDs' words per topic significantly increased and number of topics needed to sustain a 15-minute conversation significantly decreased in the second interview. Systematic, individualized communication strategies may encourage PWDs to express their needs, preferences, and ideas.

Keywords: dementia; communication; caregiver; quality of life; problematic behavior

Approximately 4.5 million persons in the United States are afflicted with dementia (National Institute on Aging/National Institutes of Health, 2004/2005). Persons with dementia (PWDs) often develop troubling memory and behavior symptoms. Many of these symptoms, such as wandering and forgetfulness, arise from memory loss that changes the way the person behaves and communicates with others. As such, opportunities for interactive social communication may decrease for PWDs. This study reports on the use of individualized communication prescriptions for PWDs to promote social communication. Beck and Heacock (1988) state that the need to communicate and interact with others is a basic human need that facilitates a sense of security and belonging. When communication difficulties arise in PWDs, their ability to respond to others diminishes and the afflicted person is at risk for depersonalization. Because PWDs may not communicate in the normal way, caregivers often regard communication from PWDs as confused or meaningless ramblings, resulting in unmet needs. Previous communication research has shown some promise in understanding and promoting communication in PWDs (Acton, Mayhew, Hopkins, & Yauk, 1999; Mayhew, Acton, Yauk, & Hopkins, 2001; Yauk, 2001).

LANGUAGE DEFICITS

Kempler (1995) summarized language deficits present in persons with Alzheimer's dementia. The earliest language deficits are word retrieval difficulties and use of empty or substitute words. Communication problems occur largely in word knowledge and the use of contextually appropriate language. Persons with Alzheimer's retain their ability to arrange words into a grammatical sentence and have no observable motor speech deficits. By the moderate stage of dementia, word retrieval worsens and there are more substitutions of empty words, use of related words, poor topic maintenance, and overuse of pronouns, making conversation difficult to follow. Discourse skills, such as turn-taking in conversation, remain intact (Kempler, 1995). By the later stages, verbal production becomes more difficult to interpret because of word and sound substitutions. Sabat (1991) agreed that turn-taking remains and reported that a PWD needs extra time to process information and to retrieve words. If this extra time is not given, the conversation can become one-sided, with the PWD only listening and making few attempts to contribute.

PWDs appear to comprehend the meanings of words even when they cannot produce the exact word. They often use related words when they are unable to retrieve the exact word (Bayles, 1991; Kempler, 1995). For example, if the PWD refers to a cup as a "milk pourer," an attentive listener can recognize the meaning. PWDs often use phonemic cues to retrieve words, suggesting that listeners can collaborate with the PWD to express his or her message. Kempler also found that PWDs use gestures to denote the function of an object when they cannot name it. …

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