Session 4: The capacitative approach in older people with dementia and disability: the centrality of listening and speaking in the care relationship

Session Content

From the active listening to an “healthy communication”

Another point to consider if you want to make effective communications and create positive relationship it’s that you need to actively listen.

“I’m here listening to you, I’m interested in you and what you will say; at the center is you and not me, with my thoughts, my hypotheses, my expectations and prejudices; what you are and what you say is important to me! “

The ability to listen actively is very important to trigger a valid communication style. Listening actively means: assuming a series of behaviours with which we communicate to the interlocutor that we are considering him and that we intend to understand him.

Some examples:

• To emote the underlying emotions
  “I suppose this situation makes you…”
  “Sometimes I have found myself in a similar situation…”
  “What kind of emotions do you feel in this situation …”
  
• Check the degree of accuracy
  “You mean that, that is, I mean that you think that …”
• Find out where it wants to go
  “Would it help if I told you…”
  “Where do you think you’re going based on what I’ve heard…”
  “Are you suggesting that we should …”
• Go beyond the first impression
  “Tell me more …”
  “There is something else besides what I heard …”

Tips for an effective active listening:

1. avoid interrupting the interlocutor
2. avoid distracting yourself from external factors or innovating yourself
3. put yourself to one side and focus on the person speaking
4. don’t prejudice but collect the information
5. increase your attention not only to what the interlocutor is saying, but to how he expresses it
6. reformulate once you have finished the speech, to see if you have understood the message or not.

The capacitative approach

The capacitative approach is a method that is based on listening to and consequently recognising the skills that the sick elderly person retains rather than on deficits.

Focusing on the needs of the resident in relation to his stage of illness remains fundamental to care planning, but can have negative repercussions on the elderly person himself and his quality of life because he too will adapt to his role as a sick person, now only in need of care, and will feel increasingly inadequate.

The capacitative approach invites practitioners to bring out and enhance the competences that are still present. Example: the elderly person forgets everything, but can still speak, we give him the possibility to do so even if we do not communicate.

The elderly person will then be able to perceive him/herself again as a person who is able to do.

Some considerations for the successful application of this method:

1. We recognise in the elderly person all the identities (parent, spouse, colleague, etc.) and the many worlds they have passed through (they have worked, had social interests, hobbies, etc.).
2. Do not consider the elderly person to be merely sick and a mere body to be cared for. If we learn to know and recognise them for what they have been and still show themselves to be, it will be easier to establish a positive relationship with them.
3. In everyone there is still a healthy part that we want to enhance. If we always consider an elderly person with dementia only as a dementia patient, he/she will also perceive him/herself as such, unable to do anything. If, on the other hand, he/she is recognised for his/her still active competences, his/her healthy self will be better preserved and his/her well-being will improve.
4. WE RESPECT in every degree and form the:

– competence to speak: as far as possible

– competence to communicate: in their own way

– emotional competence: picking up and recognising signs of emotion

– competence to bargain/decide: let them express their will and recognise it as such (even if they cannot always be satisfied)