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Where we communicate matters

Everyday situations can present communication challenges for people living with dementia.
We take for granted our ability to go out and about as we wish and take part in the activities we enjoy. But as dementia progresses, this can become more challenging. Issues may be the result of a person’s reduced memory of places, their ability to recognise everyday objects, and impaired decision-making ability. Carers and people living with dementia may minimise feelings of anxiety and confusion by limiting where they go and who they spend time with. But this can contribute to social isolation. Contending with the outside world can lead to information overload, anxiety, and confusion for people living with dementia, and can contribute to the stress faced by carers.
Uneven pavements, crowds of fast-moving people, heavy traffic, poor sign-posting, and a lack of outdoor seating and toilet facilities all present challenges. Technologies that should help, like the crossing signals, can easily add to confusion and anxiety. If the person has other health conditions, such as difficulty walking, worsening eyesight, or impaired hearing, these challenges will be greater. The coffee shop where we meet our friends may bring changes in lighting, queues, noisy equipment, and a number of trip hazards. We have decisions to make. But with noise and uncertain procedures to follow, this can be overwhelming. We take for granted our ability to recognise friends. Hello, how can we help you today? May I have a toastie, please?
To make quick decisions about what we want, choosing from written menus, for example. We expect to know how to interact with staff. All right, that’s 6 pound 90, please. Thank you very much. And to be able to pay with cash or card machines. We are faced with observing social etiquettes throughout, when queuing, ordering, and finding a seat. A person’s behaviour may not reflect what is expected of them in some places or circumstances, so many carers describe feeling anxious about the reactions of other people, since dementia is not a very visible condition. All too easily, we create disabling environments for people with dementia.
The challenge of a dementia-friendly society is to re-imagine public and private spaces so that they enable people with dementia to continue to live and interact outside the home within their community for as long as possible.
Where we communicate can make a big difference. If we think about the contexts for communication, we can see how some spaces and places can be relaxing and stimulate conversation whilst others generate distress. In this video, we examine some of the issues we face while out and about.
Things like décor and background noise can have impact on communication at home and in other places. But it can also support our interactions, by helping to reinforce and convey meaning. For example, asking someone about lunch while sitting in a doctors surgery may be ineffective – the cues around them do not support this conversation topic. Starting the same conversation about lunch in the kitchen, at the dining table or in a supermarket will supplement verbal information with supporting clues.
We may improve our communication by:
  • maximising familiarity – familiarity with a place can reduce anxiety for people living with dementia. So at home, leaving things (décor, furniture) as they are can help to reduce anxiety.
  • having adequate space for interaction – you should be able to comfortably face the person you are speaking to and have adequate and appropriate lighting.
  • reducing distraction – turn off radios/TVs or go to a quieter space if possible. Colour schemes can also have an effect on how a space is perceived.

Care and Connect App

It is not always easy to plan ahead for trips out and about – e.g. going for a coffee with friends or visiting the cinema. We don’t know in advance if the places we wish to visit have considered how their service might be experienced by someone living with dementia.
Dr Katie Brittain, formerly a researcher at Newcastle University’s Institute for Ageing, has developed an app that can help carers and people with dementia find appropriate, dementia friendly spaces in their local community and further afield. The app is called Care and Connect.
Users of the app can rate places they visit according to their experience, so that other people can share these insights and make decisions about where to visit or where to avoid. This information will become richer as more people from more places contribute their views.
App screenshots
The App is free and is available for Android and IOS: You can read more about it, and try it out from these links:
Think about the last time you went out with the person you care for, did the setting support communication or cause distraction?
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Dementia Care: Staying Connected and Living Well

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