Dementia is not a normal part of aging- it is the leading cause of disability in Australia for people over the age of 65 years. According to the World Health Organisation (WHO), the number of people living with dementia worldwide is currently estimated at 50 million and is predicted to triple by 2050.

What is Dementia?
Dementia is a chronic and progressive syndrome resulting from acquired brain disease. It is characterised by a progressive decline in memory and cognitive areas such as: complex attention, executive function, learning and language. Over time, the severity of dementia has an impact on independent functioning and daily living activities (Hedge, 2016).

The impact of cognitive change on communication can have a significant impact on day- to day communication. For example, a decline in memory, attention, executive function and or language processing can make it challenging to follow or participate in a conversation (Groher, 2015). In conjunction, loss of memory and problems with judgment can cause challenges in relation to eating and nutrition for many people with dementia.

What is the role of Speech- Language Pathologists for people with dementia?

Speech- Language Pathologists play an important role in dementia related communication or swallowing difficulties. The role of SLPs include screening, assessment, diagnosis and treatment of people with dementia- they work as part of multidisciplinary team (ASHA, 2016). Within the scope of practice, the SLPs role includes but is not limited to:

  • Educating other professionals, third-party payers, and legislators on the needs of individuals with dementia and the role of SLPs in diagnosing and managing cognitive communication and swallowing disorders associated with dementia
  • Diagnosing cognitive-communication disorders associated with dementia
  • Assessing, diagnosing, and treating swallowing disorders associated with dementia
  • Developing treatment plans; providing treatment to maintain cognitive-communication and functional abilities at the highest level throughout the course of the underlying disease; and documenting treatment outcomes
  • Providing indirect intervention through the individual’s caregivers and environmental modification
  • Consulting and collaborating with other professionals, family members, caregivers, and others to facilitate program development throughout the course of the underlying disease and to ensure continuum of care
  • Advocating for individuals with dementia and their families at the local, state, and national levels, and providing expert testimony when appropriate

How dementia affects communication and swallowing

Each individual who presents with dementia is unique and the difficulties experienced in communicating thoughts and feelings can affect the brain in different ways. According to Brush et. al (2011), communication changes in an individual with dementia include but are limited to:

  • Word finding difficulties
  • Speech and sentences which do not make sense
  • Deterioration of reading and writing skills
  • Difficulties expressing emotions appropriately
  • Inability to understand communication partners or only grasping some parts of what is said
  • Loss of social conventions during conversation or increase tendency to interrupt, ignore speaker or fail to respond when spoken to

Experiencing issues with swallowing is known as dysphagia. It is a condition which can be caused by several factors including damage to areas of the brain that control swallowing. In up to 70% of instances, people with dementia will experience dysphagia at some point, which can lead to a range of complications such as weight loss, malnutrition and aspiration pneumonia if lead untreated  (ASHA, 2016),(Hanson et. al, 2013). The following strategies can help with managing dysphasia in people with dementia.

  • Ensure the dining environment is familiar and at regular times each day
  • Cut up and prepare food that can be easily picked up (by fingers)
  • Diet modification (prescribed by SLPs)
  • For food to be visually appealing- vibrant colour and separated on the plate so that textures and flavours are distinct

Difficulties are not limited to swallow function. Cognitive and behavioural changes associated with dementia can also impact eating (ASHA, 2016). Individuals may have difficulty shopping for groceries and planning and preparing meals independently.

People with dementia may also forget to eat, initiate eating less often or have difficulty determining the need to eat (Lee & Song, 2015).

As dementia progresses, the individual may become more distracted during mealtime or have difficulty self-feeding, recognising foods or using various utensils.

Strategies for Communicating with people with dementia

  • Minimise distractions: Ensure there is that there is limited background noise e.g.: turn the radio, television off and remove things from sight that are distracting. Sit down face-to-face in a quiet and calm place.
  • Announce yourself: Identify yourself before starting a conversation and refer to the person by name. This will get the person’s attention and awareness.
  • Anticipate, ‘Mix-ups’: Listen carefully and anticipate which words may be mixed up, so you can help find the right word without over correcting.
  • One at a time: People with dementia have problems processing multiple thoughts at once. During conversation, focus on one idea or short story at time.
  • Keep it simple: Use basic language and keep anecdotes and stories brief. Avoid using slang, idioms and simplify explanations.
  • Positive speaking: Use positive language and expression. For example, instead of saying, ‘Not like that’, you could say, ‘Try it this way’.
  • Be patient: Someone with dementia may require extra time to find the right words. Let the person think and provide extra time for them to and speak without interruptions.
  • Body language: Hand gestures, facial expressions, eye contact and touch is important as dementia progresses. Use body language to increase and or reinforce your communication message.

Rephrasing questions can make a significant difference on a person with dementia. Asking ‘Yes/No’ questions or providing a force choice is more effective than using open ended questions.

Instead of asking: ‘ What would you like for dinner?’, you could try… ‘Do you want fish and salad for dinner?’

What to do now?

If you know someone who presents with Dementia and requires Speech- Language Pathology Support, give us a call at Generation Physio, we have a friendly team of professionals that are dedicated to changing the lives of our clients. All of our clinicians are mobile and come to your own home to conduct an examination. Give us a call on 1300 122 884 to book a consultation today.


Article Written By Tue Nguyen

Tue is a Speech-Language Pathologist at Generation Physiotherapy. Tue has experience working with a range of complex communication clients who present with physical impairments, hearing loss, Cerebral Palsy (CP), Autism Spectrum Disorder (ASD), and Rett Syndrome.

Prior to joining Generation Physiotherapy, Tue was a Speech-Language Pathologist at the Queensland Department of Education (DoE). In this role, Tue focused on paediatrics and school age children. Tue is bilingual in Vietnamese and English and has previously focused on clients who are Culturally and Linguistically Diverse (CALD). In her role, Tue served as a Clinical Educator and was responsible for management of Speech Pathology university students undertaking clinical placements.

Learn more about Tue here.


References
American Speech-Language-Hearing Association. (2016b). Scope of practice in speech-language pathology [Scope of practice]. Retrieved from https://www.asha.org

Brush, J. A., Sanford, J., Fleder, H., Bruce, C., & Calkins, M. (2011). Evaluating and modifying the communication environment for people with dementia. Perspectives on Gerontology, 16, 32–40.

Groher, M. E. (2015). Issues and challenges in managing patients with dementia and dysphagia. Japanese Journal of Gerontology, 30, 61–67.

Hanson, L. C., Ersek, M., Lin, F. C., & Carey, T. S. (2013). Outcomes of feeding problems in advanced dementia in a nursing home population. Journal of the American Geriatrics Society, 61, 1692–1697.

Hegde, M. N. (2006). A coursebook on aphasia and other neurogenic language disorders. Clifton Park, NY: Delmar.

Hickey, E. M., & Bourgeois, M. S. (2018). Cognitive and communicative interventions. In E. M. Hickey & M. S. Bourgeois (Eds.), Dementia: Person-centered assessment and intervention (pp. 168–213). New York, NY: Routledge.

Lee, K. M., & Song, J. A. (2015). Factors influencing the degree of eating ability among people with dementia. Journal of Clinical Nursing, 24, 1707–1717.

Martini, A., Castiglione, A., Bovo, R., Vallesi, A., & Gabelli, C. (2014). Aging, cognitive load, dementia and hearing loss. Audiology and Neurotology, 19, 2–5.

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