Learn to communicate better in dementia with the MESSAGE strategy from the University of Queensland. Each letter stands for a set of tips, which you can see demonstrated via YouTube video. I often teach these strategies to the care partners of my patients, although I didn’t have a nice acronym like MESSAGE until I came across this study and videos.
Free DIRECT download: MESSAGE Tips to improve communication in dementia (patient handout). (Email subscribers get free access to all the resources in the Free Subscription Library.)
Outline:
- The MESSAGE research study.
- YouTube training videos for MESSAGE.
- Maximize attention.
- Expression and body language.
- Keep it simple.
- Support the conversation.
- Assist with visual aids.
- Get their message.
- Encourage and engage in communication.
- Share these tips to communicate better in dementia.
- Related Eat, Speak, & Think posts.
The MESSAGE research study
Dr. Erin R. Conway and Dr. Helen J. Chenery published Evaluating the MESSAGE Communication Strategies in Dementia training for use with community-based aged care staff working with people with dementia: a controlled pretest-post-test study in 2016.
The MESSAGE acronym stands for seven communication strategies, and each strategy includes a few suggestions. The study included 38 staff members, of which 22 were in the training group and 16 were in the control group.
The outcome measures were:
- Knowledge of communication support strategies.
- Self-efficacy.
- Preparedness to provide care.
- Strain in nursing care.
- Attitude to dementia care.
The training group demonstrated improvement in outcome measures immediately following training and upon a three-month follow up for:
- Knowledge of communication support strategies.
- Self-efficacy.
- Preparedness to provide care.
The control group didn’t show improvement in any area.
YouTube training videos for MESSAGE
The University of Queensland has shared two training videos on YouTube. Each video describes the MESSAGE communication strategies and illustrates with an example.
One video is directed towards family, friends, or other care partners.
The other video is directed towards staff.
Maximize attention
The quickest way to sabotage a conversation is to start talking before you have the other person’s attention. Another major problem I often see is that people try to complete with loud background noise.
Professors Conway and Chenery recommend that we:
- Attract attention before you speak.
- Avoid distractions.
- Take turns talking in group settings.
Expression and body language
So much of our meaning is conveyed by our facial expression, tone of voice, and body language. Even if we don’t understand what someone is saying, we still get a sense of whether someone is trying to be helpful or pleasant versus angry or demanding.
In the MESSAGE videos, we’re told to:
- Stay relaxed and calm.
- Show interest.
Keep it simple
When we talk, we generally use the sentence length and structure that feels most comfortable to us. It’s what feels natural, and it’s probably similar to what we hear. This usually doesn’t cause problems.
However, when we’re talking with someone who has some trouble understanding speech, then we can run into problems.
We can achieve communication success or failure simply based on the words we choose to say and how we put them together.
Which one do you think would be easier to understand?
- Your appointment with Dr. Smith is 9 o’clock tomorrow morning, so we’ll have to get up an hour early to make sure we’re there on time.
- You have an appointment with Dr. Smith tomorrow at 9 am. We’ll get up an hour early tomorrow morning. We don’t want to be late.
Professors Conway and Chenery suggest we:
- Use short, simple sentences with familiar words.
- Offer clear choices.
Support the conversation
Another problem I often see is that people don’t make accommodations in their language when they talk with someone who is struggling. They tend to talk louder and faster, repeating themselves without pausing to give the other person time to process. Another unhelpful pattern is to assume the other person should be able to keep track of the topic of conversation.
In the video, you can watch how the following tips may play out:
- Give the other person time to respond.
- Help them to find words.
- Repeat what wasn’t understood, then rephrase.
- Give reminders of the topic.
Assist with visual aids
Visual aids can be really helpful in conveying meaning. Whenever possible, I try to provide visible hints as to what I’m talking about. I may point or use gestures. Or I may use pictures or show objects. Sometimes, I may write down key words.
In the video, they suggest that we use:
- Gestures or actions.
- Objects or pictures.
Get their message
We know that people who have dementia may often have trouble communicating their messages. This means that in order for communication to be successful, we may need to work a little harder when they’re communicating.
Since we communicate with more than just words, we have ways to figure out meaning other than just relying on the words that are spoken. We can pay attention to tone of voice, facial expression, and body language. Sometimes paying attention to where the other person is looking can help us. We can also use the context of the situation and what we know about that person to help us.
In the video, the professors suggest that we:
- Listen, watch, and work out their meaning.
- Pay attention to behavior and non-verbal messages.
Encourage and engage in communication
One of the saddest things I’ve seen is older people with dementia being ignored, seemingly because conversation can be challenging. Depending on their level of impairment and the circumstances, they may need a little or a lot of extra support to engage.
But if we pay attention to how they respond as we talk about different things and try different activities, we can see what interests them. By noticing their facial expressions, body language, and tone of voice, we can judge how fast or slow we should talk and how many words at a time is just right.
It’s well worth the time and effort to support people with dementia in communication and social activities. Not only is it the human, humane thing to do, but research shows that the positive emotions can persist long after the memory of the interaction fades.
To conclude their advice, Professors Conway and Chenery suggest we:
- Engage the person with dementia in communication.
- Focus on interesting and familiar topics.
- Provide opportunities to talk with family and friends.
Share these tips to communicate better in dementia
Share the handout and encourage people to watch the video to learn about these communication strategies. The handout lists both the QR code and URL for the video directed towards care partners.
The handout encourages learning by asking the reader to engage with this information. Although the MESSAGE strategies are listed out, one of the tips for each strategy is missing. Helpful hint: if the care partner doesn’t have time to watch the entire video, the tips are summarized near the end, at the 19:23 mark.
You can find the link to the handout at the top or bottom of this post.
Related Eat, Speak, & Think posts
- 3 easy ways to sabotage your conversations.
- Communicate better in Lewy body dementia.
- Free course to improve conversation skills in aphasia.
Free DIRECT download: MESSAGE Tips to improve communication in dementia (patient handout). (Email subscribers get free access to all the resources in the Free Subscription Library.)
Featured image by Tumiso on Pixabay.
Lisa earned her M.A. in Speech-Language Pathology from the University of Maryland, College Park and her M.A. in Linguistics from the University of California, San Diego.
She participated in research studies with the National Institute on Deafness and other Communication Disorders (NIDCD) and the University of Maryland in the areas of aphasia, Parkinson’s Disease, epilepsy, and fluency disorders.
Lisa has been working as a medical speech-language pathologist since 2008. She has a strong passion for evidence-based assessment and therapy, having earned five ASHA Awards for Professional Participation in Continuing Education.
She launched EatSpeakThink.com in June 2018 to help other clinicians be more successful working in home health, as well as to provide strategies and resources to people living with problems eating, speaking, or thinking.
[…] Communicate better in dementia with MESSAGE. […]