Many people living with dementia experience difficulties with communication. They may struggle to find words, express themselves clearly, or communicate their needs verbally. However, people can often communicate things like discomfort and pain through facial expressions, body language, vocalisations or changes in behaviour.
Pain is one of the most significant contributors to behaviours that challenge in dementia care (Husebo et al 2011). Many people living with dementia experience multiple physical health conditions associated with ageing and frailty.
Assessing and managing pain through verbal and non-verbal communication cues before and during personal care can therefore play a crucial role in reducing distress and improving engagement.
We must remind ourselves to slow down. This can be difficult when staffing levels are stretched and there is pressure to complete tasks. However, slow can be fast. Taking time to communicate effectively may prevent distress, reduce refusals and ultimately save time later.
Reflection
The key message from this article is simple: take your time.
Refusal of care is often a form of communication. Rather than focusing solely on the behaviour itself, try to understand the need behind it. Building rapport before personal care begins can significantly influence how the experience is received. A little friendship can go a long way.
Instead of rushing into someone's room, opening curtains, moving belongings and assuming they understand who you are, start with a respectful knock. Introduce yourself. Sit down. Build a connection. Seek permission. Explain what is happening and proceed gradually. Most importantly, respect the person's choices and autonomy.
Personal care should never be viewed as a task to be completed but as an opportunity to build trust, preserve dignity and understand the person behind the diagnosis. By prioritising therapeutic engagement, nurses and carers can transform some of the most challenging moments in dementia care into meaningful opportunities for connection. This ultimately leads to more person-centred and trauma-informed care for better outcomes for the people we serve.
The views expressed in this article are informed by both current evidence and my clinical experience working with people living with dementia.
References
- Algase, D.L., Beck, C., Kolanowski, A., Whall, A., Berent, S., Richards, K. and Beattie, E. (1996) ‘Need-driven dementia-compromised behaviour: An alternative view of disruptive behaviour’, American Journal of Alzheimer's Disease, 11(6), pp. 10–19.
- Husebo, B.S., Ballard, C. and Aarsland, D. (2011) ‘Pain treatment of agitation in patients with dementia’, BMJ, 343, d4065.
- Kitwood, T. (1997) Dementia Reconsidered: The Person Comes First. Buckingham: Open University Press.
- National Institute for Health and Care Excellence (NICE) (2018) Dementia: Assessment, Management and Support for People Living with Dementia and Their Carers (NG97). London: NICE.
- Substance Abuse and Mental Health Services Administration (SAMHSA) (2014) SAMHSA's Concept of Trauma and Guidance for a Trauma-Informed Approach. Rockville, MD: SAMHSA.
