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Conversation is caring

Watch Dr Tony Young explain how recognising a commitment to meaning is at the heart of good communication.
Conversation is caring. You aren’t just chatting, or finding out the things you need to know, you are acknowledging someone as a person.
As a person’s dementia progresses, we often experience a downward communicative spiral, and relationships can become more strained or difficult. Finding ways to improve the way we communicate will not only help a person with dementia be heard and understood, it can also reduce the stress that we face too.
A commitment to uncovering meaning is at the heart of this approach. So irrespective of someone’s cognitive impairments or other communicative barriers, the first step is acknowledging that a person living with dementia will continue to engage and make sense of the world around them. So what are the communication challenges? As we’ve already discovered, some communication challenges stem from the neurodegenerative symptoms of dementia, such as the tendency to greater confusion, memory problems, difficulty finding words, and so on. But since communication is fundamentally a social process, part of this difficulty arises from the way that we, as family, friends, and members of the community, interact with the person living with dementia.
There is a danger of what I would call “over-accommodation” to some of the potential problems someone living with dementia may be experiencing. As with older people more generally, we might slip into what is known as “elder-speak”, for example. This involves using a singsong voice that exaggerates our pitch and intonation, perhaps using “we” instead “you”. So asking things like “how are we doing today?” or asking questions without waiting for a reply, such as “can I take that from you?”. We may even assume a person living with dementia cannot interact with us, and so we might bypass them and speak about them rather than really to them.
This can lead to a person becoming disengaged and disheartened, contributing to that downward communicative spiral. Of course, conversations are a two-way process. If we are not being acknowledged, it can lead to us becoming disengaged and disheartened too. Knowing how to respond appropriately can make things a little easier. Family members who know a person well are often better able to know what might be the right approach to take, but not always. Often family carers try to repair miscommunications by correcting the person with dementia or by answering on their behalf.
This is an understandable and often necessary response, since in our everyday lives we’re confronted by situations in which we must explain to health professionals and others how things are in an efficient and courteous way. However, repairing or averting miscommunication can have the effect of inhibiting a person with dementia from getting their point across on their own terms, and can make it more difficult for someone else to learn about the person and how best to communicate with them. When coming into contact with new people or acquaintances, it’s worth remembering how difficult it can be to get the balance right the first time. People may draw on stereotypes and apply them without knowing the person or their cognitive abilities.
Family members can help others by appreciating that a person may feel anxious or get things wrong at first, and look for ways of supporting them to adapt their conversation style as they get to know the person with dementia a little better. This could involve giving advice to simplify their language, give more time to be understood or to listen, and to pay attention to the visual cues that we give and receive.
In this video, Dr Tony Young explains the idea of ‘conversation as caring’ by referring to what he calls a ‘commitment to meaning’.
When we are introduced to people we don’t know, we usually seek to find common ground. By sharing information we become more familiar with each other. Even when we do not share a common language, we somehow find ways to express ourselves and understand others. If we have a commitment to understanding the meaning of others, we can develop a connection.
If the expected flow of communication becomes disrupted (because of dementia, for example) we can find that a person we know very well is finding it more difficult to express themselves and connect with us. The communication is less predictable, and our understanding of each other can diminish.
Throughout the course, we maintain the view that a person is not lost as dementia progresses. Our expectations and the way we communicate may need to change, but by having a continued commitment to understanding meaning, we can retain these valued connections.
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Dementia Care: Staying Connected and Living Well

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