An SLP working with a nursing-home resident in the late stage of progressive dementia should most effectively focus on

• A. Conversational intelligibility
• B. Recall of salient vocabulary words
• C. Assisting in communication routines
• D. Comprehension of social discourse

Answer: (C)

In late-stage progressive dementia, the most effective focus is assisting in communication routines. Establishing and maintaining predictable interaction patterns—such as consistent greetings, turn-taking cues, simple yes/no prompts, and familiar topics—lets the resident participate in daily exchanges despite substantial language and memory challenges. This approach leverages preserved procedural abilities and reduces cognitive load, making communication more reliable for both the resident and caregivers. It also supports independence in practical needs and reduces frustration from miscommunication.

Recall of salient vocabulary words is unlikely to be reliable in this stage, since explicit memory for new or specific words is impaired. Comprehension of complex social discourse tends to be variable and requires processing abilities that are often compromised. While improving conversational intelligibility can help, it typically depends on access to vocabulary that may be difficult to retrieve, making routines a more consistently effective strategy.