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Tips from the Guide

Communication

Being able to talk to a person is the basis for all of our relationships in life. When the communication system breaks down, troubles begin to add up.

To understand how to best communicate with someone with dementia, you need to understand the basics of the disease, and how it might be affecting the person. Common symptoms in all dementias include progressive memory loss, language problems, poor judgment and reasoning, difficulty with impulse control, and poor coping skills. All of these make the person more emotional, and can easily lead to increased frustration. Imagine yourself in a foreign country – how do you feel if you can’t follow a conversation or can’t find the right words to say? Think of things from their perspective, and understanding communication will immediately be easier.

Communication is a compilation of verbal words (words and their meanings), voice (pitch, tone, tempo, volume), and body language (facial expressions, eyes, posture, movements, gestures). All three of these components are important because even though people with dementia may no longer understand the meaning of the words you say, they will be able to understand the remaining elements of your communication. Make sure your body and voice are conveying the same message your words are trying to convey.

Along with the challenges that a person with dementia may have in understanding communication comes changes to the person’s ability to communicate themselves. Listening even though you may not be able to understand what is said shows respect and compassion. So, even when things are not making perfect sense, talking and active listening are important. This is where body language and expression become very important communication tools.
 

Dementia Changes You Might See

Language is usually affected early in the disease and communication becomes harder as time goes by. Problems occur throughout the process and include:

• Not recognizing a word or a phrase almost as if it were spoken in a foreign language.
• Not being able to name things (word-finding difficulty), eventually not being able to say any words in a coherent fashion.
• “Perseveration” – repeating words or phrases without being able to continue to express the rest of the thought.
• Misnaming objects or people…but getting close (some may say mother when they mean wife, or pencil for paper. This can make it difficult to determine if the person doesn’t know the difference between wife and mother or if they are simply saying the wrong word).
• A tendency for multilingual individuals to return to their language of childhood or combine languages with little awareness of which language they are speaking at the time.
• Loss of ability to write, read and understand written material.
• Eventual loss of ability to communicate with others.

Remember – understanding what is being said often outlasts the ability to speak appropriately!
 

12 Tips to Try

1. You should not have conversations about the person with dementia in their presence if they are not part of the discussion. We should assume that they understand all that is being said. Nobody likes to be talked about, so include the person in your conversation, or wait until they are not around if you need to discuss something that may be upsetting.
2. Get the person’s attention before you start talking; approach them from the front. Establish eye contact before making any physical contact with the person. Use a gentle touch. Call the person by their preferred name, using a gentle tone. Deliver your message using short, simple words. Pause between sentences.
3. Limit choices. If it’s time for lunch, don’t ask the person if they are ready to eat; just say, “It’s time to eat.” On the other hand, give the person choices when it’s okay: “Would you like coffee or tea?” If this is still challenging, stick to yes or no questions: “Would you like some tea?”
4. Watch your body language: if you are angry, your face or gestures may show it, even if your words are sweet. Notice their body language, too. What is it telling you?
5. Help the person put words to their thoughts if you know what they are trying to say, e.g. “You’re trying to ask when your wife is coming, aren’t you?”
6. Ask uncomplicated questions one at a time, and repeat them, using the same words, if the person doesn’t respond. Just make sure to give them time to respond! Listen for a response. It may take up to ninety seconds for the person to process what you’ve said and come up with the right words in response.
7. Try to agree with at least part of what the person is saying. Don’t start every answer with “No, you can’t!” For example, say “Could you please come here” rather than “No, don’t go out the door!” or “You’re right, you are going home right after lunch”, is easier to take than “You have a long time to wait.”
8. Change the subject rather than waste energy arguing. It’s impossible to have a rational argument with someone who can no longer be rational due to dementia. Instead, compliment them on their smile or ask for their help, this may derail their argumentative attempts and help you feel like you’re still in charge.
9. Avoid questions that rely on memory. Don’t ask, “don’t you remember the time that…”, but rather say, “I was thinking about the time that…” and tell the story and allow them to respond from there.
10. A great phrase to use? “Tell me about it.”
11. A simple written note can sometimes help to calm a person who is trying to remember a particular piece of information.
12. Reduce background noise if possible. Although you can hear over the radio or other’s conversations, the person with dementia probably can’t focus with the extra noise and it can become overwhelming.

 

Looking for more tips?

These tips are just one part of Insight's Caregiving at a Glance Guidebook, a fingertip guide for families caring for a loved one with Alzheimer's. Techniques and strategies to empower caregivers address topics such as: troublesome behaviors, communication, eating, bathing and more.