A communication model for dementia
SUMMARY The rules for communicating with normal healthy people must be completely readapted when one is working with persons with dementia of the Alzheimer type (DAT). The rules for normal communication demand a fairly equal exchange between two communicating parties; in working with persons with dementia the exchange cannot be equal and a care-giver must make adecision to provide extra energy and input into the communication, if it is to be a meaningful one. Although there is a general pattern of language change in DAT, there are large variations between persons. If health care professionals believe that it is important to communicate with their patients, they must compensate for the barriers to communication as much as possible and choose a method of interacting with them, even when the factual content is not clear, correct or based in reality. There are four main options: correct all conversation that is not factual or based in reality; try to distract the person from the topic at hand onto one that is easier to talk about (including lying); speak to the person about sodal pleasantries; or last, try to find out what the person is talking about, what topics are still meaningful to them and help them to say whatever they still can. This chapter presents three studies about communication with institutionalized elderly persons with dementia. A model for conceptualizing communication processing and response is presented to show how and where barriers to communication can accumulate. Finally, specific guidelines for communicating optimally with persons in different stages of dementia are given.