Communicating with a Patient Who Has Dementia
Introduction
Most speech-language pathologists (SLPs) will eventually come into contact with a patient who presents with dementia. These patients can be quite clinically challenging and require communication strategies that are specifically designed to compensate for their speech/language/cognitive deficits. This article will help SLPs become familiar with some basic tenements of communication with a patient who has dementia.
Dementia Presentation
Dementia can occur at any age but it becomes more frequent with age, with a prevalence of 5%-10% in the over 65s and 20% in the over 80s (Saunders, 1993). The prevalence is higher among women as their life expectancy is greater than that of men (Centers for Disease Control, 2003). And as the prevalence of dementia increases with age so does the percentage of females in the population with dementia increase. The prevalence of elderly with dementia is highest in the long-term-care setting. This makes sense as dementia is often precisely the factor that is preventing the patient from residing in a setting that would require less care.
Patients with dementia will present with a wide variety of speech, language, and cognitive deficits dependent upon the type and severity of their dementia. For the purpose of this article, dementia is defined by adhering to a 4-stage hierarchy.
Early Stage
- Has difficulty concentrating on and performing usual job or daily life functions.
- Gets lost while going to familiar locations.
- Has a decreased desire to complete housekeeping activities.
- Has difficulty performing complex tasks such as balancing a checkbook, playing bridge, and preparing a full meal.
- Ability to recall familiar phone numbers and/or addresses is reduced; may need prompting.
- Makes poor decisions; has poor judgment.
- Takes longer to do routine chores.
- Loses things.
- Is forgetful.
- Arrives at the wrong time or place.
- Shows difficulty with social interactions and is becoming more withdrawn.
- Has mild to moderate anxiety.
- Forgets contents of what was just read due to short-term memory problems.
Middle Stage
- Cannot remember important aspects of personal life, such as address, phone number, names of grandchildren, college attended.
- Has difficulty finding words.
- Shows trouble concentrating on 2- and 3-step tasks, such as what is required for dressing and grooming.
- Shows loss of impulse control, which results in verbal outbursts or taking things that do not belong to him or her.
- Shows sloppy table manners.
- Public undressing occurs.
- Is disorientated regarding date, day, season, year, or time.
