Fundamental to the successful assessment and treatment of people with hearing loss is meaningful communication. My clients range from cognitively 100% to those in early and late stage dementia. Some clients suffer from vision impairment, reduced mobility, intellectual disability, anxiety, limited concentration, processing difficulties, depression, frailty and often present under the influence of polypharmacy. The ability to function will differ from one individual to the next. Choosing the appropriate assessment tool is essential if one wishes to obtain reliable and valid responses. A word recognition task and a sentence task for example, can provide information about discrimination ability and also the real life consequence of the hearing impairment and must be chosen appropriately and used carefully by the clinician. A task where context is given may seem more relevant because an adult is able to use their knowledge of the world and of language to fill in the blanks. For a person with dementia, however, the ability to access their knowledge may be affected because the context may not be appropriate or because the environment is not conducive to meaningful communication. A noisy dining room for example, would likely be a stressor for the individual and so meaningful communication would not be possible. Every interaction must be meaningful and the environment should support this.

Dementia sufferers will exhibit varying behaviours depending on the amount of brain deterioration together with additional impairments such as vision or hearing loss. This supports the notion that a progressively lower threshold will exist for these individuals. As Pool (2000, p. 29) states, “…we need to adopt an approach that addresses the impairment with the aim of preventing, or at least minimising the disability”. Placing a set of headphones on a client with dementia is a delicate task – I am a stranger and the client may become fearful, the room is unfamiliar, the client may be sensitive to touch, there is bright lighting and electrical equipment in a confined space – all seemingly normal things may bring about changes in behaviour and any sort of meaningful response is greatly reduced.

Fatigue has been cited as one of many stressors which increases functional impairment (Mahoney et al, 2000). An individual with dementia usually operates best in the mornings and becomes tired throughout the day. Fatigue can influence tolerance levels. A change in routine may disrupt an individual with dementia because of an inability to cope with the new environment. Familiarity is comfortable and provides structure to the day and does not impose excess cognitive demands. “The principal memory deficit in Alzheimer’s disease is the inability to store new information” (Maciejewski, 1999, p. 2). This highlights the need for appropriate communication strategies such as unambiguous language use. It is important to keep instructions simple and refrain from both quizzing the individual about irrelevant things, and testing the person which may highlight a lack of knowledge. Instead, meaningful communication such as talking about family, offering a friendly smile and good listening skills are required. Identify strengths and praise efforts. Focus on what can be done rather than what cannot be done. Can the individual express themselves creatively through music or painting? If so, promote an environment that is conducive to this. Ensuring my office is clean, free of clutter, safe and comfortable, will help facilitate meaningful communication. Bayer (2000, p. 5) states “…the immediate physical. environment is one of the most important influences on quality of life”.


Bayer, T. (2000). The dementias, Article 12: Design and environment for people with dementia living in institutional care. In Signpost, 5 (2), pp. 5-6.

Maciejewski, C. (1999). The neuropsychology of dementia. In Signpost, 3 (4).

Mahoney, E. K., Volicer, L., & Hurley, A. C. (2000). Functional impairment. In Management of Challenging Behaviours in Dementia, Chapter 2, pp. 29-46. Baltimore: Health Professionals Press.

Pool, J. (2000). Building a bridge from philosophy to practice. In Journal of Dementia Care, 8 (9).