Complex Communication 3

Question 1

What is a Cognitive Deficit?

Answer 1

• a decline in cognitive abilities, including memory, language and thinking skills

Question 2

What is Cognition?

Answer 2

• the mental processes that occurr in the brain, including thinking, attention, language, learning, memory and perception

Question 3

When do Cognitive Deficits Occur?

Answer 3

• impairments can manifest at birth or with increasing age

Question 4

How do Cognitive Deficits Occur?

Answer 4

Malnutrition
Stroke
Delirium
Dementia (Alzheimer’s disease)
Chronic alcohol use
Substance misuse
Developmental disorders
Vitamin deficiencies
Chronic diseases
- Chronic disease can lead to future cognitive impairments/deficits

Environmental factors
- Hallucinating
- Prolonged exposure to air pollution can lead to neurocognitive delays in childhood/infancy and cognitive decline in old age

Brain trauma/injury (e.g. tumours)

Head injury and infection of the brain or meninges can cause cognitive deficits at any age​

Mental illness (e.g. depression)

Neurological disorders
- Huntington disease; issues with motor skills and cognitive functioning

Drug reactions - (Sedatives and tranquillizers are associated with cognitive deficits)

Abuse

Question 5

Typical Cognitive Changes with Aging

Answer 5

• Cognitive processes become slower​
• Takes longer to learn new information​
• Slightly decreased short-term memory (recent)​
• Long-term memory (remote), and the ability to make decisions stays the same

Question 6

Atypical Cognitive Changes with Aging

Answer 6

• Memory loss of short-term/recent events​
• Disorientation, confused thoughts​
• Repetition of ideas ​
• Tangentiality (digress from original topic; When asking a client a question, they respond to a completely different topic)
• Impaired judgement ​
  
  • Do they understand pros/cons of and consequences of their actions
• Lack of insight​
• Changes in personality ​
• Dementia (many different types and causes)

Question 7

What is Dementia?

Answer 7

• a large class of disorders characterized by the progressive deterioration of thinking ability and memory as the brain becomes damaged
• no change in consciousness
• Dementia​ is a set of symptoms,​ which includes​ loss of memory,understanding and​ judgment

Question 8

Screening for Cognitive Impairment

Answer 8

1. Over 80 years old (25% have dementia)​
2. After treatment for delirium, depression (red flag)​
3. After a CVA (30% develop dementia at 3 months post CVA)​
4. Changes in function, behaviour, and mood​
5. New difficulties with driving and/or near misses

Question 9

What is Delirium?

Answer 9

• abrupt and acute change in mental status
  ○ Usually temporary and reversible
  ○ At highest risk of developing delirium when you have an infection or post-op

Question 10

What is a Cerebral Vascular Accident (CVA/stroke)?

Answer 10

• Interruption in blood flow to brain cells which causes the brain cells to die (bec they were deprived of oxygen)

Question 11

Strategies to Improve Communication with Clients with Cognitive Deficits

Answer 11

1) Consider how each client can best participate in communication
- Assess client needs, preferences, and use of aids​

2_ Speak clearly, ask simple questions and with a steady pace
- K-I-S-S Principle - Keep It Short and Simple
- E.g. Ask client “Yes” or “No” Q’s being aware that clients with expressive aphasia may provide automatic responses that are incorrect​

3) Engage in active listening
- determine what is important to the client
- Do not be entirely fixated on the schedule you have created for your day
- Be flexible and move with the needs of the client (Unless if it causes danger to yourself or others)

4) Repeat what the client said to ensure accuracy​

5) Instruct the client to speak slowly​

6) Provide alternative methods of speech communication
- E.g., writing tablet, flashcards, eye blinking, communication board with pictures and letters, hand signals, and computer

7) Adjust your communication style to meet the needs of the client
- E.g., stand in front of the client while speaking, listen attentively, present one idea or thought at a time, speak slowly but avoid shouting, use written communication, or solicit family’s assistance in understanding the client’s speech

8) Monitor the client for frustration, anger, depression, or other responses to impaired speech capabilities

9) Modify the environment to minimize excess noise and decrease emotional distress​

10) Ensure the call light is within reach and the central call light system is marked to indicate the client has difficulty with speech​

11) Talk to the client, not their caregiver​ (create an inclusive space for both)

12) Provide education and support to the caregiver
- Be an advocate for the client and caregiver!

13) Anticipatory guidance
- Prepare the person/caregiver for what to expect as the disease progresses, goals of care​

14) Collaborate with the family and a speech therapist to develop a plan ​for effective communication flashcards

15) Involve community partners as needed
- CCAC, Alzheimer’s society, community support connections, community-responsive behaviour teams​

Question 12

How to Communicate with Dementia Patients

Answer 12

1) Speak clearly and concisely
2) Adjust your volume so they can gear you
3) Use short sentences with 1 idea
4) Listen thoughtfully
5) Allow the conversation to flow naturally - if ideas change, be flexible
6) Leave plenty of time for responses
7) Use Yes or No Q’s
8) Redirect if needed
9) Music, photos, and stories are good conversation starters
10) Adopt your conversation to best suit the individual

Question 13

Strategies to Improve Communication with Clients with Hearing Impairments

Answer 13

1) Gain the client’s attention before speaking (E.g., through touch, if appropriate))

2) Refrain from shouting at the client

3) Minimize background noise​

4) Simplify language, as appropriate
(I.e., do not use slang but do use short, simple sentences​)

5) Facilitate lip-reading by facing the client directly in a well-lit environment

6) Face the client directly, establish eye contact, and avoid turning away mid-sentence​​

7) Listen attentively, allowing the client ​time to process communication and ​respond

8) Ask the client to suggest strategies for improved communication
(E.g., speaking toward a better ear and moving to a well-lit area)

9) Note and document the client’s preferred method of communication in the plan of care
(E.g., verbal, written, lip-reading, sign Language)

10) Assist the client in acquiring a hearing aid or assistive listening device​

11) Position yourself 2-3 feet away from the client​

12) Use gestures, when necessary​

13) Refer to the primary care provider or specialist for evaluation, ​treatment, and hearing rehabilitation

Question 14

Strategies to Improve Communication with Clients with Impaired Vision

Answer 14

1) Identify yourself when entering the client’s space​

2) Ensure the client’s eyeglasses or contact lenses have current prescription, are cleaned, and stored properly when not in use​

3) Provide adequate room lighting​

4) Minimize glare
(I.e., offer sunglasses or draw window covering)

5) Provide educational materials in large print​

6) Apply labels to frequently used items
( I.e., mark medication bottles using high-contrasting colours)

7) Read relevant information to the ​client

8) Provide magnifying devices​

9) Provide referral for supportive services ​(e.g., social, occupational, and psychological)