Dementia Communication Techniques: Part 2

1. Dementia Communication Techniques: Part 2 Melanie Bunn, RN, MS melanie.bunn@yahoo.com

2. Objective • Describe how nonverbal communication techniques can be implemented in a variety of clinical practice sites. • Demonstrate how the hand-under-hand technique assists people with dementia who require tactile cueing.

3. Hand-Under-Hand Position • First CONNECT with the PPA • Sit at a right angle on the person’s dominant side about an arm’s length away • Shake hands with the person • Move from the handshake to the butterfly • Shift to hand-under-hand (arm wrestling or “soul” handshake) • Remember: All RIGHT or all LEFT (right side and 2 right hands OR left side and 2 left hands)

4. Using the Position • Keep the connection between the 2 hands • Place the tool (spoon, toothbrush, brush) in the space between your thumb and first finger • Use your last 2 fingers to support the other’s hand • Use your thumb and first 2 fingers to manage the tool, like you usually do • Use your other hand to support the person’s arm

5. Pay Attention for Transition • If you pay attention as you help, you may feel the person start to direct your movements, slowing down, aiming towards particular foods. Respect preferences. • Also at that time, you can try transitioning to a different way of helping. Put the utensil in the person’s palm and close fingers around it (working end of the utensil coming out between the thumb and first finger side of the hand.) Put your hand under the outside of the person’s hand and help with the “scoop” if needed • Next meal, start with h-u-h again, get the person started, transition if the person starts to initiate.

6. Helpful Hints • You can use this position the help the person eat, drink, comb hair, brush teeth, wash, shave, put in/remove dentures, put on lipstick… • As you help, you may begin to feel the person • HELPFUL HINTS • Use cups and tools that you can manage easily • Practice on someone without dementia before you try practicing on someone with dementia. • It will feel strange at first, maybe for both of you, but give it a try and it will work.

7. Basics of Verbal Communication

8. What doesn’t work? • Telling the truth (reality orientation) • Telling lies (therapeutic lying or fiblets) • Answering “yes” or “no” questions with “yes” or “no” • Trying to explain, use logic, reason • Ignoring the person

9. Instead try… • Letting go of needing to be right • Go with the flow • Placing yourself on the other person’s side • Start with agreeing…(you’re right…this isn’t the medication you usually take, it’s really frustrating when they keep changing things) • Will you try…will you help?

10. Empathetic CommunicationMeet them where they are • Start with the feelings • “Looks like”, “sounds like” • “Seems like”, “feels like” • Don’t be afraid to talk about feelings • Get more information • “Tell me about…” • Repeat words and phrases • Move to remembering • Move from talking to doing • “Could you help me?” • “Would you try?” • Related to topic • Familiar and positive