We all communicate constantly throughout the day. Phone calls, emails, conversations, now FaceTime and Skpye – there are a million ways we communicate without even thinking about it. Much of this communication comes naturally, so why is communication so challenging with those who have dementia? It comes down to understanding. You need to understand the disease and understand their world and communication will become much easier. Here are 5 tips for understanding communication with someone with dementia.
Understand the disease
First things first – 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 behaviors 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. Also, the stage of the disease the person is in will greatly impact their ability to communicate. For those in the earlier stages, know that short term memory is often lost first. Don’t quiz the person on recent events (what did you have for lunch today is a frustrating question if you can’t remember!), but follow their lead in conversation or bring up favorite topics from the past. If the person is in the middle stages, many of the symptoms listed earlier may have set in, and these techniques below will help encourage positive communication.
Start with the Basic 6
Putting your loved one’s unique personality and interests aside for a minute, there are 6 basic steps for communicating with someone with dementia that can be helpful for everyone. First, approach from the front. You never want the person to be startled, and start off your conversation anxious! Second, establish eye contact. Third, call the person by name. These both show the person that you’re interested in engaging with them personally. Fourth, get down to eye-level if needed. If the person is sitting, take a seat with them so that you’re on the same level. Fifth, let them initiate touch. It’s easy to want to reach for someone’s hand or pat a shoulder especially if the person is a close relative or friend. However, if they have trouble remembering you, or are just processing the conversation slower, they may perceive the touch differently. Let them come to you when ready. Sixth and finally, give directions one step at a time. Again, if they are having a hard time following, saying “have a seat” is much clearer than “have a seat, take your napkin, your lunch is coming, and what would you like to drink?” Once the person is seated, then say, “here’s your napkin,” and so on.
Keep It Simple!
Getting back to your loved one specifically, how do you best communicate? Keep it simple! Just like the last step of our basic communication skills states (and it’s important to reiterate!), give directions or state requests one at a time. Explain what you are going to do using simple explanations. Use hand gestures if needed as well. Is your loved one not understanding “take your napkin?” Point to the napkin or demonstrate putting yours in your lap. They may have a slower reaction time, so allow them time to respond or take action. Offering choices can also help your loved one tremendously. Asking “would you like tea or soda” is an easier question than the open ended, “what would you like to drink?” If this is still challenging, stick to yes or no questions; “would you like some tea?” Keeping requests and questions simple will allow your loved one the ability to participate in the conversation, and still have their requests be heard.
Structure & Routine
You might be thinking, well it’s easy enough to have conversation about a meal, but what about the rest of the time? We can’t eat the entire day (as much as we might like to)! Here’s where structure and routine come in. First, structure the visit or call so that you can be prepared. Keep it short, and at a time of day that is typically best for the individual. Often that might be late morning (after they’ve had time to get up and going), or early afternoon, before they’re too tired for the day. Perhaps joining them for lunch, and then taking a short walk with them in the afternoon is a good routine for your loved one. Try out a few different call times or activities if you need to, but once you find a structure that works for you – make it the routine! This will help you both be better prepared for the visit and know what to expect. Just make sure your expectations are realistic. Everyone has good and bad days, and your loved one is no different! Don’t be discouraged if a call or visit doesn’t go well; keep trying!
Understand Their World
So finally the age old question – what do we actually talk about? Or what if we’re just talking by phone or Skype, and there’s no activities involved? Join them in their world. First, encourage reminiscing. Talk about a favorite shared memory, or family member. Before the conversation, come up with three things your loved one enjoys talking about, in case you’re at a loss for words. These could be anything from a favorite hobby or job, to talking about the grandchildren. Just 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. A great phrase to use? “Tell me about it.” This will encourage further reminiscing. And if the memory isn’t accurate? Don’t argue or correct! Arguing with someone with dementia is rarely ever beneficial. Unless the issue is one of great importance (like health or safety), it’s perfectly fine for your loved one to believe its Tuesday when it’s really only Monday. Join them in their world, and go with it. If they have some paranoia or delusions, don’t try to convince them it’s not real, because it is real to them. Just provide reassurance. Try to understand the emotion behind what the person is saying. Maybe they say, “I want to go home!” when they’re sitting in their living room. But perhaps they’re thinking of their childhood home and missing their parents. Try to reminisce about that house or a happy memory from growing up. Again, reassure the person and their feelings. What’s not helpful: “Well your parents sold that house 20 years ago and now it’s a shopping mall!” More helpful: “Your mom always used to have the prettiest flowers on the front porch.” Join the individual where they are, rather than dragging them into your reality.
Carrie Idol-Richards is the Communications Director at Insight Memory Care Center.