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Communication and Validation Strategies for
Residents with Dementia
Presented by HomeCare Rehab and Nursing LLC
CommunicationOverview of Abilities
– Common problem is an increase in verbal conflicts as ability to communicate decreases; word finding problems and losing the thread of a story.
– Decrease in ability to censor self leads to more blunt, direct, and socially inappropriate comments.
– Argue to protect pride, act defensive and less cooperative; refuse often.
– Reading to follow directions is not reliable.
Copyright © 2003
CommunicationStrategies
– Get inside visual field (2-4 feet in front).– Keep verbal directions clear and simple; avoid
“conservational speech” while guiding patient through a task.
– Allow time to respond before asking question again- ask again exactly the same way.
– Limit choices and open ended questions: Don’t ask: “What do you want for breakfast?”Ask: “Would you like cereal or pancakes?”
Copyright © 2003
Communication
Strategies– DO NOT EVER ARGUE!– Memory books may be effective with training if
the resident values it.– Can learn schedule of activities if caregivers
consistently remind them to use it.– Communication board may be effective to
make choices- no more than 2 to 4 options.– Don’t hang a sign to improve safety or
orientation.
Copyright © 2003
Communication
Overview of Abilities – Can name familiar items, can state own
name, can say “you and I” appropriately.– Can speak in short phrases.– Talks to self frequently.– Repeats self, asks questions over and over.– Phrases may have meaning only to the
patient.
Copyright © 2003
Communication
Strategies• Get in visual field before speaking or touching
(14 inches in front).• Avoid asking questions that require more than
yes or no.• Show a positive response to all communication
attempts.• Stop what you are doing and make eye contact.• Lower the pitch of your voice.
Copyright © 2003
Communication
Strategies• Use distraction to answer repetitive questions
once you have determined there are no other needs. Reassure often.
• Responds best to demonstrated commands.• Assume that the person understands everything
you are saying- don’t talk about them, talk to them.
• Scolding or lecturing is highly inappropriate and ineffective.
Copyright © 2003
Communication
Overview of Abilities• May speak incoherently but sing a full song
without errors.• Uses one or two random words to communicate.• Able to say “no”.• May be able to identify body parts when
touched.• Uses gestures to communicate until very late
stages (claps, points, waves).
Copyright © 2003
Communication
Strategies
• Keep cues limited to 2 or 3.
• Get in visual field (less than 12 inches directly in front of patient).
• Use all senses to engage patient’s attention.
• Lower your voice.
Copyright © 2003
Validation
What is validation?
1. Letting the patient know that you accept and respect their feelings.
2. Standing in their shoes- empathy.
3. Making them feel important and intelligent.
Copyright © 2003
ValidationHow do we validate a patient?
1. Match the intensity of their emotions with your response.
2. Do not lie or belittle, let them know you hear them.
3. Do not try to orient a confused or frustrated patient.
4. Take opportunity to redirect them if they offer- don’t come up with an unrelated distraction.Yes: “It sounds like your father was very caring.”
No: “Your father is dead. Did you see the weather outside?”
Copyright © 2003
Communication
Absolute No No’s
1. No parenting, disciplining, scolding.
2. No baby talk.
3. No arguing.
4. No negative body language (disgust, frustration, boredom, impatience).
5. No talking about patients in front of patients.
Copyright © 2003
Communication and Validation Strategies for
Residents with Dementia
Presented by Sue Paul, OTR/L
CommunicationOverview of Abilities
– Common problem is an increase in verbal conflicts as ability to communicate decreases; word finding problems and losing the thread of a story.
– Decrease in ability to censor self leads to more blunt, direct, and socially inappropriate comments.
– Argue to protect pride, act defensive and less cooperative; refuse often.
– Reading to follow directions is not reliable.
Copyright © 2003
CommunicationStrategies
– Get inside visual field (2-4 feet in front).– Keep verbal directions clear and simple; avoid
“conservational speech” while guiding patient through a task.
– Allow time to respond before asking question again- ask again exactly the same way.
– Limit choices and open ended questions: Don’t ask: “What do you want for breakfast?”Ask: “Would you like cereal or pancakes?”
Copyright © 2003
Communication
Strategies– DO NOT EVER ARGUE!– Memory books may be effective with training if
the resident values it.– Can learn schedule of activities if caregivers
consistently remind them to use it.– Communication board may be effective to
make choices- no more than 2 to 4 options.– Don’t hang a sign to improve safety or
orientation.
Copyright © 2003
Communication
Overview of Abilities – Can name familiar items, can state own
name, can say “you and I” appropriately.– Can speak in short phrases.– Talks to self frequently.– Repeats self, asks questions over and over.– Phrases may have meaning only to the
patient.
Copyright © 2003
Communication
Strategies• Get in visual field before speaking or touching
(14 inches in front).• Avoid asking questions that require more than
yes or no.• Show a positive response to all communication
attempts.• Stop what you are doing and make eye contact.• Lower the pitch of your voice.
Copyright © 2003
Communication
Strategies• Use distraction to answer repetitive questions
once you have determined there are no other needs. Reassure often.
• Responds best to demonstrated commands.• Assume that the person understands everything
you are saying- don’t talk about them, talk to them.
• Scolding or lecturing is highly inappropriate and ineffective.
Copyright © 2003
Communication
Overview of Abilities• May speak incoherently but sing a full song
without errors.• Uses one or two random words to communicate.• Able to say “no”.• May be able to identify body parts when
touched.• Uses gestures to communicate until very late
stages (claps, points, waves).
Copyright © 2003
Communication
Strategies
• Keep cues limited to 2 or 3.
• Get in visual field (less than 12 inches directly in front of patient).
• Use all senses to engage patient’s attention.
• Lower your voice.
Copyright © 2003
Validation
What is validation?
1. Letting the patient know that you accept and respect their feelings.
2. Standing in their shoes- empathy.
3. Making them feel important and intelligent.
Copyright © 2003
ValidationHow do we validate a patient?
1. Match the intensity of their emotions with your response.
2. Do not lie or belittle, let them know you hear them.
3. Do not try to orient a confused or frustrated patient.
4. Take opportunity to redirect them if they offer- don’t come up with an unrelated distraction.Yes: “It sounds like your father was very caring.”
No: “Your father is dead. Did you see the weather outside?”
Copyright © 2003
CommunicationOverview of Abilities
– Common problem is an increase in verbal conflicts as ability to communicate decreases; word finding problems and losing the thread of a story.
– Decrease in ability to censor self leads to more blunt, direct, and socially inappropriate comments.
– Argue to protect pride, act defensive and less cooperative; refuse often.
– Reading to follow directions is not reliable.
Copyright © 2003
CommunicationStrategies
– Get inside visual field (2-4 feet in front).– Keep verbal directions clear and simple; avoid
“conservational speech” while guiding patient through a task.
– Allow time to respond before asking question again- ask again exactly the same way.
– Limit choices and open ended questions: Don’t ask: “What do you want for breakfast?”Ask: “Would you like cereal or pancakes?”
Copyright © 2003
Communication
Strategies– DO NOT EVER ARGUE!– Memory books may be effective with training if
the resident values it.– Can learn schedule of activities if caregivers
consistently remind them to use it.– Communication board may be effective to
make choices- no more than 2 to 4 options.– Don’t hang a sign to improve safety or
orientation.
Copyright © 2003
Communication
Overview of Abilities – Can name familiar items, can state own
name, can say “you and I” appropriately.– Can speak in short phrases.– Talks to self frequently.– Repeats self, asks questions over and over.– Phrases may have meaning only to the
patient.
Copyright © 2003
Communication
Strategies• Get in visual field before speaking or touching
(14 inches in front).• Avoid asking questions that require more than
yes or no.• Show a positive response to all communication
attempts.• Stop what you are doing and make eye contact.• Lower the pitch of your voice.
Copyright © 2003
Communication
Strategies• Use distraction to answer repetitive questions
once you have determined there are no other needs. Reassure often.
• Responds best to demonstrated commands.• Assume that the person understands everything
you are saying- don’t talk about them, talk to them.
• Scolding or lecturing is highly inappropriate and ineffective.
Copyright © 2003
Communication
Overview of Abilities• May speak incoherently but sing a full song
without errors.• Uses one or two random words to communicate.• Able to say “no”.• May be able to identify body parts when
touched.• Uses gestures to communicate until very late
stages (claps, points, waves).
Copyright © 2003
Communication
Strategies
• Keep cues limited to 2 or 3.
• Get in visual field (less than 12 inches directly in front of patient).
• Use all senses to engage patient’s attention.
• Lower your voice.
Copyright © 2003
Validation
What is validation?
1. Letting the patient know that you accept and respect their feelings.
2. Standing in their shoes- empathy.
3. Making them feel important and intelligent.
Copyright © 2003
ValidationHow do we validate a patient?
1. Match the intensity of their emotions with your response.
2. Do not lie or belittle, let them know you hear them.
3. Do not try to orient a confused or frustrated patient.
4. Take opportunity to redirect them if they offer- don’t come up with an unrelated distraction.Yes: “It sounds like your father was very caring.”
No: “Your father is dead. Did you see the weather outside?”
Copyright © 2003
Communication
Absolute No No’s
1. No parenting, disciplining, scolding.
2. No baby talk.
3. No arguing.
4. No negative body language (disgust, frustration, boredom, impatience).
5. No talking about patients in front of patients.
Copyright © 2003
