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Page 1 of 40 aspecmaps.free.fr/NVQ3/DEM308.pdf
Understand the role of communication and interactions with individuals who have Dementia by Gaël Romanet.
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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.
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Understand the role of communication and interactions with individuals who have Dementia by Gaël Romanet.
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
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Understand the role of communication and interactions with individuals who have Dementia by Gaël Romanet.
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
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Understand the role of communication and interactions with individuals who have Dementia by Gaël Romanet.
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.
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Understand the role of communication and interactions with individuals who have Dementia by Gaël Romanet.
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.
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Understand the role of communication and interactions with individuals who have Dementia by Gaël Romanet.
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.
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Understand the role of communication and interactions with individuals who have Dementia by Gaël Romanet.
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).
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Understand the role of communication and interactions with individuals who have Dementia by Gaël Romanet.
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.
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Understand the role of communication and interactions with individuals who have Dementia by Gaël Romanet.
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.
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Understand the role of communication and interactions with individuals who have Dementia by Gaël Romanet.
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.
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Understand the role of communication and interactions with individuals who have Dementia by Gaël Romanet.
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.
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Understand the role of communication and interactions with individuals who have Dementia by Gaël Romanet.
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.
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Understand the role of communication and interactions with individuals who have Dementia by Gaël Romanet.
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.
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Understand the role of communication and interactions with individuals who have Dementia by Gaël Romanet.
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.
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Understand the role of communication and interactions with individuals who have Dementia by Gaël Romanet.
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?
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Understand the role of communication and interactions with individuals who have Dementia by Gaël Romanet.
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.
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Understand the role of communication and interactions with individuals who have Dementia by Gaël Romanet.
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.
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Understand the role of communication and interactions with individuals who have Dementia by Gaël Romanet.
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.
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Understand the role of communication and interactions with individuals who have Dementia by Gaël Romanet.
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.
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Understand the role of communication and interactions with individuals who have Dementia by Gaël Romanet.
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.
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Understand the role of communication and interactions with individuals who have Dementia by Gaël Romanet.
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).
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Understand the role of communication and interactions with individuals who have Dementia by Gaël Romanet.
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.
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Understand the role of communication and interactions with individuals who have Dementia by Gaël Romanet.
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.
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Understand the role of communication and interactions with individuals who have Dementia by Gaël Romanet.
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.
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Understand the role of communication and interactions with individuals who have Dementia by Gaël Romanet.
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.
Page 27 of 40 aspecmaps.free.fr/NVQ3/DEM308.pdf
Understand the role of communication and interactions with individuals who have Dementia by Gaël Romanet.
2.3 Explain the importance of involving individuals with Dementia in a range of activities (1 page to answer the
question – Page 27)
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
Page 28 of 40 aspecmaps.free.fr/NVQ3/DEM308.pdf
Understand the role of communication and interactions with individuals who have Dementia by Gaël Romanet.
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.
Page 29 of 40 aspecmaps.free.fr/NVQ3/DEM308.pdf
Understand the role of communication and interactions with individuals who have Dementia by Gaël Romanet.
Graphic of Reality Orientation Approach
Page 30 of 40 aspecmaps.free.fr/NVQ3/DEM308.pdf
Understand the role of communication and interactions with individuals who have Dementia by Gaël Romanet.
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.
Page 31 of 40 aspecmaps.free.fr/NVQ3/DEM308.pdf
Understand the role of communication and interactions with individuals who have Dementia by Gaël Romanet.
Graphic of Validation Approach
Page 32 of 40 aspecmaps.free.fr/NVQ3/DEM308.pdf
Understand the role of communication and interactions with individuals who have Dementia by Gaël Romanet.
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
disease in the late stages.
Page 33 of 40 aspecmaps.free.fr/NVQ3/DEM308.pdf
Understand the role of communication and interactions with individuals who have Dementia by Gaël Romanet.
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
disease in the late stages.
Page 34 of 40 aspecmaps.free.fr/NVQ3/DEM308.pdf
Understand the role of communication and interactions with individuals who have Dementia by Gaël Romanet.
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"
Page 35 of 40 aspecmaps.free.fr/NVQ3/DEM308.pdf
Understand the role of communication and interactions with individuals who have Dementia by Gaël Romanet.
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.
Page 36 of 40 aspecmaps.free.fr/NVQ3/DEM308.pdf
Understand the role of communication and interactions with individuals who have Dementia by Gaël Romanet.
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.
Page 37 of 40 aspecmaps.free.fr/NVQ3/DEM308.pdf
Understand the role of communication and interactions with individuals who have Dementia by Gaël Romanet.
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.
Page 38 of 40 aspecmaps.free.fr/NVQ3/DEM308.pdf
Understand the role of communication and interactions with individuals who have Dementia by Gaël Romanet.
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.
Page 39 of 40 aspecmaps.free.fr/NVQ3/DEM308.pdf
Understand the role of communication and interactions with individuals who have Dementia by Gaël Romanet.
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.
Page 40 of 40 aspecmaps.free.fr/NVQ3/DEM308.pdf
Understand the role of communication and interactions with individuals who have Dementia by Gaël Romanet.
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
question – Page 40)
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.