Course content – PFLEGE-16

4. Module 3 · Communication & validation

Communication

Communicating with appreciation

Communication with people with dementia requires adaptation – and it is the key to relationship and wellbeing. Basic rules: be calm and patient (give time!), approach and address the person from the front and at eye level (not from behind/by surprise – that startles them), maintain eye contact, address them by name, use simple, short sentences and clear questions (no long explanations, not several questions at once), speak slowly and clearly, support non-verbally (facial expression, gestures, touch, a friendly tone – people with dementia often understand the emotional level better than words!), and remain respectful and appreciative (no ‘baby talk’, no infantilising – the person is an adult). Very important: respond to the feelings instead of insisting on facts.

The central concept is validation (according to Naomi Feil): accepting with appreciation the feelings and the (experienced) reality of the person with dementia, instead of correcting or refuting them. To validate means ‘to declare valid’ – taking the person’s feelings seriously and giving them the feeling of being understood. This creates security and trust and reduces anxiety and restlessness.

What this module is about. How to speak and act so that a person with dementia feels safe, and how validation answers feelings instead of correcting facts.

What you will be able to do afterwards. You can approach a person respectfully, choose between four typical answers, use validation in your own words and explain why you do so to colleagues.

Think about it first. Mr Hoffmann (fictitious), 82, says to you with a worried face: “Where is my wife? We have to pick up the little ones from school.” You know that his wife died years ago and that his children are adults. What are three things you could say? What would each one do to Mr Hoffmann? You will compare your ideas with Figure 3.2 on the next page.

Learning objectives of this module

You apply the basic rules of communication in dementia.
You understand and use validation.
You respond to feelings instead of correcting.
You use non-verbal communication consciously.
You can approach a person with dementia in five respectful moves and adapt your speech to their needs (apply).
You can compare four possible answers to an unrealistic statement and justify why you choose validation (analyse, apply).

Communication starts before the first word

The person with dementia notices you long before you speak. They see your pace, your face, the way you stand and whether you smile. If you arrive rushed, they feel rushed. For this reason, the first skill is not about language at all. It is about arriving calmly. Figure 3.1 shows a sequence you can use for every encounter, even short ones.

Figure 3.1: Approaching a person with dementia respectfully. Source: own illustration.

Each move has a reason. Coming from the front prevents a fright. Eye level takes away the feeling of being looked down on. Your name and a smile tell the person that you are friendly, since they may not remember you. Waiting acknowledges that the person needs more time to understand and answer. Many conflicts in care begin with a moment where a carer moved faster than the person could follow.

Words that work

Keep sentences short and put one idea in each. Prefer concrete words (“Please sit here”) to abstract ones (“Let us get ready”). Offer choices only when they are simple: “Tea or water?” is better than “What would you like to drink?”. Use the person’s name, but check how they like to be addressed; many older people prefer the formal form. Avoid “we” for “you” (“How are we today?”) and baby talk, because both signal that you do not see an adult. If the person does not understand, do not repeat the same words louder. Say it again more simply, or show it with a gesture.

Remember: Arrive calmly, come into view, speak simply and wait. The person reads your manner before your words.