When you really stop and think about it, there isn’t any action that your body has taken that didn’t include some type of internal dialogue.
To some degree, every physical behavior has intentionality, a kind of conversation we have in our own minds, whether it be a litany of swear words, a thought process of remembrance, or an emotion related to what we see or feel or hear.
When it comes to dementia care I believe we make the mistake of terming physical communication techniques or last resorts as “behaviors”. When termed as such, we then view a “behavior” as something we should treat and therefore get rid. I believe it should be seen as an additional form of communication.
If we change our mindset regarding the limitations in communication abilities and the attempts a dementia patient uses to express themselves, we can then see these verbal and non verbal expressions as gifts; something that will help us. The gifts give us more insight into that person, what they are thinking, what they are feeling and how we can reach them.
Hand signals while driving is a prime example of behavior we see in our everyday lives. We accept it because we understand EXACTLY what is being communicated is hand. Just the other day I was driving toward Indiana and I dropped my apple. Now, hold on Officer Friendly, before you virtually hand me a ticket, it was actually an apple, the fruit that grows off on trees, not a smart phone.
I was doing everything legal, I wasn’t multitasking, the roads were fairly clear for a Saturday morning. My eyes drifted over towards the passenger seat where my apple had fallen and so did my hands on the wheel, which then let my car slightly drift into the left hand lane.
Unbeknownst to me, there was another car in that lane and clearly there was no space for me there. I understand, I wouldn’t want me there either. Instead of a gentle tap of the horn, making me aware of my intrusion upon his space, he laid on the horn, held it down for what felt like an eternity and then continued to speed around me, entering into my lane, nearly cutting me off.
He then proceed to “wag his finger” in the rear view and then put his hand up as if he could not believe what I had just done. This was a clear form of communication using his physical body to let me know just how upset he really was. Any verbal exchange at this point would have been slightly weird as we were both going about 70 mph in separate vehicles.
Nonetheless I read his body language loud and clear. His wagging finger and waving arm, a clear message that I had done something wrong. Maybe he assumed I was multitasking, on my phone or something else questionable, but regardless he didn’t like the position I put him in (mentally and physically) and didn’t provide me with the benefit of the doubt. He used a very explicit form of body language as a form of communication to express his thoughts.
In my experience while working with those with dementia, I have always looked at “behaviors” as being a way to communicate whether it be wandering, disrobement or hoarding. Each one of these physical forms of communication tell us something: perhaps someone is hoarding because they are looking for something, perhaps they are disrobing because they are hot or do not like what they are wearing, perhaps they wander because they want to walk, go somewhere or are unhappy with where they are.
Regardless of the action it speaks volumes. Instead of being “squashed”, medicated, care-planned, tackled and overcome via care staff meetings, we should consider those “behaviors” as gifts; As if we are Sherlock Holmes and we just had a “ELEMENTARY !!! DEAR WATSON” moment.
Non verbal gifts give us more to go on especially as a patient becomes more advanced in their dementia. We need to hone our skills in nonverbal communication, understand how important and insightful the intentional physical communion is.
For those of us who care for the dementia sufferer we must also be intentional with our observance of these specific beautiful forms of communication, intentional of our actions and intentional with the most effective reciprocity of communication in return. We must work to cherish them as gifts, never be in a place of judgement, jumping to anger, wagging the finger, or raising of the arms in frustration. Rather acknowledge the intentionality of another’s attempt to communicate, know that they are trying to tell us something, for it is our job to figure that out.
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