Chaplain's Corner

A couple of months back I was feverishly working to catch up on some of the professional development reviews that we are required to do each year at Bethesda Place.  I received my slip from Staff Development informing me of my failure to do quite a number of reviews so I sat down one afternoon and decided, “Today is the day.”  As I worked my way through several of the self-studies I was reminded of some of the things that we so easily forget.  But when I came to the review of a session we call “What I Say and Do Does Make a Difference” I was grateful for the demand that we review these things each year.  As I worked my way through the review I thought, “This material is worth sharing.”

As we deal with persons with dementia, some of the responses that we get confuse us, and some times even make us angry.  The confusion and anger are a result of our ignorance of the other person’s new reality.  A reality they moved into of no fault of their own and one that is inescapable – the reality of life with dementia.  By arming ourselves with knowledge and understanding, we can become so much better at loving these dear folks and so much less apt to slip into frustration with them.

Somewhere along the line in my education I studied communication.  In that study I learned that 10% of what we communicate we communicate with words and 90% of what we communicate we communicate in other ways, all those non-verbal things like a raised eyebrow or the inflection of our voice or the gestures we make with our hands or the way we are standing.  When a person has dementia, that person’s capacity to understand words diminishes sometimes to the point where there is no understanding of words at all.  But the capacity to “read” gestures, expressions, body movement remains intact much longer than one’s capacity to process language.

What does this mean?  It means that when we relate to a person with dementia we need to be less dependent on words and more dependent on our body language.  If we come to visit and we are uptight, even if our uptightness is at someone altogether different, the person with dementia will “read” your tension, will instinctively assume that it is with them, and respond to you defensively or even aggressively.  Now, such a reaction to your tension spoils any visit you might have had and may set the person with dementia off for the rest of the evening.  All because we were not careful with what we communicated.

So when we visit with someone with dementia, and I know such visits can be truly challenging, we need to keep in mind the following things:  First, be calm and slow in your actions and speech.  Your calmness you have will have a calming effect on the person with dementia.  Your ease, your casual approach man times will be responded to with ease and calm. When you approach the person, approach from the front.  Make sure they can see you coming and don’t surprise them.  Dementia makes surprises difficult to deal with and often results in fear or aggression: the only “fight or flight” thing kicks in because dementia has robbed the person of the capacity to process your approach and understand it.

When you come, come with a smile.  Smiles are so important; they communicate joy, welcome, safety all of which will put your relative or friend who has dementia at ease.  When you walk through the doors of the personal care home, or you arrive at the home and prepare to go in if the person is still living in the community, stop yourself and remind yourself to smile.  In fact, why not make that the practice in your life in every encounter.

When you are visiting, come to the level of the person with dementia.  If they are sitting, sit.  If they are standing, stand.  If they are lying in bed, sit beside their bed.  When we stand over someone, in non-verbal terms it communicates power, authority and makes the other feel vulnerable.  A person with dementia feels vulnerable to a degree that most of us would not yet understand.  If we can remember this and position ourselves in a posture of equality with them, it will have a positive impact on the visit.

Don’t forget the importance of touch.  In some ways we have become a touch fearful society.  But we don’t have to be afraid to touch; we just need to touch appropriately and sensitively.  Holding hands when walking, especially if there is some unsteadiness in the step of the person with dementia can be very supportive and that support is felt.  A handshake when meeting and departing is always a good gesture.  It communicates respect.  If the person with dementia is a family member or you have had a close relationship a hug can be a blessing, or an arm around the shoulder.  There is a power in touch that we have forgotten about in our fearfulness.  One study I read has done research on hugging and states that “You need four hugs a day for survival, eight for maintenance, and twelve for growth.”  I dare say many of us are hardly surviving if this is true.  What is a hug?  It is an expression of unconditional acceptance.  It says, “I value you.” And in a culture where self-esteem seems to be a chronic problem for many, maybe what we need is not more mental health workers, but more people who are willing to simply say, “I accept you for who you are” by offering a hug.

Our tone of voice is so important.  You know this from relating to babies and animals.  If you say the meanest thing in a pleasant voice to your family dog, what does the dog do?  It comes over, wags its tail and responds as if you just said, “Good girl!”  Now don’t get me wrong, I am not comparing the person with dementia to an animal, but when verbal communication becomes ineffective, the tone in our voice communicates so much.  So when you are talking with those who have dementia, talk in a tone that is caring and soft and reassuring, stay away from joking that requires the ability to understand subtleties like idioms, and other figures of speech and that requires the ability to understand irony, which is many times reflected in our tone playing off the words we use.  Straight, uncomplicated, pleasantly intonated communication will be quite helpful for the person with dementia.

When you speak, use short, uncomplicated sentences, simple words and straight forward explanations.  Any communication that is not simple will not be understood and many times even the simplest thought is not understood. But as long as there is even the smallest amount of comprehension, speak simply.  One note, don’t revert to “baby talk” when communicated with those with dementia; be concrete in your speech and stay away from figures of speech.

Frankly, some of my favorite people are people with dementia.  The stripping away of all the sophistication that we learn to use that actually clouds communication is so often gone and a person with dementia generally speaks forwardly and openly and without pretense.  There is a wonderful beauty in this and a kind of humor that brings joy to my heart.

Don’t stay away from your family and friends when dementia becomes apart of the reality, but do remember a few of these pointers and the visits will go so much better!