Nonverbal Communication
&
Quality of Life in Dementia
Zunera Khan10/03/2020
Background - Dementia
Fifty million people with dementia. Likely to almost double
every 20 years, reaching 74.7 million in 2030 and 131.5 million
in 2050.
In the UK, 1/3 of people with dementia live in care homes. The
majority of these individuals have moderate or severe dementia
and have highly complex care needs.
PM Dementia Challenge 2020: Importance of improving quality
of life and meaningful care of people with dementia.
Non-drug approaches to address major drivers of QoL,
particularly through social interaction and pleasant activities for
both agitation and antipsychotic use.
Care Needs Food
Medication
Falls
Activities of Daily Living
Mental health
Anxiety
Depression
Agitation
Social Interaction
Input by Multidisciplinary Teams
Hancock et al., 2006
When interacting with one another
Communication can be either verbal or
non verbal.
Only 7 % of what we communicate is
through spoken words.
Rest is through how words are spoken
and other Nonverbal indices
Communication
Forms of Nonverbal
Communication
Eye contact
Shows: personal interest, affection, hostility, or attraction
Helps with the flow of conversation
Engage and elicit the other person’s response
How Words are Spoken
• When we speak, other people “read” our tone in
addition to listening to our words
• Pitch (how louder you speak), your tone
• Timing and pace, and inflection
• Someone's tone of voice, for example, can indicate
anger, happiness, affection, fear, or confidence; these
behaviours help to convey the message stronger.
Forms of Nonverbal Communication
Forms of Nonverbal Communication
Facial Expressions
• Human face is extremely expressive, able to express countless
emotions without saying a word.
• Facial expressions are universal.
• The facial expressions for happiness, sadness, anger, surprise,
fear, and disgust are the same across cultures.
Gestures
• Movement of part of the body, especially a hand head, to express
an idea or meaning
• We wave, point, sign, and use our hands while we are arguing or
speaking animatedly; expressing ourselves often without thinking
with gestures.
Touch
• Touch is an integral part of nursing care, especially for
building relationship and rapport
• A light touch on the arm can bring comfort and enrich
the communication.
• Instrumental touch Vs. affective expressive touch
• Found to be effective method of interacting with limited
cognitive function
Forms of Nonverbal Communication
Forms of Nonverbal Communication
Posture & Spacing
Space and position can communicate many different nonverbal
cue; e.g. interest, intimacy, affection & aggression or dominance
Body positioning may indicate if one is listening, attending and
involved (Von Cranach 1971, Gross 1990)
One may feel uncomfortable during a conversation because the
other person was standing too close and invading our space?
DANVA – Facial Expressions (Nowicki et al 1994)
DANVA – Facial Expressions
DANVA – Facial Expressions
Importance of Nonverbal communication
1. Reinforces or modifies what is said in words. People may
vigorously nod their head when saying yes to emphasis
that they are agreeing with the other person
2. Where NVC plays an important role in conveying
information about their emotional state.
3. NVC not only Defines BUT Reinforces relationships
between people.
Person living with dementia may
show symptoms with
Nonverbal cues
Aggression
Facialexpression loss
of interest
Anxiety
Change in Appetite
Reduced social interaction
Change in sleep
Low mood
Agitation
Nonverbal Communication &
Quality of Life In Dementia - Study
Study Sample
&
Study Participants
100 People with dementia in care homes.
Average age - 85 years old (SD 1.8)
69% female Vs. 31% - male.
Participants with Dementia (n =100)
– 21 Care homes across London / Essex
Quality of Life – AD (Logsdon, 1999) (QoL-AD) - Proxy and
Self reported
Camberwell Assessment of Need in Elderly (CANE) (Orrell et
al., 2004)
Emory Dyssemia Index (EDI) – Impairment of NVC (Nowicki
and Duke, 1992) (Baseline – 12 weeks – 24 weeks)
Sheffield Screening Test for Acquired Language Disorders
(STALD) (Baseline – 12 weeks – 24 weeks)
Neuropsychiatric Inventory (NPI) (Cummings, 1994)
Functional Assessment Staging Tool (FAST) (Reisberg,1988)
Verbal Fluency – (FAS) (Benton 1976)
Study Assessments
Emory Dyssemia Index
➢ Greater impairment in people living with severe dementia
as compared to people with moderate to severe dementia
Care Needs and Communication
Impairment in Nonverbal communication
impacted number of care needs
As the level of impairment went up, number of
care needs increased..
Impairment in Nonverbal
Communication and Quality of Life
(QoL)
Impairment in Nonverbal communication impacted QoL
As the level of impairment went up there was a decline in people’s QoL
Communication and Neuropsychiatric Symptoms
Impairment in Nonverbal communication
impacted Behavioural Symptoms..
As the level of impairment increased,
behavioural symptoms also increased…
Follow up time points – Message
Nonverbal Communication was still
associated with behavioural symptoms, QoL
and Caregiver distress at the follow up visits
at 3 months and 6 months..
EDI total score Baseline
EDI total score 12 weeks
EDI total score 24 weeks
NPI total items A-J .410** p < .001(n= 100)
.416**p < .001(n = 78)
.301*p = 0.011(n = 70)
NPI Baseline Agitation Cluster
Score
.284**p =. 004(n = 100)
.413**p < .001(n = 77)
.271*p = .023(n = 70)
Occupational disruptiveness score NPI–NH
.330**p < .001
(n= 100)
.444**p < .001(n = 78)
.275*p = .021(n = 70)
Proxy-reported QoL-AD
- 0.351**p<.001
(n= 100)
-.245*0.031(n=77)
-.434**p< .001(n = 70)
Impairment in Nonverbal Skills in
Moderate - Severe Stages of Dementia
Lower scores indicate less impairment
20.00
16.00
14.00
12.00
10.00
10.00
10.00
9.00
8.00
7.00
0.00 5.00 10.00 15.00 20.00 25.00
Objectics
Nonverbal Receptivity
Conversational Skills
Social Rules
Chronemics and Use of Time
Space Touch
Facial Expression
Paralanguage
Gaze & Eye Contact
Hands Gesture
Median
ED
I S
ub
scale
s
Nonverbal Communication in People with Moderate/Severe AD
Impairment in Nonverbal Skills in Severe
Stages of Dementia
Lower scores indicate less impairment
28.00
25.00
20.00
15.00
13.00
12.00
12.00
12.00
10.50
7.00
0.00 5.00 10.00 15.00 20.00 25.00 30.00
Objectics
Nonverbal Receptivity
Social Rules
Conversational Skills
Paralanguage
Facial Expression
Gaze & Eye Contact
Space Touch
Chronemics and Use of Time
Hands Gesture
Median
ED
I S
ub
scale
s
Nonverbal Communication in People with Severe AD
Conclusion
Importance of nonverbal communication in the delivery care for people with dementia living in nursing homes
Impairment in nonverbal communication is also associated with more agitation and aggression
Two way Communication is important
Training care on using nonverbal skills that are least impaired for people with dementia
Use of gestures and Gaze when interacting with people with dementia
Further psychosocial intervention models for this population should incorporate nonverbal communication as a base therapeutic target.
Thank you…
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