This module focuses on communication losses in the early and middle stages that you may see among Connected Horse participants, and offers strategies for communicating more effectively and easily. Many of these tips are good communication tools regardless of whether someone has a diagnosis of dementia or other cognitive challenges.
The tools for screening participants that you will receive at your on-site training will let you know, ahead of time, whether a participant with dementia:
You can also use them to assess communication styles and abilities during the first workshop day.
Participants in the Connected Horse workshops who have dementia may have some difficulties communicating in traditional ways. It is not possible to predict the rate and type of communication loss as dementia progresses. Losses may vary from one person to another even though they may appear to be the same stage. One person may experience an inability to speak appropriately while another can no longer write. Losses can even vary from one day to the next, depending on the individual’s mood, health status and the environment.
At first, the person may have trouble following directions, understanding large amounts of information, or writing and speaking. In the late stages of dementia, the person progresses to being unable to communicate with words.
This is very hard for the individual with dementia. The person wants to communicate, and may know what he or she wants to say, yet be unable to vocalize it. Someone with Frontal Temporal Dementia or who has suffered a stroke may have damaged vocal chords, tongue, or mouth, interfering with the ability to speak. Struggling with these limitations may damage self-esteem, causing the person to withdraw, or show agitation or anger, in turn creating other problems.
One reason the Connected Horse Program is so profound for people living with dementia and their partners is that it teaches communication. It allows people to see that communication is much more than a rapid verbal response. By learning to watch and be present with the horse, participants can establish a relationship with no words at all. When someone has been feeling defensive or left out, this connection can be powerful.
Losses may vary even among people in similar stages of dementia, but in general, you will find these communication and social skills lost in the earlier and middle stages of dementia.
Communication Losses in Earlier Stages of Dementia
People in the early stages of dementia may try to cover memory loss by using common phrases such as “I’m happy to hear that.” When the person does not know the correct response, he or she may make up a response. The person may have some difficulty remembering names or the words for objects. The person may also need a longer period of time to process information and think of the responses. Lastly, the person may often change the subject.
Other losses include:
Social skills lost at this stage include:
In general, we encourage facilitators to ask simply stated, open-ended questions that are failure free. It is also important to allow each participant the time to respond. After a minute of silence, it might seem right to ask the participant if you can share something you saw and then ask for agreement.
Communication Losses in Middle Stages of Dementia
We do not typically provide workshops for people in the middle to later stages of dementia. However, it is useful to understand the basic communication deficits that occur for many people living with more advanced dementia.
As memory loss increases, finding the right words becomes harder. More complex and less common words may disappear first. Nouns and proper names are replaced with pronouns or generic terms like thingamajig. Requests to repeat questions or directions become more frequent. Problems with reading and understanding directions often increase.
Other losses in this stage include:
Social skills continue to diminish. At this stage, a person:
In the very last stages of dementia, people may lose words, jumble sentences, forget what they were saying, and eventually lose all meaningful speech. But as Module 3 explained, among these losses, certain abilities remain intact, like memories from long ago, observations of feelings and emotions, or understanding of gestures. These abilities can provide an entrance to tap into as you facilitate the Connected Horse Program among people living with an earlier stage of dementia.