“When was the last time you really engaged with a person living with dementia?”
This was a question I posed during a recent online training session I ran with a small group of social care staff. Some of the people they support are living with dementia, so they said that they are ‘always’ engaging with them. But then I asked the question again, with a bit more emphasis:
“When was the last time you REALLY engaged with a person living with dementia?”
‘Really’ is the most important part of the question because the aim of what I’m trying to achieve with this group of staff is to move their engagement from almost entirely functional to including more meaningful interactions.
What do I mean by functional engagement? In the main, it is interactions along the lines of:
“Do you want a cup of tea?”
“Would you like to do …….. activity?”
“What do you want to eat for lunch?”
“Would you like to wear this today?”
As a person’s dementia progresses, conversation can become increasingly confined to the functional. Sometimes for speed, because we just need to know what the person wants. Sometimes because we are fatigued and not even thinking about a more expansive conversation. Sometimes because we don’t think the person could cope with a more expansive interaction. And sometimes because we are unsure of how to create such conversation and so avoid it through our own fear or anxiety.
This, however, can leave the person feeling frustrated, unappreciated, irrelevant, invisible. We might see changed behaviour. We might think there is something ‘wrong’ with the person. What is wrong, however, is that we haven’t provided any further outlet for the person’s expression than functional, day-to-day necessities. We are, in effect, depriving the person of the joy of exploring the abilities, thoughts and ideas that they have.
That’s not to say that the above examples aren’t important questions. It’s vital that we are finding out the person’s preferences and enabling them to exercise choice. But what I’m looking to build in alongside this functional engagement is interactions that value the person and engage them in ways that, prior to their dementia, would have been part of their normal life.
Meaningful conversation is more absorbing, interesting and stimulating than functional chit-chat. It appreciates that the person has knowledge and wisdom. It recognises that they have opinions, thoughts, ideas and an imagination.
You can build in expansive, creative or critical conversation at any point in a person’s dementia. Yes, if the person is struggling with communication is may become more difficult, but moments of lucidity are still possible. Even if you don’t see such lucidity, don’t underestimate how the person may have been validated, engaged and enthused by being offered conversation that values them.
Ideas to stimulate meaningful conversations
The most important element to remember with the type of meaningful conversation I’m advocating is that it isn’t memory based. So we aren’t going to be saying to the person: “Do you remember…..?”
Instead we are going to work to the person’s strengths, which for most people with dementia will lie in tapping into their imagination and intuition rather than factual information.
Of course you always need to personalise your conversation, so the following suggestions won’t work for everyone. Hopefully, however, they provide a positive starting point for meaningful conversation that isn’t just beneficial for the person but is also rewarding for the individual communicating with them.
Use imagination: “I wonder what would happen if….?”
This is a great question that enables the questioner and the person with dementia to create a scenario and explore it together. It supports the person to use their imagination and doesn’t rely on rights and wrongs or factual recall.
Extend imaginative thought into fantasy or humour: “What would you take on a desert island?” “How would you spend a million pounds?” “Would you rather have pink hair or blue hair?” “Would you rather be a crocodile or a snake?”
These questions enable the person to offer their opinion, and perhaps expand into how and why they made their choice(s). Let your imaginations run wild!
Be curious: “What do you think of this?” “What does this make you think of?” “What do you think would happen if….” “What do you think the person in this picture is thinking/feeling?” “What do you think you might do with this?”
These questions help the person to use their curiosity to explore items/objects/pictures/news stories and many other things (such as sensory items), and again don’t rely on factual recall.
Ask for opinions / be taught by the person: “What do you think I should do with….?” “What would you choose?” “How should I….?”
These questions make the person feel useful, and enable them to share their opinions and/or teach you something.
Tips for success
Bear in mind that to achieve meaningful interaction you need to be taking a side-by-side approach with the person. Talking and sharing together, as equals. Not rushing. Not being distracted. Not being shy.
Just as the person will be using their imagination and intuition, so you will need to use yours too, and most of all have fun together.
Until next time…