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Understand the role of communication and interactions with individuals who have Dementia by Gaël Romanet.



DEM 308 - Understand the

role of communication and

interactions with individuals

who have Dementia

Unit purpose and aim

This unit provides the underpinning knowledge required to develop therapeutic relationships with individuals with Dementia

based on positive interaction and communication. It does not assess competence.



Task 1 - Understand that individuals with Dementia may communicate in different ways

1.1 Explain how individuals with Dementia may communicate through their behaviour

1.2 Give examples of how carers and others may misinterpret communication

1.3 Explain the importance of effective communication to an individual with Dementia

1.4 Describe how different forms of Dementia may affect the way an individual communicates

Task 2 - Understand the importance of positive interactions with individuals with Dementia

2.1 Give examples of positive interactions with individuals who have Dementia

2.2 Explain how positive interactions with individuals who have Dementia can contribute to their wellbeing

2.3 Explain the importance of involving individuals with Dementia in a range of activities

2.4 Compare a reality orientation approach to interactions with a validation approach

Task 3 - Understand the factors which can affect interactions and communication of individuals with Dementia

3.1 List the physical and mental health needs that may need to be considered when communicating with an

individual with Dementia

3.2 Describe how the sensory impairment of an individual with Dementia may affect their communication skills

3.3 Describe how the environment might affect an individual with Dementia

3.4 Describe how the behaviour of carers or others might affect an individual with Dementia

3.5 Explain how the use of language can hinder positive interactions and communication



Exemplification – DEM 308

Carers may include; Partner; Family; Friends; Neighbours

Others may include; Care worker; Colleagues; Staff; Managers; Social worker; Occupational Therapist; GP; Speech and

Language Therapist; Physiotherapist; Pharmacist; Nurse; Specialist nurse; Psychologist; Admiral Nurses; Psychiatrist;

Independent Mental Capacity Advocate; Community Psychiatric Nurse; Independent Mental Health Advocate; Advocate;

Dementia care advisor; Support groups

Wellbeing may include; Sense of Hope; Sense of Agency; Confidence; Self-esteem; Physical health

Evidenced in wellbeing indicators are the following; Can communicate wants, needs and choices; Makes contact with other

individuals; Shows warmth and affection; Showing pleasure or enjoyment; Alertness, responsiveness; Uses remaining abilities;

Expresses self creatively; Is co-operative or helpful; Responding appropriately to individuals; Expresses appropriate emotions;

Relaxed posture or body language; Sense of humour; Sense of purpose; Signs of self-respect

Reality Orientation is an approach that tries to place the individual in the here and now, reminding them of the day, place, time

and situation they are in

Validation Approach means using non-judgmental acceptance and empathy to show the individual that their expressed feelings

are valid. Focussing on the feelings rather than the content of speech



Assignment task – DEM 308 Answers

Task 1 - Understand that individuals with Dementia may communicate in different ways

What is Dementia?

Within the health and social care setting for individuals living with Dementia, staff often describe Dementia as; the

less of everything You know; the less of the You day after day.

At the first ever G8 Dementia Summit held in London in December 2013, Prime Minister David Cameron spoke about the global

challenge of Dementia, which has been labelled "the 21st century plague". The word plague comes from the Latin plaga,

meaning a stroke. The most common form of Dementia is Alzheimer’s disease, named after Dr Alois Alzheimer, who first

described its symptoms and pathological character in a lecture in 1906. Dr Alois Alzheimer (14 June 1864 – 19 December

1915) was a Bavarian born German psychiatrist and neuropathologist and a colleague of Emil Kraepelin. Dr Alois Alzheimer is

credited with identifying the first published case of "Presenile Dementia", which Emil Kraepelin would later identify as

Alzheimer’s disease. Emil Kraepelin (15 February 1856 – 7 October 1926) was a German psychiatrist. Emil Kraepelin believed

the chief origin of psychiatric disease to be biological and genetic malfunction. His theories dominated psychiatry at the start of

the 20th century. Alzheimer’s disease only come to prominence in recent years, and includes other well-known forms of

neurodegenerative disorders including Vascular Dementia, Mixed Dementia, Dementia with Lewy's Body, Frontotemporal

Dementia, Parkinson’s disease, Multiple Sclerosis, Huntingdon’s disease, HIV-related cognitive impairment and AIDS Dementia

complex, Motor Neurone Disease, as well as a variety of rare and little known conditions such as Fatal Familial Insomnia.

These diseases are strongly age related.

Dementia is a term used to describe the deterioration of brain function that results in loss of memory, reduced language skills,

impaired reasoning and loss of daily living skills. This is the Dementia syndrome; however, as the individuals try to live with

their Dementia they may display behavioural and emotional problems. There are over 100 different types of Dementia. An

individual may have a combination of different causes of Dementia; in particular Alzheimer’s disease and Vascular Dementia.

Each of these diseases tends to affect particular areas of the brain and will cause different changes in an individual’s

behaviour. Individuals living with Dementia have the same rights as others. The Human rights do not stop when Dementia

comes.



1.1 Explain how individuals with Dementia may communicate through their behaviour (3 pages to answer the

question – Page 6 to 8)

What is Communication?

Communication is the act of transferring information from one place to another. The definition of communication is

“the transmitting and receiving of information through a common system of signals and symbols.”

Individuals communicate to express personal needs and preferences; to share ideas and information; to reassure; to express

feeling and/or concerns; to build relationships; to socialise; to ask questions and to share experiences. Also individuals

communicate in order to establish and maintain relationships with others; to give and receive information and instructions; to

understand and be understood; to share opinions; knowledge; to express feelings and emotions; to give encouragement and

show others that they are appreciated and valued.

Within my health and social care setting for individuals living with Dementia, communication is an essential tool for a senior

care assistant position, to ensure the individual’s needs are meet. Good communication practice between the staff and the

individuals ensure the optimal wellbeing for both staff and individuals. Good communication practice ensures any health and

safety issues are recognised and reported with hand over at the beginning of each shift. Staff duty to document in individual's

care plan any health and safety issues, e.g. new bruise on individual's skin, what time the individual fallen asleep and how the

individual sleeps during the night. Individuals living with Dementia lack capacity regarding their choices and decisions over

care. Staff duty to always put the individual first in the centre of the care provided. For example, at meal times, staff must ask to

each individuals what meals and what drinks they would like to have. Promoting active participation will make the individual

more valued and will help the individual to be more concerned about his health conditions. Putting the individual in the centre of

all care provided, will, little by little, establish a process of trust for both individuals and staff. I have seen in my workplace new

individuals admitted with the label self-caring because they were reluctant to be assisted with personal care and personal

hygiene because of inactive participation. Those same individuals turn to staff and request for a bath or shower after some

days. Good communication is a key factor in the formation of healthy relationships with the individuals and staff. Individuals with

Dementia are still human being and seek the need to form relationships with carers and others.



What is the Dynamics of Communication?

Dynamics of Communication is the decomposition of the information that is transferred during a conversation in

which both parties involved transmit information.

7% of meaning is transmitted in spoken words. The everyday words chosen by the sender to transfer verbally the information to

the receiver (see graphic page 8);

38% is transmitted in the tone of the voice, paralinguistic or vocal cues (pitch; linguistic tone; quality of the voice; loudness and

intensity; rate of speech; vocabulary) help to convey the feelings or emotions to the recipient and helps reinforce the meaning

of the information during an interaction;

55% is transmitted in non-verbal (action clues) through the automatic reflexes (posture; facial expressions and eye contact;

physical gestures; mannerisms; body language; actions of any kind including touch; behaviour). These can also convey

powerful messages and emotions and often convey the true meaning of an interaction and the nature of the relationship.

Within my health and social care setting for individuals living with Dementia, part of duty of care is to observe the individual’s

reactions during a communication. The body language is more than the half (55% body language) of personal communication.

That means staff are going to miss a large part of communication if staff don't pay attention to an individual's facial and body

reactions. By observing and understanding the body language of an individual, will help to know how the individual is feeling

within the care setting. Individuals living with Dementia talk less and less because the process of speech is slowly degenerated

due of cells in the brain that are dying. Only 7% of personal communications are spoken words and more than a third of

elements of personal communication (38%) are about the voice and tone. The way an individual's voice and tone are, is very

important. This can help to detect any form of abuses. It is important to observe individuals reactions when communicating to

understand the impact of the interaction; to understand the emotional state of the individual; to check if the information has

been understood; to know how and when to adjust the communication methods (formal: done in accordance with rules and

policies; informal: done in a relaxed and friendly manner; written or verbally) used; to recognise where and when there are

barriers to effective communication. The environmental factors are the intentional or unintentional use of objects (dress;

uniforms; arrangement of furnishings; keys; possessions that others do not have) to influence a situation or interaction in a

positive or negative way and again provide a clue to the nature of the relationship.



I am working as a senior care assistant. Within my health and social care setting, individuals with Dementia may

communicate through their behaviour; because their behaviour are a good indicator of what they are trying to express,

especially if they have difficulties expressing their feeling and needs with words; because the body language of an individual

with Dementia provides information regarding wellbeing (The body language is more than the half of personal communication -

That means staff are going to miss a large part of communication if staff don't pay attention to an individual's facial and body

reactions); because individuals with Dementia want to be heard and validated and the way they behave are a good indicator of

how they are feeling in the now moment e.g. an individual presenting as angry may be feeling frustrated, e.g. individuals

resenting as sad may be experiencing vivid memories of a past event that seems very real and current to them; because the

brain of an individual living with Dementia is no longer able to interpret the world the individual is living in due of the

deterioration of brain function that results in loss of memory, reduced language skills, impaired reasoning and loss of daily living

skills e.g. an individual may be label as aggressive when staff enter to the individual room to offer a cup of tea because the

individual do not understand what is happening in the now moment.

The importance from staff to really understand what is like to live with Dementia day after day. Individuals living with Dementia

may communicating through a positive or negative behaviour; use of gestures; use of inappropriate verbal response; inability to

speak; becoming withdrawn; tactile approach; non-verbal language; sign language. Individuals with Dementia are trying to live

their life with Dementia so they may display behavioural and emotional problems - This is the Dementia syndrome.

The importance from staff to speak clearly and slowly when communicating face to face with an individual living with Dementia;

will ensure the individual is able to understand everything that staff are saying; will provide a calming way of getting staff

message across; will help the individual who have hearing difficulty to understand every word; will help anyone who is foreign to

understand staff in an easy way. Many things can go wrong during communicating between an individual living with Dementia

and staff e.g. background noise, difficulty to hear (especially if the English language is not the individual mother language), bad

work environment, staff problems and competencies. Also, individuals living with Dementia will react differently e.g. kinematics

(Touch), auditory (How it sounds, what will be said matter), visual (Pictures), and olfactory (Smell memories).



1.2 Give examples of how carers and others may misinterpret communication (1 page to answer the question –

Page 9)

Within the health and social care setting for individuals living with Dementia, the following are some examples of

how carers (Partner; Family; Friends; Neighbours) and others (Care worker; Colleagues; Staff; Managers; Social worker;

Occupational Therapist; GP; Speech and Language Therapist; Physiotherapist; Pharmacist; Nurse; Specialist nurse;

Psychologist; Admiral Nurses; Psychiatrist; Independent Mental Capacity Advocate; Community Psychiatric Nurse;

Independent Mental Health Advocate; Advocate; Dementia care advisor; Support groups) may misinterpret communication; e.g.

an individual living with Dementia with poor mobility asks to go to the toilet several times during the day due of living with short

term memory that affect the individual's cognitive impairment - the individual has been assisted going to the toilet but do not

remember it; e.g. carers and others may believe the same individual is trying to attract attention, but the individual is

increasingly trying to interpret a world that no longer makes sense to them because their brain is not able to process the

information correctly due of Dementia; e.g. two individuals living with Dementia are engaging communication - because their

brain are affected by Dementia, they may misinterpret the sense of the communication. This can be very distressing for both,

and may start shouting to each other. An individual living with Dementia is experiencing memory losses and may feel frustrated

and angry, and may start shouting to other individuals, carers and others. Individuals living with Dementia are often rude or

exhibiting sexual behaviours. Carers and others may misinterpret communication because the individuals living with Dementia

is trying to interpret a world that makes no sense to them because the brain functions are not able to process the information

correctly. Carers and others may misinterpret communication from individuals living with Dementia; as being abusive; individual

having a mental illness; individual being affected by drug or alcohol abuse; individual having learning difficulties; missing

underlying needs; being deliberately uncooperative. Importance of staff to have training and knowledge about Dementia will

reduce misinterpretation regarding communication.

Below graphic representation of how Dementia affects the different parts of the brain.



1.3 Explain the importance of effective communication to an individual with Dementia (1 page to answer the

question – Page 10)

Within the health and social care setting for individuals living with Dementia, the importance of effective

communication to an individual with Dementia means staff to treat the individual with Dementia with respect and dignity as a

unique and valuable human being. Did you sleep well? How do you feel? Would you like a cup of tea? This simple and very

important questions help to make feel the individual important, listened and valued. By taking time to listen to an individual

living with Dementia, to communicate with the individual, using simple words, in a calm manner, and allowing time for the

individual to answer, by showing affection as appropriate, matter for an individual living with Dementia. Individuals living with

Dementia need to feel respected and valued for who they are now, as well as for who they were in the past. An individual living

with Dementia lives in a world where things that have just happened are quickly lost due of brain damages. Individuals living

with Dementia may forget where they are now, and where they live. They also may forget what age they have, and where their

loved one is. Carers and others can help to increase the wellbeing of the individuals living with Dementia by answering and

reassuring the individuals, by telling them the facts that they are missing. It may be necessary to repeat the answers several

times, to ensure the individuals living with Dementia understand the sense of the communication through simple words. The

importance to avoid confrontation while communicating with an individual living with Dementia is essential. Staff to never

confront individuals with their mistakes as this could make the problem worse.

Importance of effective communication to an individual living with Dementia; increase engagement for the individuals, carers

and others; boost the individual's self-esteem; enhance the wellbeing of the individual by feeling more valued; reduce the

individual of being isolated, promote social inclusion, reassure the individual by feeling calm. Effective communication is an

enjoyable process for both individuals and staff. Staff will feel more motivated and individuals will feel more listened. Effective

communication promotes active participation and inclusion by reducing the likelihood of discrimination and different forms of

abuse e.g. physical abuse, emotional/psychological abuse, institutional abuse, self-neglect, and neglect by carers and others.

Promote effective communication with an individual living with Dementia; means staff to reduce as far as possible any ambient

noise; means staff to give a short simple answer; means staff to ensure the individual is comfortable; means staff to gain eye

contact with the individual when it is possible; means staff to get the individual’s attention before engaging communication;

means staff to call the individual using the individual's preferred name every time communication is meet with the individual;

means staff to speak clearly and calmly; means staff to avoid speaking aggressively or raising voice as this may distress the

individuals living with Dementia.



1.4 Describe how different forms of Dementia may affect the way an individual communicates (11 pages to answer

the question – Page 11 to 21)

Within the health and social care setting for individuals living with Dementia, different forms of Dementia may affect

the way an individual communicates depends on how the individual’s brain is affected by Dementia. As stated on page 5 - What

is Dementia? - Dementia is a term used to describe the deterioration of brain function that results in loss of memory, reduced

language skills, impaired reasoning and loss of daily living skills. This is the Dementia syndrome; however, as the individuals try

to live with their Dementia they may display behavioural and emotional problems. There are over 100 different types of

Dementia. The most common types are Alzheimer’s disease (see page 12 to 14), Vascular Dementia (see page 15) and

Dementia with Lewy's Body (see page 17 to 18). An individual may have a combination of different causes of Dementia; in

particular Alzheimer’s disease and Vascular Dementia. Each of these diseases tends to affect particular areas of the brain and

will cause different changes in an individual’s behaviour.

Dementia is an umbrella term. It describes the symptoms that occur when the brain is affected by certain diseases or

conditions. There are many different types of Dementia although some are far more common than others. They are often

named according to the condition that has caused the Dementia.

Different forms of Dementia e.g. Alzheimer’s disease (see page 12 to 14); Vascular Dementia (see page 15); Mixed Dementia

(see page 16); Dementia with Lewy's Body (see page 17 to 18); Frontotemporal Dementia (see page 19); Parkinson’s disease

(see page 20); Multiple Sclerosis (see page 20); Huntingdon’s disease (see page 20); HIV-related cognitive impairment and

AIDS Dementia complex (see page 20); Motor Neurone Disease (see page 20); Fatal Familial Insomnia (see page 21).

Different forms of effects e.g. slurred speech; word substitution; loss of language skills; use of inappropriate language; reduced

communication; inability to express oneself; reduced understanding; frustration; repetition.



What is Alzheimer’s disease?

Alzheimer’s disease is the most common cause of Dementia in the elderly (see graphic page 11). During the course

of the disease, the chemistry and structure of the brain changes, leading to the death of brain cells. The signs and symptoms of

Alzheimer’s disease are caused by damage and the death of brain cells. The main features of this type of Dementia are;

Memory Impairment; Loss of Language Skills; Failure to Recognise People; Impaired Movement; Personality Changes; Lack of

Insight; Disrupted Sleep Patterns; Impaired Planning Skills; Hallucinations. These signs and symptoms are progressive and so

they worsen over time.

Alzheimer’s disease affects how individuals think, remember, behave, perceive and communicate. Alzheimer's disease is a

degenerative brain disease that causes chemical and structural changes to the brain which destroys the ability to remember

and to reason. Individuals living with Alzheimer's disease experience memory loss and the increasing inability to understand

language. This means that an individual with Alzheimer's disease may lose empathetic feelings and may not recognise carers

and others from one day to the next. Alzheimer's disease can affect speech and language. An individual living with Alzheimer's

disease may lose words gradually or get the order of their words muddled which makes conversation very difficult.



How Alzheimer’s disease affects the different parts of

the brain?

Alzheimer’s disease affects; the Frontal Lobe of the brain regarding the intelligence, judgement and behaviour of the

individual; the Temporal Lobe of the brain regarding the memory of the individual; the Parietal Lobe of the brain regarding the

language of the individual.



What are the risk factors for Alzheimer’s disease?

Research has revealed that there are certain risk factors which increase the risk of an individual developing the

Alzheimer’s disease. Risk factors are usually classified as genetic or environmental.

Genetic risk factors for Alzheimer’s disease have been found due to research into disease concordance, how often a disease

occurs in twins and family members. Having a family history of Alzheimer’s is an important risk factor for developing the

disease, and so far twin studies show about 40% concordance between identical twins. This means that in twins where one

twin has Alzheimer’s, 40% of the second twins also have the disease.

Environmental risk factors are events that happen in an individual’s life which is not determined by genetics e.g. History of

Head Trauma; Smoking, Diabetes; Reduced Physical or Cognitive Activity; Circulatory Risk Factors; Increasing Age. Sadly,

another risk factor is loneliness, a condition that is all too prevalent in our society, especially amongst the elderly.

Alzheimer’s disease is caused by the build-up of a protein called Beta-Amyloid Peptide in certain areas of the brain, which

forms tangles within brain cells. Beta-Amyloid Peptide is a by-product of a cell membrane protein called Amyloid Precursor

Protein (APP). Enzymatic Reaction is due of a split effect from the Amyloid Precursor Protein (APP), which forms a smaller

beta-amyloid peptide, and as beta-amyloid peptide build up in the brain they cause progressive damage to the brain cells and

ultimately cause them to death, affecting cell signalling and communication, which is affecting the individual's speech.



What is Vascular Dementia?

Vascular Dementia is the second most common type of Dementia in the elderly (see graphic page 11). Vascular

Dementia is caused by reduced blood supply to the brain due to diseased blood vessels. To be healthy and function properly,

brain cells need a constant supply of blood to bring oxygen and nutrients. Blood is delivered to the brain through a network of

vessels called the vascular system. If the vascular system within the brain becomes damaged - so that the blood vessels leak

or become blocked - then blood cannot reach the brain cells and they will eventually die. This death of brain cells can cause

problems with memory, thinking or reasoning. Together these three elements are known as cognition. When these cognitive

problems are bad enough to have a significant impact on daily life, this is known as Vascular Dementia.

How Vascular Dementia affects the different parts of the

brain?

The most common cognitive symptoms in the early stages of Vascular Dementia are; problems with planning or

organising, making decisions or solving problems; difficulties following a series of steps e.g. cooking a meal; slower speed of

thought; problems concentrating, including short periods of sudden confusion. An individual in the early stages of Vascular

Dementia may also have difficulties with; memory e.g. problems recalling recent events; language e.g. speech may become

less fluent; visuospatial skills e.g. problems perceiving objects in three dimensions. The main symptoms of Vascular Dementia

include; abrupt onset; progressive memory loss; progressive deterioration of intellectual abilities, processing speed, cognitive

and motor abilities; slow, unsteady gait; focal neurologic symptoms; individuals unable to understand what is being said, so

they cannot respond and are unable to communicate.

Below graphic representation of how Vascular Dementia affects the different parts of the brain.



What is Mixed Dementia?

Mixed Dementia is the third most common type of Dementia in the elderly (see graphic page 11). Mixed Dementia is

a condition where changes representing more than one type of Dementia occur simultaneously in the brain. In the most

common form, the plaques and tangles associated with brain cells in Alzheimer’s disease (see page 12 to 14) are present

along with blood vessel changes associated with Vascular Dementia (see page 15).

How Mixed Dementia affects the different parts of the

brain?



What is Dementia with Lewy's Body?

Dementia with Lewy's Body is the fourth most common type of Dementia in the elderly (see graphic page 11).

Dementia with Lewy's Body affects the cerebellum part of the brain. This can cause difficulties with balance, co-ordination and

visual recognition. Individuals may have hallucinations which are very real to them. Individuals living with Dementia with Lewy's

Body will eventually not recognise their loved ones.

How Dementia with Lewy's Body affects the different

parts of the brain?

All of us have some fluctuation in our abilities over days, depending on our mood, health and energy. With

individuals living with Dementia, we often find fluctuations in the abilities to do a specific task or remember something.

Fluctuations in cognitive ability are particularly common in Dementia with Lewy's Body. Carers and others interacting with

individuals living with Dementia, it seems strange to see the individual able to remember something on one day, and not be

able to remember it later. It is helpful to know that such fluctuations may be characteristic of Dementia with Lewy's Body. Often,

individuals living with Dementia with Lewy's Body, get disoriented because of problems such as; loss of memories; visuospatial

problems; discomfort with too much stimulus or noise; inability to understand objects around them.

Below graphic representation of how Dementia with Lewy's Body affects the different parts of the brain.



Within the health and social care setting, individuals living with Dementia with Lewy's Body is having multiple problems, such

as; the individual may wander and forget the way back to return to him/her room; the individual may consider himself/herself as

younger and expect a different home, and may not recognize the children and grandchildren, or mistake the daughter for the

wife; the individual may keep insisting he/she wants to go home; the individual may be anxious about not knowing where the

toilet is.

In Dementia with Lewy's Body, recent memories are lost, and individuals often revert to older memories, or unconsciously try to

fill gaps in their memories using their imagination. Individuals living with Dementia with Lewy's Body cannot recognize people or

places, and may not even recognize their home and family. Often, individuals living with Dementia with Lewy's Body are unable

to create new memories, and they may also have problems understanding complex instructions or concepts. This affects their

ability to learn new things, use new devices, and adjust to new places. Individuals living with Dementia with Lewy's Body may

also get stressed when they meet new persons or see new things, and start avoiding such situations. In Dementia with Lewy's

Body, individuals may suffer from hallucinations, delusions and paranoia. Individuals who hallucinate may sometimes realize

they are hallucinating, but at other times, they may be confused or frightened because they believe what they are seeing or

hearing. Hallucinations may make familiar tasks difficult when they cannot distinguish between reality and hallucination. Carers

and others near them may not realize that the individual living with Dementia with Lewy's Body, is hallucinating and then

confused and frightened. Delusions and paranoia also affect how the individuals living with Dementia with Lewy's Body

interacts with others. They may accuse people of stealing their possessions or even of trying to kill them. It is difficult to make

the individual understand what is real and what is delusion, or to calm down a paranoid individual.



What is Frontotemporal Dementia?

Frontotemporal Dementia is the fifth most common type of Dementia in the elderly (see graphic page 11). Difficulties

with language occur in all forms of Dementia but the particular problems experienced by an individual will vary according to the

type of Dementia and level of disability they have. For example, in Frontotemporal Dementia it may be the first symptom that an

individual develops. In many instances, language skills will vary from day to day and time to time. Make the most of good days

and learn to cope with the bad ones.

How Frontotemporal Dementia affects the different parts

of the brain?

Frontotemporal Dementia is an umbrella term for a diverse group of uncommon disorders that primarily affect the

frontal and temporal lobes of the brain, the areas generally associated with personality, behaviour and language. In

Frontotemporal Dementia, portions of the frontal and temporal lobes are atrophy, or shrink. Signs and symptoms vary,

depending upon the portion of the brain affected. Some individuals living with Frontotemporal Dementia undergo dramatic

changes in their personality and become socially inappropriate, impulsive or emotionally blunted, while others lose the ability to

use and understand language. Different effects due to different forms of Dementia that may affect the way an individual

communicates are the following; slurred speech; word substitution; loss of language skills; use of inappropriate language;

reduced communication; inability to express own needs; reduced understanding; frustration; repetition.

Below graphic representation of how Frontotemporal Dementia affects the different parts of the brain.



What is Parkinson’s disease?

Parkinson’s disease is a progressive disease of the nervous system marked by tremor, muscular rigidity, and slow,

imprecise movement, chiefly affecting middle-aged and elderly people. It is associated with degeneration of the basal ganglia of

the brain and a deficiency of the neurotransmitter dopamine.

What is Multiple Sclerosis?

Multiple Sclerosis is a chronic, typically progressive disease involving damage to the sheaths of nerve cells in the

brain and spinal cord, whose symptoms may include numbness, impairment of speech and of muscular coordination, blurred

vision, and severe fatigue.

What is Huntingdon’s disease?

Huntingdon’s disease is a hereditary disease marked by degeneration of the brain cells and causing chorea and

progressive Dementia.

What is HIV-related cognitive impairment and AIDS

Dementia complex?

The Human Immunodeficiency Virus (HIV) attacks the body's immune system, making the individual affected more

susceptible to infection. Individuals living with HIV sometimes develop cognitive impairment, particularly in the later stages of

their illness. Acquired Immune Deficiency Syndrome (AIDS) Dementia complex is typically seen in the late stages of HIV/AIDS.

The symptoms vary widely from individual to individual and can include; Poor concentration; Mental slowness; Difficulty

learning new things; Changes in behaviour; Forgetfulness/Memory loss; Confusion; Difficulty finding words; Withdrawal from

hobbies or social activities; Depression. Symptoms of worsening Dementia can include; Speech problems; Balance problems;

Muscle weakness; Vision problems; Loss of bladder/bowel control.

What is Motor Neurone Disease?

Motor Neurone Disease is a progressive disease involving degeneration of the motor neurons and wasting of the

muscles.



What is Fatal Familial Insomnia?

Fatal Familial Insomnia (FFI) is an extremely rare autosomal dominant inherited prion disease of the brain. It is

almost always caused by a mutation to the protein PrPC, but can also develop spontaneously in patients with a non-inherited

mutation variant called Sporadic Fatal Insomnia (SFI). Fatal Familial Insomnia has no known cure and involves progressively

worsening insomnia, which leads to hallucinations, delirium, and confusion states like that of Dementia. The average survival

span for patients diagnosed with Fatal Familial Insomnia after the onset of symptoms is 18 months. The mutated protein, called

PrPC, has been found in just 40 families worldwide, affecting about 100 individuals; if only one parent has the gene, the

offspring have a 50% risk of inheriting it and developing the disease. With onset usually around middle age, it is essential that a

potential patient is tested if they wish to avoid passing Fatal Familial Insomnia on to their children. The first recorded case was

an Italian man, who died in Venice in the year 1765.

Below (Canyon House Retreat by Mary-H), page 22 (Elephants by Mathilda-M), and cover (Green Eyes by Howard-S), are

painting created by individuals who have Dementia - Memories in the Making is an Alzheimer’s Association art therapy program

for individuals living with Alzheimer’s disease and related Dementia. Volunteer facilitators help individuals with Dementia –

many of whom often have no art background – to create drawings and paintings. These sessions provide for individuals living

with Alzheimer’s disease and related Dementia, social interaction, inclusion, and boost their self-esteem while opening the

channels of communication with loved ones.



Task 2 - Understand the importance of positive interactions with individuals with Dementia

What are Positive Interactions?

Within the health and social care setting for individuals living with Dementia requiring care or support, positive

interactions are ways of working; that ensure staff promote the eight Person Centred Values (individuality, rights, choice,

privacy, independence, dignity, respect, and partnership) through daily needs; that ensure staff meet the individuals Rights

(individuals have a right to be treated as an individual; to be treated equally and not be discriminated against; to be respected;

to have privacy; to be treated in a dignified way; to be protected from danger and harm; to be supported and cared for in a way

that meets their needs, takes account of their choices and also protects them; to communicate using their preferred methods of

communication and language; to access information about themselves); that ensure staff establish consent according to an

individual’s mental capacity, regarding informed agreement to an action or decision that involve the individual; that recognise

the individual as an active partner through Active Participation - a way of working that recognises an individual’s right to

participate in the activities and relationships of everyday life as independently as possible (the individual is regarded as an

active partner in their own care or support, rather than a passive recipient); that ensure staff take into account the individual's

wellbeing (spiritual, emotional, cultural, religious, social, and political), the individual's heritage (culture, history and personal

experiences), and the environment factors that contribute to the wellbeing of individuals (physical, people, and environmental)

through daily needs; that include the individual in the centre of the care planning process through Person Centred Approaches -

this will promote active participation by enhancing the individual's wellbeing by feeling valued as part of the care team; that

ensure staff promote active support - A proven model of care that enables and empowers individuals with intellectual disabilities

to participate fully in all aspects of their lives regarding choice and preferences of food, clothing, beliefs, lifestyle, and preferred

means of communication, wishes as well as need and support; that help carers and others to find out the individual’s history,

preferences, wishes and needs; that help carers and others to understand the links between identity, self-image and self-

esteem, and to support an individual in a way that promotes their sense of identity, self-image and self-esteem; that help carers

and others to meet the importance of recognition (equality, diversity and inclusion - model of diversity); that help carers and

others to understand the legal and organisational requirements around equality, diversity, discrimination, and rights; that ensure

staff promote effective communication using the preferred name for the individual during an one-on-one activity - individuals

living with Dementia requiring care or support need to be stimulated through daily activities such are drawings and paintings

(see page 21 - Memories in the Making - Alzheimer’s Association).



2.1 Give examples of positive interactions with individuals who have Dementia (1 page to answer the question –

Page 23)

Within the health and social care setting for individuals living with Dementia, examples of positive interactions with

individuals who have Dementia are the following; perceiving and integrating information; recalling enjoyable experiences e.g.

family outing; celebrating important memories or events; appreciating underlying emotions and feelings; reminiscence therapy;

use of gestures; using sign language; through memory books; pictorial approach.

I am working as a senior care assistant. Within my health and social care setting, examples of positive interactions with

individuals who have Dementia are met as follow; Mr. K.M. likes to go to The Salvation Army on Thursdays and Sundays. I

ensure a cab is booked on Thursdays and Sundays for him to attend The Salvation Army where he feels involved as this is

important for his wellbeing; Ms. E.M. likes to go to Zumba dance on Sundays. I ensure one activity staff is available for her to

attend the Zumba dance on Sundays as this is important for her wellbeing; Mr. F.D. likes to go to the Day Centre on Mondays,

Wednesdays, and Fridays. I ensure a Day Centre cab is booked on Mondays, Wednesdays, and Fridays as this is important for

his wellbeing for him to attend the Day Centre where he meets stimulation group games regarding cognitive impairments that

help to maintain good socialisations; Ms. I.R. likes to have lunch with her husband that is coming from outside with homemade

food, three times a week. This is important for her wellbeing to have lunch with her husband three times a week in her room as

she is living with Dementia and Schizophrenia. She meets communication regarding cognitive impairments that help to

maintain good socialisations by recalling enjoyable experiences with her husband. My duty of care is to ensure positive

interactions with individuals who have Dementia are met within my health and social care setting, as this is part of wellbeing.

Staff duty to document in Mr. K.M., Ms. E.M., Mr. F.D., and Ms. I.R. my day my life care plans - regarding daily notes; lifestyle;

activity and interaction recording log - are documented properly and accurately using the correct care setting jargon. My day my

life care plan is the document where day to day requirements and preferences for care and support are detailed. Staff duty to

ensure their N.O.K (Next Of Kin) and social workers are informed of those positive interactions activities.

Positive interactions mean staff; to be in a positive mood; to communicate using the correct tone of voice; to understand how

important the body language is when communicating with individuals living with Dementia; to communicate using the preferred

name of the individual; to establish eyes contact when communicating with an individual living with Dementia; to not correct an

individual that is using a wrong word; to ensure individuals are feeling valued, supported and respected; to promote active

listening when communicating with the individual will demonstrate respect e.g. saying - good morning, how are you, I

understand, would you like to drink a cup of tea, do you want to go outside, I wish you a good night, see you on tomorrow

Monday - this will help the individual living with Dementia that is disorientated by the time, place, and person; to understand that

individuals living with Dementia have needs and emotions as everybody else; to be empathetic and see things from the

individual’s point of view; to promote group activities that ensure inclusion for individuals as well as one on one interaction with

the individual; to not label the individual as recalcitrant or aggressive because of refusing group activities or one on one

interaction; to be aware of personal likes, dislikes and cultural preferences of the individual; to understand positive interactions

will help the individual to maintain good self-esteem and independence; to understand the individual with Dementia is unique

and must be treated as unique regarding personal needs, preferences and choices; to understand positive interactions will help

the individuals to maintain good mobility and independence by feeling involved in daily needs; to understand carers and others

should be involve regarding positive interactions with individuals who have Dementia e.g. Ms. I.R. likes to have lunch with her

husband that is coming from outside with homemade food, three times a week; to understand the holistic needs and wellbeing

are linked; to understand positive interactions are linked with person centred approaches; to understand positive interactions

are the opposite of treating individuals in an institutional way; to celebrate diversity through positive interactions.



2.2 Explain how positive interactions with individuals who have Dementia can contribute to their wellbeing (3

pages to answer the question – Page 24 to 26)

What are the factors that contribute to the wellbeing of

an individual?

Factors that contribute to the wellbeing of an individual are the following; emotional; relational; physical; financial;

intellectual; environmental; vocational; career; spiritual.

Other factors that contribute to the wellbeing of an individual living within the health and social care setting may include aspects

that are; cultural e.g. staff to respect and to promote the individual's likes and dislikes, choices and preferences; religious e.g.

individuals going to the Church, means relationships with other individuals sharing the same religion, belief, faith; social e.g.

staff to promote inclusion through group activities with other individuals; political e.g. individuals voting for elections; emotional

e.g. individuals having close bonds with own family and friends, sharing good memories, looking at photographs. Others values

that underpin within my work setting and contribute to the wellbeing of individuals through the rights; to be treated as an

individual; to be treated equally and not be discriminated against; to be respected; to have privacy; to be treated in a dignified

way; to be protected from danger and harm; to be supported and cared for in a way that meets their needs, takes account of

their choices and also protects them; to communicate using their preferred methods of communication and language; to access

information about themselves.



Positive interactions with individuals who have Dementia can contribute to their wellbeing by; giving a sense of

hope; giving a sense of control; giving improved confidence; improving self-esteem; improved physical, intellectual, emotional

and social health; enabling social inclusion; enabling engagement; increasing self-respect.

Evidenced in wellbeing indicators with individuals who have Dementia are the following; Can communicate wants, needs and

choices; Makes contact with other individuals; Shows warmth and affection; Showing pleasure or enjoyment; Alertness,

responsiveness; Uses remaining abilities; Expresses self creatively; Is co-operative or helpful; Responding appropriately to

individuals; Expresses appropriate emotions; Relaxed posture or body language; Sense of humour; Sense of purpose; Signs of

self-respect.

Evidenced in wellbeing indicators and positive interactions are directly linked within the health and social care setting for

individuals who have Dementia. By; treating the individuals living with dementia as an adult; focusing on abilities; by respecting

the privacy of the individuals; by offering choice; by expressing feelings and make feel valued the individuals living with

dementia - help to provide positive interactions that ensure the wellbeing of individuals who have Dementia. Individuals who

have Dementia are human being - right to be respected, right to privacy, and right to have choice doesn't stop with Dementia.

The following is to be followed when working within the health and social care setting for individuals living with

Dementia:

An individual living with Dementia is still an adult:

It is important that carers and others treat the individual living with Dementia as an adult and with courtesy, however advanced

their Dementia. Be kind and reassuring without talking down to the individual living with Dementia as though they are a small

child. Never talk over the head of an individual living with Dementia or across them as though they are not there. Do not talk

about the individuals living with Dementia in front of them unless they are included in the conversation. Avoid scolding or

criticising the individuals living with Dementia as this will make them feel small. Look for the meaning behind what individuals

living with Dementia may be trying to communicate even if it seems not to make sense.

Focus on abilities:

Help the individuals living with Dementia to avoid situations in which they are bound to fail since this can be humiliating. Look

for tasks they can still manage and activities they can still enjoy. Give them plenty of praise and encouragement and let them

do things at their own pace and in their own way. Do things with the individuals living with Dementia, rather than for them, so

they can maintain some independence. Break activities down into small steps so that the individuals living with Dementia has

some feeling of achievement, even if they can only manage part of a task. Much of our self-respect is often bound up in the way

we look. Encourage the individuals living with Dementia to take pride in their appearance and give them plenty of praise.

Respecting privacy:

Try to make sure that the individual’s right to privacy is respected. Carers and others may knock on their bedroom door before

entering, for example. When the individual living with Dementia needs help with intimate activities such as washing or going to

the toilet, this should be done in a sensitive way. Make sure that the bathroom door is kept closed if other individuals are

around.



Offering choice:

It is important that the individuals living with Dementia should be informed and wherever possible consulted about matters

which concern them. They should also be given every opportunity to make appropriate choices. Even if you are unsure how

much the individuals living with Dementia can understand, always explain what you are doing and why. You may then be able

to judge their reaction from their expression or body language. Although too many choices can be confusing, you can continue

to offer choice by phrasing questions that only need a yes or no answer.

Expressing feelings:

Dementia affects the thinking and reasoning part of the brain and memory. It does not mean that the individual no longer has

feelings. Individuals living with Dementia are likely to be sad or upset at times. Individuals living with Dementia have the right to

expect from carers and others, understanding how individuals are feeling and to make time to offer support rather than ignoring

them or jollying them along. In the earlier stages, individuals living with Dementia may want to talk about their anxieties and the

problems they are experiencing. It is important that carers and others do not brush these worries aside, however painful they

may be, but listen and show that, carers and others are there for them and will be there for them.

Feeling valued:

Individuals living with Dementia needs to feel respected and valued for who they are now, as well as for who they were in the

past. It helps when carers and others are flexible and tolerant, and can make time to listen and to chat and enjoy being with the

individuals living with Dementia.



2.3 Explain the importance of involving individuals with Dementia in a range of activities (1 page to answer the


Within the health and social care setting, the importance of involving individuals living with Dementia in a range of

activities means; benefits to help to slow the decline of Dementia in the early stages, via cognitive stimulation that help to keep

the processes of the brain functioning; reducing challenging behaviour of individuals living with Dementia that are feeling bored

and frustrated, due of lack of activities; taking part in activities that provide a welcome distraction from the stresses of the illness

and helps to enables an individual to make choices, and focus the individual on the positive aspects of life; embracing

empowerment; increasing an individual’s ability to make decisions; enables an individual to take control over their lives;

reduces risks; helps an individual to solve problems; enables an individual to make choices; helps an individual to be socially

engaged; staff to promote stimulation through active participation when providing personal care; staff to promote stimulation

through person centred approach when updating individual's care plan folder e.g. my day my life care plan. Activities can be as

simple as holding a conversation, exchanging ideas, reading out loud for the individual, listening to the music, singing, playing

card games, art and craft, scrapbook, practicing exercise, going for a walk and discussing what is seen, painting, making

collage, doing gardening, being involved in daily living tasks.

Below is an example of an activity board for individuals with Dementia.

Morning Afternoon Evening

Monday

Tuesday

Wednesday

Thursday

Friday

Saturday

Sunday



2.4 Compare a reality orientation approach to interactions with a validation approach (7 pages to answer the

question – Page 28 to 34)

What is a Reality Orientation Approach?

Reality Orientation Approach is; a way of working that tries to place the individual living with Dementia in the here

and now, reminding the individual of the day, place, time and situation the individual is in; a way of working where the

environment, including date, location, time, current surroundings, and situation the individual is in, is frequently pointed out and

woven into the conversations with the individual living with Dementia.

Strategies for Reality Orientation Approach are the following; Staff to communicate with the individual living with Dementia

about the time of day, the date, and the season; Staff to communicate with the individual living with Dementia using the

individual's name frequently; Staff to communicate with the individual living with Dementia about current events; Staff to

communicate with the individual living with Dementia by referring to clocks, calendars and newspapers; Staff to communicate

with the individual living with Dementia showing signs and labels on doors and cupboards; Staff to communicate with the

individual living with Dementia by asking questions about photographs or other decorations that belong to the individual living

with Dementia.

Reality Orientation Approach involves the individual living with Dementia with; the here and now; the day; the place; the time

and situation; the environment; the date; the location; the time; the current surroundings; the season; staff using the individual's

name frequently; current events; clocks, calendars and newspapers; signs and labels on doors and cupboards; questions about

photographs or other decorations.

Reality Orientation Approach; provides stimulations regarding cognitive impairment for an individual living with Dementia; is not

suitable for individuals living with Dementia who are fixed on believing they are in a certain place or situation and are settled in

that belief - using Reality Orientation Approach in this situation could cause distress for the individuals living with Dementia - in

this situation staff to promote Validation Approach; helps staff to work in a better and calmer environment by improving

cognitive functioning, mood and behaviour, when accompanied by medication e.g. donepezil, for individuals living with

Dementia; delay nursing home placement by slowing cognitive decline for individuals living with Dementia.



Graphic of Reality Orientation Approach



What is a Validation Approach?

Validation Approach is; a way of working that uses non-judgmental acceptance and empathy to show the individual

living with Dementia that the expressed feelings are valid; a way of working that focuses on the feelings rather than the content

of speech; a method of interacting with individuals living with Alzheimer’s disease in the late stages - individuals living with

Alzheimer’s disease in the late stages, frequently exhibit abnormal, sometimes even incomprehensible, behaviour e.g. they

may think they are living in a different time or place or they may continuously repeat a physical gesture - individuals living with

Alzheimer’s disease in the late stages show unconventional behaviour, while illogical, is an attempt to communicate and

express their needs; built on an empathetic attitude and a holistic view of individuals living with Alzheimer’s disease in the late

stages.

Strategies for Validation Approach are the following; Staff to understand and empathize with the needs the individual living with

Alzheimer’s disease in the late stages is trying to express; Staff to understand the theory behind Validation Approach is the

belief that individuals living with Alzheimer’s disease in the late stages do and say things for a reason; Staff to communicate in

a way that is validating the words and actions of the individuals living with Alzheimer’s disease in the late stages to encourage

them to keep communication open with the rest of the world; Staff to understand a foundational principle of Validation Approach

that states, that elderly individuals are to be valued as is, and those living with Alzheimer’s disease in the late stages should not

be changed.

Validation Approach involves the individual living with Alzheimer’s disease in the late stages; to communicate with staff by

helping disoriented feeling; to feel less stress by enhancing dignity and increasing happiness; to resolve unfinished issues in

order to die in peace; to have the opportunity to express wishes through verbally or non-verbally manners; to verbalize their

frustrations, worries and fears, so the negative emotions can diminish.

Validation Approach; helps staff to have a better understanding by stepping into the shoes of the individuals living with

Alzheimer’s disease in the late stages, and seeing the world through their eyes, carers and others can step into their world and

better understand the meaning of their sometimes bizarre behaviour; prevents individuals living with Alzheimer’s disease in the

late stages from shutting down further mentally; keeps the cognitive functions active as much as possible for the individuals

living with Alzheimer’s disease in the late stages; helps the individuals living with Alzheimer’s disease in the late stages to forge

a trust with their staff as a means to encouraging communication between both; contributes to better cognitive functioning and

behaviour for the individuals living with Alzheimer’s disease in the late stages.



Graphic of Validation Approach



Below is a table that compares a Reality Orientation Approach to interactions with a Validation Approach:

Reality

Orientation

Approach

Validation

Approach

When

appropriate to

use

Is not suitable for individuals living with

Dementia who are fixed on believing

they are in a certain place or situation

and are settled in that belief - using

Reality Orientation Approach in this

situation could cause distress for the

individuals living with Dementia -

Is suitable for individuals living with

Dementia who are fixed on believing

they are in a certain place or situation

and are settled in that belief - in this

situation staff to promote Validation

Approach.

Ease of use

See page 34 - Short case study to show

how Reality Orientation Approach can

be applied

See page 34 - Short case study to show

how Validation Approach can be applied

Timescales

For individuals living with Alzheimer’s

disease in the early stages.

For individuals living with Alzheimer’s

disease in the late stages.

Benefits to the

individual

Provides stimulations regarding

cognitive impairment for an individual

living with Dementia; improving

cognitive functioning, mood and

behaviour, when accompanied by

medication e.g. donepezil, for

individuals living with Dementia; delay

nursing home placement by slowing

cognitive decline for individuals living

with Dementia.

To communicate with staff by helping

disoriented feeling; to feel less stress by

enhancing dignity and increasing

happiness; to resolve unfinished issues

in order to die in peace; to have the

opportunity to express wishes through

verbally or non-verbally manners; to

verbalize their frustrations, worries and

fears, so the negative emotions can

diminish; prevents individuals living with

Alzheimer’s disease in the late stages

from shutting down further mentally;

keeps the cognitive functions active as

much as possible for the individuals

living with Alzheimer’s disease in the

late stages; helps the individuals living

with Alzheimer’s disease in the late

stages to forge a trust with their staff as

a means to encouraging communication

between both; contributes to better

cognitive functioning and behaviour for

the individuals living with Alzheimer’s




Below is a table that compares a Reality Orientation Approach to interactions with a Validation Approach:

Reality

Orientation

Approach

Validation

Approach

Benefits to care

workers

Helps staff to work in a better and

calmer environment.

Helps staff to have a better

understanding by stepping into the

shoes of the individuals living with

Alzheimer’s disease in the late stages,

and seeing the world through their eyes,

carers and others can step into their

world and better understand the

meaning of their sometimes bizarre

behaviour.

Skills required

Understand the theory behind Reality

Orientation Approach; Effective

communication; Calm and friendly

approaches; Use of gestures and body

languages; Appropriate tone of voice;

Establishing eye contact.

Understand the theory behind Validation

Approach; Showing emotions;

Validating dreams; Being non-

judgmental; Showing feelings; Showing

empathy; Showing compassion;

Showing esteem for elderly.

How the

individual is

engaged

Using the time of day, the date, and the

season, the individual's name

frequently, current events, referring to

clocks, calendars and newspapers,

showing signs and labels on doors and

cupboards, asking questions about

photographs or other decorations that

belong to the individual living with

Dementia.

By a way of communication that is

validating the words and actions of the

individuals living with Alzheimer’s




Short case study to show how Reality Orientation

Approach can be applied

Mr. K.M.: "Doctor, I have to go to the toilet but I don't know where!"

Staff: "Mr. K.M. the toilet is in your room"

Mr. K.M.: "Oh, Doctor I know that. That’s why I have to go to the toilet, right now but I don't know where!"

The following response may be more appropriate, because it focuses instead on the need here and now and avoids confusion -

by orienting elderly individuals using simple words and signs on doors.

Mr. K.M.: "Doctor, I have to go to the toilet but I don't know where!"

Staff: "Follow me, I show you where the toilet is"

Mr. K.M.: "Oh, Doctor you are kind. That’s why I am asking you where is the toilet" (The individual now is feeling less worried).

Staff: "You see on the door, the big sign, is the toilet"

Mr. K.M.: "Thank you Doctor. I was worried" (The individual now is fully orientated and feel less stressed).

Express the emotional need of the individual to be orientated and to meet needs. e.g.:

Mr. K.M.: "Doctor, I have to go to the toilet"

Staff: "Follow me. You see on the door, the big sign, is the toilet"

Mr. K.M.: "Thank you Doctor"

Short case study to show how Validation Approach can

be applied

Ms. I.R.: "Doctor, I have to go home now to feed my children"

Staff: "Ms. I.R. you can’t go home. Your children are not there. You are 96 years old. Your children are grown and live far away"

Ms. I.R.: "Oh, Doctor I know all that. That’s why I have to get out of here, right now. I have to feed them. They’re coming home

for lunch, and the door is locked. Get me out of here!"

The following response may be more appropriate, because it focuses instead on the objective here and now and avoids asking

why - a concept that disoriented elderly individuals may not wish or be able to deal with.

Ms. I.R.: "Doctor, I have to go home now to feed my children"

Staff: "What will you feed them?"

Ms. I.R.: "Oh, Doctor, I am a good mother" (The individual here confuses present and past time). "They love tuna. Do you think

that’s good for them?"

Staff: "It has a lot of protein. Is that what you fed your children? Do your grandchildren eat tuna?"

Ms. I.R.: "They love it. I brought them all up right!" (The individual now moves between past fantasy and present reality. When

her need to be a good mother is expressed, she can place herself in present time).

Express the emotional need of the individual aloud, thereby affirming the individual’s right to feel and to express feelings. e.g.:

Ms. I.R.: "Doctor, I have to feed my children"

Staff: "You must have been a good mother. You must miss your children"

Ms. I.R.: "You know it. I always cared for them. Whatever they wanted, I gave them. You guessed it. But I get along all right

now without them"



Task 3 - Understand the factors which can affect interactions and communication of individuals with Dementia

What is Person Centred Approach?

Person centred approach is a way of working developed from the work of the psychologist Dr Carl Rogers (1902 –

1987). In health and social care settings, the person centred approach is a way of working that put the individual at the heart of

the care planning process. This will provide a framework for the individual to plan and set a direction of their care planning

process according to the individual's physical and psychological needs, spiritual beliefs, culture, likes and dislikes, family and

friends. The person centred approach method is linked with the active participation method, which is a way of working that

recognises an individual’s right to participate in the activities and relationships of everyday life as independently as possible; the

individual is regarded as an active partner in their own care or support, rather than a passive recipient.

The eight person centred values, also called the 8 Core Care Values, are an agreed set of principles that are believed to be the

foundation of all good care practice and provide care workers with an agreed set of principles and standards by which care

workers benchmark their practice which ensures they conduct themselves in a way that embraces these principles.

The 8 Core Care Values are the following: individuality; rights; choice; privacy; independence; dignity; respect; partnership.

Individuals have a right to be treated as an individual; to be treated equally and not be discriminated against; to be respected;

to have privacy; to be treated in a dignified way; to be protected from danger and harm; to be supported and cared for in a way

that meets their needs, takes account of their choices and also protects them; to communicate using their preferred methods of

communication and language; to access information about themselves.



3.1 List the physical and mental health needs that may need to be considered when communicating with an

individual with Dementia (1 page to answer the question – Page 36)

Within the health and social care setting, physical and mental health needs that may need to be considered when

communicating with an individual with Dementia are the following; inability to recall information; memory loss; requires clear

information; use of large print/images; awareness of hearing impairment; use appropriate communication methods; speak in

short sentences; allow time for response; do not be afraid of silence; to be able to communicate nonverbally; recognise cultural

needs; recognise lack of motor control.

Below is a table that compares the effects of Dementia on communication in the early stages to the effects of

Dementia on communication in the late stages:

Effects of Dementia on

communication in the early

stages

Effects of Dementia on

communication in the late

stages

Repetitive speech. Speech is lost.

Difficulty finding the correct word, particularly the name of

objects, places and people.

Unable to find the words of objects, places and people.

May substitute an incorrect word. Misinterpret visual signals so that an individual's daughter

may be called wife.

Slow to find a word. Great difficulty using verbal language to communication.

Ask the same question several times. Constantly repeat one or more phrase or sound.



3.2 Describe how the sensory impairment of an individual with Dementia may affect their communication skills (1

page to answer the question – Page 37)

Our five senses combine to give us a better view of the world.

Within the health and social care setting, the sensory impairment of an individual with Dementia may affect their

communication skills because Dementia means deterioration of brain function that results in loss of memory, reduced language

skills, impaired reasoning and loss of daily living skills. Senses and communications mean sight, hearing, speech, and complex

communication needs. For an individual with Dementia, the sensory impairment may affect their communication skills because

the world makes less and less sense e.g. individual with Dementia with limited sight and short-term loss memory may find it

difficult to mobilise, e.g. individuals with Dementia with hearing problem may find it difficult to hold a conversation with carers

and others, e.g. individuals with Dementia with speech problem may find it difficult to use the correct words, especially in the

early stages of Dementia (see page 36 - table that compares the effects of Dementia on communication in the early stages to

the effects of Dementia on communication in the late stages). Also staff can find it challenging to persuade an individual with

Dementia to wear hearing aids as this may cause irritation and discomfort for the individual. Carers and others may easily

misinterpret the body language and verbal communication of an individual with Dementia with hands and face tremors.

Dementia clearly impacts on communication - individuals with Dementia; may need image/print enlarged (see page 39); may

misunderstand; may be confused; may be disorientated; may withdraw; may feel isolated; may need specialist equipment e.g.

braille.



3.3 Describe how the environment might affect an individual with Dementia (2 pages to answer the question –

Page 38 to 39)

Within the health and social care setting, the environment might affect an individual with Dementia regarding

interactions and communication due of; Internal environment; Sensory environment; Behavioural environment; Physical

environment; Environmental stressors.

Internal Environment e.g. pain; discomfort; illness; side effects of medications; poorly fitting dentures; hunger; thirst;

feeling too hot; feeling too cold.

Sensory Environment e.g. hearing loss and vision loss are key impairments in the elderly and can aggravate

communication for an individual with Dementia; sensory loss can add to cognitive problems which comprises the ability to make

sense of individual’s surroundings; staff to ensure glasses fit well, are clean and worn at all times; staff to ensure a hearing aid

is working and fitted; individuals with Dementia may forget to wear these aids or have misplaced them in which case the duty of

staff is to find them or replace them.

Behavioural Environment e.g. staff to be aware of body language; staff to be calm while communicating with an

individual with Dementia; staff behaviour means being aware of how the words and actions from staff affect individuals with

Dementia.

Physical Environment e.g. an individual with Dementia finds it more difficult to adjust to their physical environment

due of brain damage that affects memory; appropriate physical environment can help an individual with Dementia to

communicate better and be more independent; signs and labels on doors and cupboards provide clues for an individual with

Dementia.

Environmental stressors e.g. the physical environment of care settings for individuals with Dementia, are often

noisy, and can be very stressful for them.



What is environment?

Environment is composed of; Physical (background noise, resources, layout, and décor); People (carers, health

care professionals, and other residents); Environmental (culture, routines and practice). Environment may lead to the following

problems; lack of space could cause challenging behaviour; lack of attachment could cause withdrawal; loss of identity could

cause a feeling of exclusion; change of familiar environment may cause confusion. A good environment might not affect

interactions and communication of individuals with Dementia, include; Image/print enlarged (see below); Old photographs;

Memory boxes; Familiar objects; Video messages.



3.4 Describe how the behaviour of carers or others might affect an individual with Dementia (half page to answer

the question – Page 40)

Within the health and social care setting, the behaviour of carers (Partner; Family; Friends; Neighbours) or others

(Care worker; Colleagues; Staff; Managers; Social worker; Occupational Therapist; GP; Speech and Language Therapist;

Physiotherapist; Pharmacist; Nurse; Specialist nurse; Psychologist; Admiral Nurses; Psychiatrist; Independent Mental Capacity

Advocate; Community Psychiatric Nurse; Independent Mental Health Advocate; Advocate; Dementia care advisor; Support

groups) might affect an individual with Dementia, due of; ignoring the individual e.g. staff deliberately ignore an individual with

Dementia that asks to go to the toilet, the individual will start shouting, this is about privacy, which is one of the 8 Core Care

Values as stated on page 35; responding too quickly e.g. staff responding too quickly to an individual with Dementia that is not

able to process correctly the information due of cognitive impairments, the individual will start being agitated and aggressive

because the individual will still be waiting an answer with a feeling of frustration, this is about rights, which is one of the 8 Core

Care Values as stated on page 35; lack of empathy e.g. staff that show lack of empathy to individuals with Dementia should not

work in a care settings, lack of empathy and lack of caring attitude will lead to poor personal care, poor personal hygiene, and

poor personal needs for the individuals, this is about dignity and choice, which are part of the 8 Core Care Values as stated on

page 35; socially excluding the individual e.g. individual that is socially excluded will feel discriminated and this will lead to

challenging behaviour regarding personal care, personal hygiene and personal needs, this is about individuality and

independence, which are part of the 8 Core Care Values as stated on page 35; using abusive language e.g. staff that use

abusive language to individuals with Dementia should not work in a care settings, using abusive language will lead the

individuals to respond in an inappropriate ways, and will lead to challenging behaviour, this is about respect, which is one of the

8 Core Care Values as stated on page 35; making assumptions on behalf of the individual e.g. staff that is making assumptions

on behalf of the individual will broke the sense of trust, and will lead to uncooperative behaviour regarding personal care,

personal hygiene and personal needs, this is about partnership, which is one of the 8 Core Care Values as stated on page 35.

3.5 Explain how the use of language can hinder positive interactions and communication (half page to answer the


Within the health and social care setting, the use of language can hinder positive interactions and communication,

due of; staff speaking too fast to an individual with Dementia that is not able to process correctly the information due of

cognitive impairments, the individual will start being agitated and aggressive with a feeling of frustration; staff using

inappropriate tone of voice when communicating with an individual with Dementia should not work in a care settings, using

inappropriate tone of voice is a trigger to challenging behaviour as the individual will respond in an inappropriate ways by

feeling aggressed; staff using technical terminology inappropriately when communicating with an individual with Dementia will

affect the individual with a feeling of confusion and will lead the individual to frustration; staff not communicating in the

individual’s preferred language will affect the individual with Dementia by a feeling of confusion and will lead the individual to

frustration; staff that is patronising an individual with Dementia, will only serve to intensify inappropriate behaviour because

patronising an individual with Dementia is a trigger to challenging behaviour; staff that is verbally abusing an individual with

Dementia should not work in a care settings, verbal abuses will lead an individual with Dementia to respond in an inappropriate

ways, and will lead to challenging behaviour regarding personal care, personal hygiene and personal needs.

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