Underlying Beliefs and Principles
DemTalk is not produced with the intention of being a set of hard and fast 'rules' that are set in stone.
It is designed to be a dynamic tool, adaptable to different contexts and to the needs of individuals which, of course, vary enormously. That said, it is possible to draw up a statement of agreed principles which would underlie guides and inform good communication practice.
DemTalk is therefore based on the following:
- what we know about the nature and importance of communication.
- beliefs about the effects of dementia on communication.
- beliefs about the communicative needs of people living with dementia.
The nature and importance of communication
Any communication between people has two main, strongly related purposes:
- the sharing of meaning.
- the fostering of social connections between people.
Communication is a basic human need and, as such, making it as effective as possible should be a basic human right. Communication enables us to project our identity and to have our identity confirmed. Communication can be seen as a process, as well as an act, or series of acts.
Briefly, seen as a process, it consists of:
- communicators (the people involved in the conversation).
- the message (what people are ‘trying to say’).
- the medium (presentational: the voice, face, body; representational: words, pictures, architecture; or mechanical: TV, computer, telephone).
- the channel (vocal, gestural/visual, chemical/olfactory, tactile).
- a code (a system of meaning shared by a group, for example, a language).
- noise (factors tending to blur the message, for example, misunderstandings arising from ‘misreading’ body language, as well as background environmental distracters like loud music).
- feedback (things which allow the message sender to be able to judge whether they have been understood).
- context (who is communicating with whom, when, where and with what presuppositions and expectations).
The effects of dementia on communication
People living with dementia may:
- be easily disorientated.
- experience a sense of loss of purpose and identity.
- feel uncomfortable exploring/exposing their diminished competences.
- be anxious about their condition and its possible progress.
As a consequence, they may:
- have difficulty following rapid or complex speech.
- attempt to convey meaning in ways that are discontinuous and lacking in logical structure, but may express underlying concerns in a way that can be understood intuitively.
- have difficulty encoding or decoding meaning.
- be especially susceptible to ‘noise’, be it environmental, socio-cultural or situational.
- find some behaviours unhelpful in others’ attempts to communicate – for example, a perceived patronizing tone or a too-rapid action accompanying an explanation.
The communicative needs of people living with dementia
We believe that people with dementia should be:
- agentive, i.e. able to be in control of their own lives and circumstances as far as possible.
- offered support in continuing to ‘own’ a clear idea of themselves as individuals, and of themselves in a particular socio cultural context.
- helped to feel less anxious.
- aided in their attempts to negotiate and maintain a sense of self and of personal and social identity.
- assisted in their attempts to communicate effectively with others.
- helped to retain and regain competencies.
- approached and treated in such a way that their dignity and freedom of choice are reinforced and supported.
Dementia can profoundly affect a person’s ability to communicate effectively.
People living with dementia are, nevertheless, individuals with communicative needs. Addressing these needs in a clear and principled manner, which fully acknowledges individual ‘personhood’, is a key element in any positive encounter between people with dementia and their carers.
Overall, a person-centred approach to communication between carers and those living with dementia should have the effect of initiating a virtuous circle of improving communication.
With this, the recognition of a person’s individual agency by a carer both increases the individual’s sense of competence and improves the quality of social interaction for both parties.
These principles are at the heart of DemTalk.