Communication and Dementia Helen Crouch Speech and Language Therapist Older Adults Mental Health Milford Hospital helen.crouch@surreycommunityhealth.nhs.uk - PowerPoint PPT Presentation

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Communication and Dementia Helen Crouch Speech and Language Therapist Older Adults Mental Health Milford Hospital helen.crouch@surreycommunityhealth.nhs.uk

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Title: Communication and Dementia Helen Crouch Speech and Language Therapist Older Adults Mental Health Milford Hospital helen.crouch@surreycommunityhealth.nhs.uk


1
Communication and Dementia Helen
Crouch Speech and Language Therapist Older Adults
Mental Health Milford Hospital helen.crouch_at_surrey
communityhealth.nhs.uk
2
Communication and Dementia
  • All dementias have some form of communication
    difficulty.Some dementias present with
    communication difficulty as their first feature.

3
Dementias
  • Alzheimers Disease
  • Vascular Dementia
  • Dementia Lewy Body
  • Semantic Dementia
  • Primary Progressive Aphasia
  • Parkinsons
  • Huntingtons
  • Picks
  • MND

4
  • Language in Alzheimers Disease
  • Early word finding difficulties
  • Memory restricts comprehension
  • Progressively fluent empty speech
  • Language reflects underlying confusion

5
Semantic Dementia
  • Fluent empty speech
  • Impaired naming and comprehension
  • Semantic paraphasias
  • Idiosyncratic word usage
  • Loss of word meaning in speech and understanding
  • Well preserved repertoire of speech
  • Intact grammar

6
Progressive Non Fluent Aphasia
  • Non fluent hesitant speech
  • Impaired word retrieval
  • Errors of sounds and words
  • Comprehension relatively preserved

7
Vascular Dementia
  • Pattern of language deficit is determined by area
    of damage
  • Stepwise progression
  • May be improvement of function during the course
    of the disease

8
Impact on Functional Communication
  • Difficulty with
  • Following conversations
  • Following the television
  • Understanding humour or sarcasm
  • Sticking to one train of thought
  • Remembering the names of things
  • Understanding book/newspaper even though still
    able to read aloud
  • Writing

9
  • Insensitivity to other peoples communication
    needs
  • Does not take turns in conversation
  • Does not initiate conversation
  • Says things which arent true or real
  • Speech doesnt convey any meaning
  • Asks the same questions repeatedly
  • Mispronounces words
  • Repeats things already said
  • Slowness at responding

10
Risk to individual
  • Decrease in quality of life and sense of well
    being.
  • Reduced access to and benefit from services.
  • Social exclusion
  • Increased level of dependence at an earlier
    stage.
  • Challenging behaviour not managed effectively.

11
Philosophy of Care
  • All people have something to communicate
  • Behaviour is an attempt to communicate an
    unfulfilled need.
  • Optimising communication skills of person with
    dementia and caregivers is a central theme.

12
Aims of intervention
  • Maximise and maintain communication skills e.g.
    for decision making.
  • Enhance coping skills and self efficacy.
  • Reduce the impact of a communication disorder.
  • Reduce stress on caregivers by providing
    management strategies.

13
How?
  • Assessment
  • Providing advice, training and support.
  • Introducing specific approaches
  • Life story work
  • Talking Mats
  • SENSES framework

14
Strategies to support conversation
  • Observe and listen.
  • Check for hearing aid and glasses.
  • Attract attention first (name).
  • Speak slowly.
  • Short sentence length.
  • Key words.
  • Gesture and pointing (pictures/objects).
  • Repeat/rephrase (dinners ready/food) .

15
  • Use names not pronouns
  • ?Content of speech eg sudden change in topic,
    relying on memory, abstract
  • Avoid questions
  • Offer choices
  • Validate rather than challenge
  • Provide a reason for communication
  • Respond to emotion
  • Use preserved skills (assessment based)
  • Communication aid

16
  • Be calm and still
  • Think about your posture/body language
  • Eye contact
  • Minimise competing noises/conflicting stimuli
  • Provide time

17
Useful references
  • Speech and Language Therapy
  • Provision for People with Dementia
  • www.rcslt.org
  • Information on Semantic Dementia and
  • Primary Progressive Aphasia.
  • http//www.cerebralfunctionunit.co.uk/
  • Talking Mats. Dementia effectiveness.
  • www.talkingmats.com

18
Questions
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