Communicating with people with advanced dementia

There are 850,000 individuals with a diagnosis of dementia in the UK, many of whom are likely to progress to a state of advanced dementia. Professional care places a considerable strain on NHS resources and the distress that Alzheimer’s places on those living with the illness, their loved ones and professional caregivers cannot be underestimated. Much of this distress owes to the breakdown in speech-based communication that accompanies the illness.

People with advanced dementia who have lost the ability to speak are typically thought to have no communicative abilities or desire to interact and, as such, are typically excluded from the social world. Research by Dr Maggie Ellis and Professor Arlene Astell of the School of Psychology & Neuroscience has found that, despite a lack of speech, people with advanced dementia retain both the urge to interact and individual repertoires of non-verbal communicative capacities including sounds, movements, facial expressions and the capacity to imitate. These behaviours can be used by caregivers to re-engage individuals with advanced dementia in social interaction - an approach now known as 'Adaptive Interaction'. Organisations providing care for individuals with dementia have recognised the value of this evidence-based approach. For example, Alzheimer Scotland recommends Adaptive Interaction in a public document and the Alzheimer’s Society commissioned Dr Ellis to develop a training programme in the approach that is currently being rolled out to approximately 1000 volunteers across the UK.

While not eliminating Alzheimer’s disease, Adaptive Interaction supports the interpretation of behaviour as intentionally communicative and provides the means to engage with those living with advanced dementia. By supporting communication, Adaptive Interaction increases the wellbeing of those diagnosed and their family members and the job satisfaction of formal caregivers.

Astell, A. J., & Ellis, M. P. (2006). The social function ofimitation in severe dementia. Infant and Child Development, 15(3), 311-319.

Ellis, M. P., & Astell, A. J. (2011). Adaptive Interaction - a new approach to communicating with people with advanced dementia. Journal of Dementia Care, 19(3), 24-26.