Dementia, popularly known as "dementia", occurs when the mental and behavioral functions of the brain are impaired. Providing information about the issues to be considered when approaching dementia patients, Specialist. Dr. Celal Şalçini drew attention to the importance of controlling the tone of voice and mannerisms while talking to patients.
Üsküdar University NPISTANBUL Hospital Neurology Specialist Dr. Celal Şalçini gave important information about the points to be considered when approaching dementia patients.
Talk to patients slower than your normal speed
"Information processing speed decreases in dementia patients. For this reason, we can reduce the burden on the patient's mind by reducing the speed of our speech." Dr. Celal Şalçini,
"In this way, the number of words and concepts that the patient needs to process in the mental process decreases and your dialog can be more effective. Provide variable (multimodal) input Most of the patients with dementia primarily have impaired verbal memory and their verbal inputs are difficult to memorize, and reinforcing these inputs with writing and accompaniment will make it easier to remember and learn. For example; while teaching a name, it should also be printed, read or associated with a picture."
Reduce the number of people talking
Stating that when many people talk together, dementia patients have difficulty in following and participating in the conversation, Specialist Dr. Celal Şalçini said. Dr. Celal Şalçini,
"This increases the patient's confusion and agitation, and as a result of the anxiety the patient becomes withdrawn and prefers not to talk. For this reason, you should prefer to talk one-on-one with dementia patients or reduce the number of people talking as much as possible."
Speak a little louder, without making your voice high-pitched
Uzm. Prof. Dr. Celal Şalçini said, "The elderly, whether they have dementia or not, have difficulty in understanding speech rather than difficulty in hearing" and continued his words as follows:
"This is due to the loss of perception of high-frequency sounds and the decrease in information processing speed. As much as possible, speak a little louder than your normal tone of voice, without making your voice high-pitched.
Pay attention to your tone and demeanor
Although people with dementia lose the ability to understand words and concepts, they are aware of the way you speak, your demeanor and tone. When talking to the patient, avoid raising your voice, speaking explosively and too loudly, speaking in a threatening and commanding tone. This will improve your dialog with the patient and you will avoid making the patient angry, uncomfortable, restless or outburst.
Talk about the here and now
Talk to patients in the present tense, try not to talk about the future. Talk about things in the environment that patients can see or feel. In other words, let the patient feel what is being talked about.
Sentence Content - Do not give more than one proposition when talking to the patient. As the patient's mental information processing is impaired, they will have difficulty understanding a second proposition. Patients have impaired short-term memory, so they are likely to forget the first proposition when they come to the last proposition in the sentence. For example, the following sentences have variable propositions:
Proposition 1: My stomach hurts,
Proposition 2: I woke up in the morning with a stomach ache,
Proposition 3: I woke up in the morning with a stomach ache because of the food I had eaten in the evening.
Thus, one should construct sentences similar to the sentence in Proposition 1, avoid long sentences with many propositions as in Propositions 2 and 3, break sentences if necessary, and move on to Sentence 2 after understanding Sentence 1. Revise the sentences that are not understood and make them understandable.
Speaking in the activity increases comprehensibility
Many studies have found that talking to the patient in activity increases intelligibility. Placing flowers, building something, sewing and painting activities allow patients to generate conversations around immediate things:
Use simple words
Simple and frequently used words will be easier to understand. It is therefore more efficient to convey information using frequently used words. Sentence a and b may be describing the same thing and sentence b is easier to understand. Revise the words that are not understood and use understandable words. (A: Harmonica is a must, B: Mouth harmonica is very durable)
Use a real name instead of a pronoun
Avoid using pronouns instead of nouns in sentences. For example, use the person's name instead of 'he/she'. This is because when a pronoun is used, it must be remembered with the name it replaces. This puts additional burden on the patient's memory and makes it difficult to understand. It is necessary to use the 2nd sentence as in the example below. (1st sentence Ayşe and Mehmet. She drove Hasan to school. They didn't want him to be late for class. Sentence 2 Ayşe and Mehmet drove Hasan to school. They didn't want Hasan to be late for class.
Do not use multiple choice words
Patients have difficulty answering open-ended questions that require free recall, such as 'What did you eat last night?' or 'What would you like to eat? You should avoid asking open-ended questions that require free recall and ask multiple choice questions such as 'Would you like meat or chicken for dinner?
Do not treat the patient like a child
Due to the deterioration in their brain structure, patients with dementia are almost as vulnerable as a child due to the slowdown in their understanding and perception of what is done in their daily functions. Due to the problem in learning processes, treating the patient like a child can sometimes be perceived as sarcastic by the patient and may make the patient uneasy. At the same time, sarcastic attitudes should be avoided and unnecessary jokes should be avoided. Humor may exceed mental capacities due to patients' inability to abstract and perceive concepts. For these reasons, treating the patient like a child will make him/her feel helpless and may cause him/her to become restless.
Avoid putting patients in a free recall environment
When visitors come, it would be better to say 'Ahmet and Zeynep have come to visit' instead of 'look, guests have arrived'. This way, the patient will not feel distressed because they do not remember.
Avoid frequent changes of location
People with dementia have problems processing new information. Therefore, avoid changing previously learned situations. Patients have difficulty in adapting to the new place and the location of the furniture, they have difficulty in learning the new place and confusion increases due to these reasons. For this reason, relocation should be avoided, and if relocation is unavoidable, the interior design of the new room should be similar to the old room, and the same items should be placed in similar places or in visible places (glasses, kumada, comb, etc.).
Stop constantly editing the patient's mistakes
People with dementia often make mistakes and caregivers often correct them, especially in front of other people. Once the patient becomes defensive, he or she develops irritability, discomfort, restlessness or outbursts and loses the will to speak."
Organize the patient's living space
Üsküdar University NPISTANBUL Hospital Neurology Specialist Dr. Celal Şalçini concluded his words as follows:
"The purpose of environmental changes is to create a safe and peaceful environment that makes life easier. Put a night light in the patient's bedroom and bathroom. Put a safety gate in the stairwell. Remove or secure carpets if possible. Install stabilized furniture or grab bars on the walkway to provide support during instability. Hide electrical cables to prevent tripping. Lock doors to prevent the patient from wandering away; however, make sure that the patient can exit in case of a fire. Place a fixed light source with remote control at the head of the patient's bed. Place non-slip bath towels in bath and shower areas. Wear an identification bracelet on the patient's arm with the patient's name, surname and the presence of memory impairment."
