The PSW participants expressed that there were situations in which they found communication with PLWD to be “challenging,” “difficult,” or “hard.” PSWs noted that various dementia-specific communication, and memory and behavioural impairments exhibited by PLWD were difficult to respond to and challenged the experience of
communicating. The dementia-related communication impairments cited by PSWs as posing difficulties to communicative encounters included: impaired verbal language production, reversion to a native language, and problems with topic management. The dementia-specific memory and behavioural impairments mentioned by participants as being challenging to respond to involved: wandering, suicidal ideations, reversion to the past, resistiveness to care, and physical aggression. Many participants expressed that it was challenging to communicate with PLWD who experienced communication-related impairments. Situations in which PLWD demonstrated impaired verbal language
production was among the most commonly cited by PSWs as presenting challenges to the communication experience. Participants expressed that when PLWD experienced
impairments in verbal language production, communication could be difficult due to the lack of verbal reciprocity in communicative encounters.
PSW_01_05, for example, stated that communication with minimally verbal PLWD was “...difficult. Because like, we talk for someone to respond.”
Instances in which PLWD were minimally verbal was similarly noted as
presenting challenges to PSWs’ communication experiences. PSW_01_17 discussed that
communication with minimally verbal PLWD was “hard” because it was difficult to make meaning of clients’ attempts at communication.
PSW_01_03 similarly shared that communication with PLWD, who were
minimally verbal, presented difficulties accurately understanding and interpreting clients’ true needs or wants:
Um I saw a client not too long ago, everything was ‘mhm,’ ‘ mhm,’ ‘mhm,’
‘mhm.’ Meaning I’m thinking okay everything is okay. But it may not be...Right? He’s just used to saying that. Or that’s, that’s his thing. So, and he didn’t say words. He just “‘mhm,’ ‘ mhm’ [=! Laughing]...So, like I say, you think everything is okay but it’s not necessarily.
Several participants shared that it was difficult to communicate with PLWD who were unable to speak English, either due to reverting to a native language, or a general lack of English proficiency. Participants expressed that in these situations, language barriers arose in the communication dyad, resulting in difficulties in ensuring a successful communicative encounter. PSW_01_03, for instance, described reversion to a native language as the most significant challenge she encountered in her interactions with PLWD, as it posed difficulties in recognizing and understanding clients’ wants:
Language is huge...Language. Um yeah that’s probably the biggest challenge right there...Oh um, say Italian. Or you know, like ethnicity or whatever. Yeah,
that is the biggest thing because often they revert back to speaking their own
language, right?...So they may know some English, you know. Or before they,
they knew a lot more English...But they’ll jump back to their home language. And that’s a challenge... Because not only are you trying to figure out what it is they want. Um, but you’re trying to understand their words.
An additional communication-related impairment that was cited as presenting challenges to communication involved instances in which PLWD exhibited problems with topic management. This was noted by PSW_01_17, who expressed that
communicating with clients who experienced issues with misalignment of topic was “hard,” as in these situations, PLWD “...make no sense of what they say...Like they’re try to tell you +// You try to tell them, uh, ‘Have you eaten today?’ and he, he’s talking, he, him or she’s talking about weather.”
Many participants expressed that they found it difficult to communicate with PLWD who experienced certain memory and behavioural impairments. Some PSWs, for example, shared that it was difficult to communicate with PLWD who wandered, either due to challenges associated with successfully convincing, or redirecting these
individuals. PSW_01_11 described also difficulties communicating with a client who expressed suicidal ideations because of challenges associated with effectively redirecting the client:
And for the whole six hours +// And she liked to walk. So I was walking her
around the block...And down the street and everything. And to the park. And you
know. And no matter what I said, it always came back to, ‘I could kill myself that way.’ ‘I could, I could jump out of here.’ ‘And I could be dead.’ Or, ‘if I just ran on the road would I die?’ ‘How fast would I die if I ran out on the road?’ ‘If I just stopped eating.’ And it was continuous...
Situations in which PLWD reverted to the past was also cited as posing
difficulties to the communication experience by PSW_01_03. She shared that it could be challenging to communicate with clients who reverted to the past, as it was difficult to determine if what was being communicated by PLWD pertained to a prior, or recent experience:
And, and sometimes, you know, they could be in their mind reverting back to
something that happened to them when they were a kid. But here I am I’m trying to think okay, what they’re saying has something to do with what’s going on right now. But it’s not...So that’s a huge challenge. Like where, where, what time in their life are they at? At that moment? But if they can’t tell me I have no idea, right?
Resistiveness to care was another behaviour exhibited by PLWD that was
reported as being difficult to respond. PSW_01_07 expressed that “it can be a challenge to get them to cooperate,” and further shared that communicating effectively to gain consent to perform care was an aspect of caregiving which she found to be the most difficult. Others similarly noted difficulties in communicating successfully with PLWD to facilitate the performance of care, specifically when PLWD demonstrated physically aggressive behaviours. PSW_01_12, for example, shared: “But sometimes [the client is] a little bit aggressive. Like, so hard to like, so hard to get him down to the washroom.”