Communication in Challenging Situations

Certain situations present particular communication challenges in dementia care. Understanding specific approaches for these scenarios is essential for nursing professionals.

Managing Responsive Behaviors Through Communication

Responsive behaviors (sometimes called “challenging” or “disruptive” behaviors) are often expressions of unmet needs or responses to environmental factors. Effective communication can help identify and address the underlying causes:

During Agitation or Distress

When a person with dementia becomes agitated or distressed:

• Approach calmly and at eye level
• Use a low, soothing tone of voice
• Keep sentences short and simple
• Validate the person’s emotions (“I can see you’re upset”)
• Avoid arguing or correcting
• Offer reassurance through both words and appropriate touch
• Use distraction to redirect attention if appropriate
• Give the person physical space if needed
• Identify and address potential triggers

Research by Burgio et al. found that using validation statements before attempting redirection was significantly more effective than redirection alone, reducing agitation episodes by 30% over a four-week intervention period (Burgio et al. 151).

Repetitive Questions or Statements

When a person repeatedly asks the same question or makes the same statement:

• Answer as if it’s the first time
• Look for the emotion behind the repetition
• Provide written answers for frequently asked questions
• Use distraction to redirect attention
• Address underlying needs (boredom, anxiety, need for reassurance)
• Avoid pointing out the repetition

Confabulation and False Beliefs

When a person confabulates (creates false memories) or expresses false beliefs:

• Avoid direct contradiction or argumentation
• Validate the underlying emotion
• Gently redirect to a different topic
• Provide reassurance rather than correction
• Use distraction if the false belief is causing distress
• Focus on feelings rather than facts

Refusal of Care

When a person refuses necessary care:

• Consider timing (try again later if possible)
• Explain simply what you need to do and why
• Break tasks into smaller steps with pauses
• Offer limited choices to provide a sense of control
• Use bridging statements that acknowledge concerns before explaining necessity
• Use positive, encouraging language
• Demonstrate what will happen
• Consider if pain or discomfort is contributing to refusal

A study by Small et al. found that using specific communication strategies during personal care reduced resistance behaviors by 28%, including a simplified explanation of each step, positive statements, and single-step directions (Small et al. 773).

Communication During Care Activities

Routine care activities present opportunities for meaningful communication:

During Personal Care

Personal care can be particularly challenging due to its intimate nature:

• Announce your presence and intentions before touching
• Explain each step simply before doing it
• Use encouraging, positive language
• Maintain dignity through covering and privacy
• Allow as much independence as safely possible
• Use distraction through conversation about pleasant topics
• Be alert to signs of pain or discomfort
• Give simple choices when possible

During Mealtimes

Mealtimes involve multiple sensory inputs and complex tasks:

• Reduce environmental distractions (background noise, visual clutter)
• Provide simple, one-step instructions if assistance is needed
• Describe foods being offered
• Use visual cues (show the food, demonstrate the action)
• Allow sufficient time without rushing
• Maintain a pleasant social atmosphere
• Avoid discussing eating problems during the meal
• Use adaptive equipment without drawing undue attention to it

During Transitions

Transitions between activities or locations can be particularly challenging:

• Signal transitions in advance
• Use consistent cues for regular transitions
• Explain where you are going and why
• Use visual cues to support verbal instructions
• Allow extra time for processing
• Provide reassurance throughout
• Use bridging objects (familiar items that travel with the person)

Vasse et al. noted that communication-enhanced care routines resulted in significantly improved cooperation and reduced distress during transitions, with implementation of consistent verbal and visual cues reducing transition-related agitation by 40% (Vasse et al. 894).

Communication in Group Settings

Group settings present unique communication challenges:

In Group Activities

• Position people with similar abilities together when possible
• Seat people with hearing or vision impairments appropriately
• Establish clear turn-taking signals
• Address individuals by name
• Use both verbal and visual instructions
• Break complex activities into simple steps
• Provide templates or examples for creative activities
• Allow for different levels of participation
• Celebrate contributions without infantilizing

During Family Visits

• Prepare families with communication suggestions
• Create a quiet, comfortable environment for visits
• Suggest conversation topics based on the person’s interests
• Provide activities that can be shared
• Encourage non-verbal interaction when verbal communication is limited
• Help family members interpret nonverbal communication
• Support families in adapting expectations
• Model effective communication techniques

Research by Savundranayagam et al. demonstrated that brief communication skills training for family members significantly improved visit satisfaction for both the person with dementia and their visitors, with a 27% increase in reported positive interactions following training (Savundranayagam et al. 148).