Communication Strategies

Question 1

List the 10 PROPOSED strategies for effective communication with someone with dementia

Answer 1

1) Eliminate Distractions
2) Approach the person slowly and from the front
3) Use short simple sentences
4) Speak slowly (no experimental evidence/ __)
5) “Elderspeak” (not effective)
6) Ask one question/ give one instruction at a time
7) Yes/no vs open-ended questions
8) Repeat and rephrase
9) Avoid interrupting (no evidence )
10) Encourage the person to describe the word he is searching for

Question 2

Describe eliminating distractions:

Answer 2

• a non-verbal strategy of controlling the environment
• reduce distractions by simplifying the surroundings (ie. turn off the TV)
• Studies show this is associated with fewer breakdowns in communication

Question 3

T or F: A study shows that approaching the person from the front and maintaining eye contact are strategies used rarely by the caregiver during activities.

Answer 3

False- They are used frequently although caregivers perceived that they use them less often

Question 4

Using short simple sentences reduces demands on __________

Answer 4

working memory

Question 5

Describe 4 study results that support using short simple sentences:

Answer 5

1) Associated with fewer breakdowns in communication with a caregiver (small et al. 2003)
2) Increased success on a description-picture matching task when using simple sentences (Kemper et al. 1994)
3) Better comprehension of simple sentences on the Revised Token Test (Tomoeda et al. 1990)
4) Fewer Errors with simple sentences than complex sentences during a sentence-picture matching task (Small et al. 1997)

Question 6

Describe one possible disadvantage of using short simple sentences:

Answer 6

Using this strategy over time may lead to a decline in ability to understand complex sentences

Question 7

T or F: You should simplify sentences if the client can still understand complex sentences

Answer 7

False - use sentences that are at the level the client understands not below that level

Question 8

__________ compensates for slower information processing speeds by allowing additional processing time but could increase ______ demands

Answer 8

speaking slowly

working memory

Question 9

T or F: There is experimental evidence supporting speaking slowly

Answer 9

False - no experimental evidence

• more breakdowns in communication with a caregiver though caregivers felt it helped
• no difference in sentence comprehension b/w slow and normal rates

Question 10

________ is systematic speech accommodations directed towards older adults.

Answer 10

“Elderspeak”

Question 11

Describe 4 strategies used by people using Elderspeak:

Answer 11

1) Simplistic vocabulary and grammar
2) Shortened sentences
3) Slowed speech
4) Also exaggerated prosody

Question 12

T or F: Elderspeak is an effective way of speaking to older adults

Answer 12

False - older adults with and without dementia react negatively

Question 13

Describe results of 3 studies showing ways the negative effects of elderspeak:

Answer 13

• decreased successful task performance
• negative assessments of their own and the speakers communicative competence
• resistance to care

Question 14

T or F: People with Alzheimer’s disease have more difficulties with multi-propositional sentences due to greater demands on their working memory.

Answer 14

True - ask one question or give one instruction at a time

Question 15

Several studies show that Yes/no questions are _______ for communication.

Answer 15

more effective

Question 16

T or F: Open-ended questions have no place in communicating with someone with dementia

Answer 16

False

• positive relevant and meaningful responses to open ended questions too
• open-ended questions were proposed to be useful to encourage emotional responses.
• open-ended questions requiring semantic vs episodic memory were more effective

Question 17

Tappen et al. proposed that closed ended questions may be better for ________ while open-ended questions may ecourage ________

Answer 17

everyday living tasks

emotional response

Question 18

In a study 32 pairs of caregivers and individuals with dementia prepared a meal. Questions were coded for type (yes/no vs open ended) and for outcome (success vs failure).
Communication success was:
- highest with \_\_\_\_\_\_\_ ( \_\_\_%)
- lower with \_\_\_\_\_\_\_ (\_\_\_%)
- lowest with \_\_\_\_\_\_\_ (\_\_\_%)

Answer 18

• highest with yes/no questions (83%)
• lower with choice questions (67%)
• lowest with open-ended questions (39%)

Question 19

Caregivers use yes/no questions more frequently (___% vs___%) and yes/no questions were associated with ______communication breakdowns.

Answer 19

66% vs 34%

fewer

Question 20

In a study cargivers and spouses with AD were audiotape and transcribed. Conversations were coded according to occurance, type, memory type and outcome. Describe the results:

Answer 20

• yes/no questions were used the same as open-ended questions
• —– yes/no were more successful
• episodic memory questions were used twice as often as semantic memory questions
• —– semantic memory questions were more successful

Question 21

T or F: Repeating and rephrasing questions is shown to increase comprehension

Answer 21

True

Question 22

_______ is good if they haven’t heard what they heard. _______ is good when they heard but didn’t understand (ie. if they respond something similar to what you expect but not the right way)

Answer 22

repetition

rephrase

Question 23

T or F: Small et al. found that caregivers that used the strategy of avoiding interrupting and allowing plenty of time to respond had fewer breakdowns in communication

Answer 23

False- no clear difference between caregivers that used and didn’t use this strategy

Question 24

T or F: Caregivers consider it important to simplify their language and not interrupt their loved ones but instead encourage them to come up with their words and caregivers frequently employ this strategy.

Answer 24

True

Question 25

Caregivers perceived themselves to use the strategy of ____________ but they virtually never used it. Because it only occurred once during the Small et al. (2003) study the use was not recorded and more research is required.

Answer 25

Encouraging the person to “talk around” or describe the word he or she is searching for.

Question 26

Of the 10 proposed strategies list which work/ don’t work:

Answer 26

• **Effective: Experimental Evidence:
  1) Eliminate distractions
  2) Approach the person slowly and from the front
  3) Using short simple sentences (as long as appropriate level)
  6) Ask one question or give one instruction at a time
  7) Use yes/no questions and semantic memory
  8) Repeat and rephrase
  
  • **No Evidence either way:
    9) Avoid interrupting; Allow plenty of time to respond
    10) Encourage the person to “talk around” or describe the word he is searching for
  • **Detrimental: Experimental Evidence:
    4) Speaking slowly (caregivers felt it helped)
    5) Elderspeak

Question 27

A review article based on 13 studies found the most effective techniques for communication were ________ combined with ________

Answer 27

memory aids combined with specific caregiver training

Question 28

List the 7 parts of the FOCUSED program:

Answer 28

1) Face to face
2) Orientation
3) Continuity
4) Unsticking
5) Structure
6) Exchange
7) Direct

Question 29

Describe FOCUSED program: Face to face

Answer 29

• face the patient directly
• attract the patient’s attention
• maintain eye contact

Question 30

Describe FOCUSED program: Orientation

Answer 30

• orient the patient by repeating key words several times
• repeat sentences exactly
• give the patient time to comprehend what you say

Question 31

Describe FOCUSED program: Continuity

Answer 31

• continue the same topic of convo for as long as possible

- prepare the patient if a new topic must be introduced

Question 32

Describe FOCUSED program: Unsticking

Answer 32

• help patients become unstuck when they use a word incorrectly by suggesting the word they want
• repeat the patients sentence using the correct word
• ask “Do you mean . . .”

Question 33

Describe FOCUSED program: Structure

Answer 33

• Structure questions to give the patient a simple choice to respond with
• Provide only two options at a time
• Provide options that the patient would like

Question 34

Describe FOCUSED program: Exchange

Answer 34

• keep the normal exchange of ideas in conversation
• begin conversation with pleasent normal topics
• ask easy questions the patient can answer
• give the patient clues as to how to answer

Question 35

Describe FOCUSED program: Direct

Answer 35

• keep sentences short, simple and direct
• use specific, concrete nouns rather than pronouns
• Use hand signals, pictures and facial expressions

Question 36

Describe the two benefits of the FOCUSED Program

Answer 36

• Increased Knowledge and improved communication satisfaction for nursing assistance caring for AD patients
• education in strategies altered attitudes towards patients and improved quality of life for patients with dementia