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Skip to 0 minutes and 7 secondsWe may face challenges at particular times of the day and doing particular tasks and situations such as going to the bathroom or brushing our teeth. So how do we go about helping someone with dementia do this? We use a thing called the wheel of communication. We don't start off with that particular activity, we go back to basics and say, what are the core skills of communicating with somebody? That's the hub of our wheel. And the outer hub is the idea of-- what's the specific skills you need for someone with dementia?

Skip to 0 minutes and 42 secondsSo that's taken account of the memory problems we talked about before that, that's taking account of the sensory difficulties, that may take account of the physical difficulties that many folk or frailties that many folk we see have. So how do you communicate with someone who has say, Lewy Body dementia, who has very poor mobility, is on lots of sedating medication, who can't hear very well, who can't speak very well? And then we help staff to recognise what are some of the barriers to communication, how to overcome those, and then we move onto the specific skills of how to help someone go the toilet, how to help someone clean their teeth.

Skip to 1 minute and 23 secondsSo the techniques I would use would be connect with you-- so you don't lose your dignity. You understand what you can do. You can help yourself as much as you can. But it may be the case that you can't clean your own teeth and I would need to assist you. So there's certain handholds we've used that would mimic you cleaning your own teeth. So I would hold your hands in a special technique and get you to move your hand to your mouth, but I'll be holding your hand, moving your hand to your mouth. And what happens is that for many, many years you've cleaned your own teeth.

Skip to 2 minutes and 0 secondsWhen you feel your own hands-- that neural activity happening your jaw relaxes and you're much more likely to accept the toothbrush as opposed to me sticking a toothbrush in your mouth. And there are all sorts of techniques like that we use. We look at the best evidence around the world, we look at all the little things that may help that process. So when people have dementia, they becomes very hypersensitive around the mouth. So what we may also do is also place a hand on your shoulder. And what that does is give reassurance.

Skip to 2 minutes and 36 secondsBut also it takes away the hypersensitivity around the mouth, so there's another point where I'm contacting you, which your brain is paying attention to that as well and not the sensitivity around your mouth. There's all these little techniques we also help staff to utilise.

Communication to support daily living ?

In this video, Dr. Ian James describes his ‘wheel of communication’ - a tool that he uses when training care staff. He finds it useful for thinking about how we should communicate around tasks of daily living. The wheel starts with basic communication skills before we think about how to approach particular tasks.

wheel of communication (Click to expand)

The starting point

He argues that a good way to start any practical task is to learn from good customer service as this can help to connect with a person and de-escalate emotional situations. For example, if we think of someone with good customer service skills (such as a police officer or hotel receptionist) they know how to calm a situation, discover what someone wants and they do their best to deliver a good service, whilst acknowledging a person’s distress. They have learned that arguing, ignoring or patronising customers is unlikely to calm the situation. They may use phrases which suggest you are right, such as:

“I am sorry I upset you”
“I am sorry you are right” (you need to give up the reality of being right)
“I am sorry, I was trying to help”.
“I am sorry this must be hard”
“I am sorry I didn’t mean to make you feel that way/silly”

(Suzannah Thwaites, based on Teepa Snow ‘five sorries’ )

Do you think a customer service approach might help you de-escalate emotional situations?

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Dementia Care: Staying Connected and Living Well

Newcastle University

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