What are effective communication strategies for patients with cognitive decline?

Always be face-to-face with the patient and avoid being backlit. It can be unnerving to not know who is talking and backlighting can make a person look like a terrifying shadow.

One thing I found helpful is utilizing visual aids and tangible objects during interactions. Patients with cognitive decline often find it easier to process and understand information when it is presented in a visual or tactile format. Implementing tools like easy-to-read charts, images, or physical items related to the discussion can stimulate memory recall and support comprehension. Additionally, employing consistent, simple, and clear language, coupled with a gentle tone, can facilitate a more effective and empathetic communication strategy. These approaches, rooted in patience and understanding, cater to the patient's current cognitive capabilities, thereby fostering a supportive and inclusive communication environment.

Make eye contact and smile, hold their hand, take your time and speak words of encouragement to them whether they appear to understand or not, it is the tone of your voice that they will understand.

Speak slowly and watch for grimacing/ facial expressions for signs of any distress ,discomfort, or pain. Approach them slowly , explain to them what you are doing before touching them. Some Altzheimers patients are hearing impaired , and some may startle easily. Take your time with them and please be patient with them.

All of the contributions I have read are wonderful. I think the things that are important in the setting of cognitive changes are the same things that we are all looking for in any relationship -to be seen -presumtion of good intent -to be valid and treated as such -to be allowed to have agency -humor -transparency Remembering that meeting people where they are without judgment, or expectations can open lines of communication you may not have thought was possible.

Showing care and compassion to patients who are experiencing cognitive decline provides reassurance that you are patient and willing to take the needed time to address any concerns or challenges they face.

Actively listen to what a patient has to say and be mindful of what is occurring within that person even if one needs to research the issue or their record for more insight. I worked with someone with traumatic brain injury, and all he needed was understanding and more time to think through tics. Do your due diligence to find what is helpful and written or voice to text communication helps.

Being put at ease, with reassuring words, can be hugely beneficial. Having consideration for their perspective, that they maybe feeling anxious, nervous, confused etc… is important. Whatever you need to say in that moment to make them feel reassured and safe, even though they may not be taking about reality, can be the kindest thing to do. In particular if you are talking to a dementia sufferer. And on the flip side, being patient when listening can build trust, making someone feel heard.

It is important to demonstrate you are engaged and listening through your tone of voice, and body language. Eye contact can also be helpful, but remember not all people will feel comfortable with this - neurodiverse populations, or even those from different cultural backgrounds, may actually find this confronting or offensive. If in doubt, speak with the person's family or carers who know them well (if it is not appropriate to ask them directly) about whether eye contact is appropriate, and also look for the person's own cues that may suggest whether they are comfortable or not.

Individuals I've worked with have communicated feeling shut out from the healthcare community when professionals, there to support them, become frustrated and often fire the patient, removing support. The issue usually lies in trying to impose their own expectations of behavior onto the individual. I've found success using a patient centered approach with a lot of patience, consistency, and kindness . As professionals we need to remember these individuals are not purposely trying to frustrate us. They are frustrated with themselves already. Setting specific goals with them for interactions is also helpful. If there are many issues to discuss, it may be beneficial to have multiple interactions versus trying to tackle everything at once.

On the other hand, offering the patient two choices (e.g., “Do you want a turkey sandwich or tomato soup for lunch?”) gives the patient the opportunity to succeed in a communication interaction and have more agency over their day. “What do you want for lunch?” Is an overwhelming question that can be difficult to answer and can create stress for both parties.

I agree with other contributors that open-ended questions are not the best option in many circumstances, and offering limited choices will actually enhance the person's ability to participate in decision making. An open-ended question like "What should we do now?" could be too overwhelming, compared to "would you like to go to the shops, call your friend, or play a game?" Ensure the choices offered are person-centred though, by speaking with family who know the person well about what they usually enjoy or prefer, rather than random choices that you as the carer have come up with.

I agree that offering limited choices is best when you are trying to determine a patient's preference/decision. However, the open ended question is a good way to engage and stimulate conversation with someone with cognitive decline.

Open-ended questions can be particularly beneficial as they prompt cognitive stimulation. Asking a question like, "How does this music make you feel?" may evoke certain memories, feelings, or even a sense of identity, enriching the consumer's experience.

As questões abertas não são o mais adequado para estes casos, aliás podem gerar mais frustração e confusão. Podemos abrir mais o leque de respostas ou suportar as escolhas com imagens ou listas de palavras para selecionar. Se for possível, um sistema de comunicação aumentativo poderia ser o melhor facilitador por abranger diversas temáticas e vocabulário variado.

Non-Verbal Communication: Pay attention to non-verbal cues like facial expressions and body language. Use facial expressions to convey,words may not be understood. Listen Actively: Give the person your full attention and listen carefully. Be patient and resist the urge to interrupt or finish their sentences. Allow them to express themselves at their own pace. Use Visual Aids: Show pictures, diagrams, or written instructions to reinforce what you're saying. Point to objects or pictures to help them understand and communicate. Maintain Eye Contact to establish a connection. Be aware that some individuals may find extended eye contact uncomfortable. Repeat and Recap the person doesn't understand something, repeat, recap or rephrase it.

By actively engaging in their own narrative, consumers can bolster their sense of self. This approach allows individuals to reflect on their achievements, relationships, and experiences, affirming their identity and enhancing self-esteem.

Sim, está comprovado científicamente que as memórias mais antigas permanecem intactas nestes casos. Assim trará ao paciente uma sensação de ser capaz de relatar, muitas vezes com detalhe, algo que já passou e sentir mais confiança na sua memória. Pedir fotografias ou objetos desse momento/feito podem ajudar no detalhe do relato e a construir o discurso.

In my experience, partnering with clients in the development of their treatment plan validates their role as an active participant in their health care and an influence on their outcomes. It also improves compliance as they tend to be more motivated when involved. A client’s goals should be attainable and unique. For example, one client may aspire to walk to their mailbox daily while another aspires to participate in a marathon. A client with cognitive decline should be involved in decision-making to the best of their ability. Routine assessment can help determine the extent to which they are able to safely make rational decisions.

Have you ever seen the effect on early retirement? The difference between people that leave the active life and those who keep it (it doesn’t need to be something with a salary)? Engaging in active initiatives is powerful for all kinds of problems: Depression improved when gardening together, autism with animal caring, etc. Unfortunately we tend to protect people that we feel are vulnerable by alienating them, and that is all but beneficial for them. Our brain is like a muscle, the less we train it, the lazier it gets. And as we do in muscle recovery with physiotherapy, patients with cognitive decline need to work on their brain muscle. This is done by stimulation, by challenging the brain to work on a problem, to do a certain task…

Including patients in the decision-making process involves presenting them with relevant options and potential risks in a clear and accessible manner. This helps ensure that the chosen course of treatment aligns not only with clinical best practices but also with the patient's values and preferences.

Aqui o sistema de comunicação aumentativo facilitaria a interação com diversos parceiros nos diferentes contextos e permitiria ter a escolha/decisão nos eventos em que se encontra. Não existindo essa hipótese, deve ser exposto de forma clara se direta ao paciente as suas opções para que faça uma escolha com apoio da palavra/imagem. Planear o seu dia, escrever a rotina para que se oriente e sinta independência podem ser uma ajuda.

Getting guidance on how to speak to a loved one who is experiencing cognitive decline is hugely important. It’s not easy. And it’s not something that’s automatic. Each person is also individual. They need, love and support, making those conversations all important. Knowing the best way, to approach a subject, and how a person will potentially respond, will be a huge comfort for all. It maybe needed to repeat something many, many times, and that’s ok. Avoid saying: ‘I told you that’. Being reminded you have forgotten is a natural response, but can be distressing and add to confusion. Asking for support, care givers can reach out to their network of healthcare professionals, they may support with resources too.

Social workers and counsellors can provide emotional support and coping strategies. In the realm of mental health, which is often fraught with stigma and misunderstanding, having a trained professional to talk to can be invaluable.

La orientación a familiares, cuidadores y personas cercanas de pacientes con deterioro cognitivo es la instancia primera de juntos construir un marco de cuidado saludable para todos los involucrados. No es algo fácil, pero con las herramientas adecuadas el cuidador y el cuidando se pueden seguir beneficiando del afecto y el vínculo que comparten, disminuyendo el agotamiento.

We have seen that the communication channel is essential to assure message delivery. Not only does the message need to be understandable, but also the way we chose to deliver it. Patients with cognitive diseases sometimes prefer to communicate in a written way because it allows them to order their ideas and re-read until they understand. It also gives them space to answer, whereas direct communication forces a quick reply. With channels like WhatsApp now they can receive written messages and answer through voice, which enables a stable and easier communication with them.

Los pacientes con deterioro cognitivo son personas por sobre todo, tratarlos con humanidad, empatía es la clave principal para ayudarlos en el proceso que viven. El trato humano y empático aporta calidez en el vínculo y asegura un porcentaje alto de estimulación positiva. Así podemos ser cómplices de una vejez activa y una calidad de vida más saludable.

When early intervention with cognitive decline takes place it helps to consistently reinforce and practice the existing neural pathways for communication. Speech-language therapy at the beginning phases helps to slow down the decline and have coping mechanisms in place. My first suggestion would be to seek help from a professional.