4. Sensory impairment
A number of people with dementia will have some form of sensory impairment (such as sight loss, hearing loss or both). People with both sensory impairments and dementia are likely to have additional difficulties with their communication. However, there is still a lot you can do to help them communicate effectively.
All of the tips and suggestions in this factsheet may be useful for people with dementia who have difficulties communicating. A number of additional suggestions for people with sensory impairments are outlined below.
Most people over 70 will have some degree of hearing loss. They may consider themselves as deaf, 'hard of hearing' or having 'acquired hearing loss'. This may be due to age-related damage or other causes (such as noise damage, infection, diseases or injury).
In comparison, people who are born deaf or become deaf at a young age are considered to have 'profound deafness'. They may consider themselves as Deaf (often referred to as Deaf with a capital D), use British Sign Language (BSL) as their first language and identify with the Deaf community.
How a person with hearing loss communicates will depend on a range of factors including:
- the type of hearing loss they have
- whether they use a hearing aid, BSL, lip-reading or a combination of all of them
- personal preference and life history.
There are strong links between dementia and hearing loss that suggest hearing loss can make developing dementia more likely. People with hearing loss are likely to experience more difficulties as a result of their dementia. They may already find it harder to communicate, and not being able to hear what is going on around them or hear other people speak can add to their confusion. Both dementia and hearing loss can also make people feel socially isolated, so having both conditions at once can be very difficult for someone. This makes good communication extremely important.
Tips: Communicating with someone with hearing loss
- If the person uses a hearing aid, check that it is fitted and working properly. If you think the hearing aid isn't working or if you need help checking it, speak to your GP or make an appointment with the audiology department at your local hospital. Ask the person if they would like to lip-read.
- Turn your face towards the person and ensure your face is well-lit so your lip movements can be easily seen.
- Don't shout or over-exaggerate words or lip movements (this can actually make it harder for the person to understand you).
- Speak clearly and slightly slower, but keep the natural rhythms of your speech.
- Don't cover your mouth.
- Consider using visual clues such as objects or pictures to help.
- It may be helpful to check if the person has too much ear wax, as this may make any hearing loss and communication difficulties worse.
Many people experience some degree of sight loss as they get older. It is estimated that 1.6 million people over 65 are living with sight loss in the UK. This may be age-related, or due to a condition such as cataracts or age-related macular degeneration. Many people with sight loss will need glasses to help them see.
People with sight loss are likely to experience more difficulties as a result of their dementia. Not being able to see what is around them can lead to a greater sense of disorientation and distress, as well as decreased mobility and a risk of falls. Having both dementia and sight loss can also make people feel isolated from those around them. This makes good communication extremely important.
Communicating with a person with dementia and sight loss may be difficult as the person may not be able to pick up on non-verbal cues or follow a conversation as easily. There is a lot you can do to help them.
Tips: Communicating with someone with sight loss
- Check the person is wearing their glasses, if needed, and that these are clean and that the prescription is up-to-date. If someone has more than one pair of glasses, ensure they are labelled or marked for the activity they have to be used for - for example, reading glasses.
- Introduce yourself or try to gain the person's attention before starting or ending a conversation. If you don't, they may become confused about who is talking, be unsure if they are being spoken to, and may not know if people enter or leave the room. If you are helping the person with a task, let them know what you are going to do before and during it.
- Use references when describing where something is - for example, your water is on the table on your right. It may be helpful to use imaginary hands on a clock face to describe where something is, especially for people who have lived with sight loss for many years (eg the cup is in front of you at 12 o'clock position).
- Make the most of the physical environment - for example, make sure there is good lighting, which is consistent, even and can be adjusted. Try to reduce shadows as the person may mistake them for obstacles.
- The person may not be able to pick up on non-verbal communication, such as body language. Bear this in mind when talking to them.
- If you are communicating with someone in writing, such as sending them a letter, think about the colour of paper and font size (for example, black text on white or yellow paper often makes text easier to read, as does larger text).
- People with learning disabilities are 10 times more likely to have serious sight problems than other people. They are also at greater risk of developing dementia at a younger age, particularly people with Down's syndrome. You should make sure a person with learning disabilities and dementia has a communication passport - a practical tool that gives information about a person's complex communication difficulties, including the best ways to communicate with them.