A Person-Centered Approach to Supporting Communication

“Hey, hon. I need to heat up my coffee. Can you put it in the thing…you know, the box that’s for heating the food. The…the..mike..the miker. Oh, forget it.”

It may begin like this. Word substitutions, verbose workarounds for a word that won’t come, that “tip of the tongue” feeling familiar to many of us (which is actually a normal part of aging.) But for those living with dementia, such minor changes lead to more significant ones, impacting interaction with the people and environments that matter most.

Communication challenges in dementia can have many underlying factors: cognitive decline, memory loss, difficulties in processing information, and mood or behavior. Signs of communication changes may present as difficulty with finding words, understanding others, or engaging in meaningful conversations. Non-verbal communication skills, including reading and writing, are also often impacted; the avid reader or productive emailer may begin to pull away from these tasks in favor of less language-demanding activities. Even mild changes in communication can be enormously frustrating and potentially embarrassing, especially for individuals who pride themselves on their gifts as orators or speakers. As a result, a person may begin to gradually withdrawal from social situations, leading to isolation and reduced opportunities to engage and connect. 

Despite anticipated decline, individuals and their support partners can work to maintain communication skills and uphold quality of life via a person-centered care approach. Person-centered care is a holistic and integrative approach designed to maintain well-being and quality of life for people with dementia, and it includes the individual, the carers, and the family (Kim and Park, 2017). By creating a communication-supportive environment, those living with dementia may sustain participation in meaningful life communication over the course of their disease journey. Here are some recommendations to consider:
 

1. Identify personally meaningful topics of interest:

• Words related to professional expertise, hobbies, or travel experiences
• Names and connections of family and close friends
• Favorite foods and beverages

2. Use Visual Supports:

• Use pictures, drawings, or maps
• Create a visual schedule for daily routines and keep these easily visible
• Try large font written words to label common objects, including personal care items or assistive devices like a walker

3. Simplify Language:

• Use clear and concise language, avoid complex sentences or abstract concepts
• Break down lengthy information into smaller, more manageable chunks to enhance comprehension
• Avoid open-ended questions (“What do you want for dinner?”) in favor of a few choices (“Would you like fish or pasta?”)

4. Include Non-Verbal Communication:

• Use gentle touch or direct eye contact to establish attention to communication
• Encourage and accept the use of gestures, pointing, or other non-verbal expressions to convey thoughts or needs
• Pair questions or directions with gesture or pointing to help with comprehension
• Allow extra time to respond

5. Validate Communication Efforts:

• Try phrases like “I know you’re trying to tell something important.”
• Acknowledge what you can and use yes/no questions to confirm: “I saw you point to the door. Would you like to go outside?”
• Offer empathy when communication breaks down: “I’m sorry this is hard for us. Let’s take a break and try again later.”

Creation of a memory book is one of the most effective interventions to support communication. Featuring personalized content, a memory book can be as simple or as detailed as desired, with options to share information about someone’s childhood, education, career accomplishments, family life, or preferences related to daily activities or meals. Developing a book in the earlier stages of a diagnosis provides opportunity for collaboration with communication partners; an individual living with dementia may identify the most relevant and desired topics of conversation to be included in their book. As the disease progresses, a memory book serves as an opportunity for ongoing stimulation, a means to sooth agitation, or help new care partners to get to know the person featured. Examples of memory books can be found here and here.

Supporting communication in the setting of dementia takes flexibility, creativity, and curiosity. A Speech Language Pathologist is a healthcare professional who specializes in evaluation and treating communication impairments, focusing on an individual’s strengths and personalized needs, with training for all communication partners. Through increased understanding of changing brain functions and development of proactive strategies, we can sustain meaningful connections, dignity, and respect in the face of this challenging condition.

Author

Lauren Schwabish, M.S., CCC-SLP is the owner of Neuro Speech Services, PLLC. Lauren received her Bachelors of Science degree with Honors in Communicative Disorders from the University of Wisconsin-Madison and holds a Masters degree in Communication Sciences from Hunter College of the City University of New York. She is licensed by the Commonwealth of Virginia and the State of Maryland and is certified by the American Speech Language Hearing Association.

For more than 20 years, Lauren has provided speech, language, and cognitive therapy services to people with stroke, acquired brain injury, brain tumors, and other complex neurologic diagnoses. Her therapy approach focuses on brain health optimization, life participation, and creative approaches to enhancing independence. Lauren is a strong client advocate who enjoys collaborating with families and health care professionals to ensure the highest quality of care for the whole person. She is passionate about supporting community stroke awareness and creates accessible, engaging, and empowering health education opportunities for individuals and community groups.

To learn more about Lauren's work you can check out her website or contact her at lauren@neurospeechservices.com

Source: Kim, S. K., & Park, M. (2017). Effectiveness of person-centered care on people with dementia: a systematic review and meta-analysis. Clinical interventions in aging, 12, 381–397. https://doi.org/10.2147/CIA.S117637