Dementia and communication
Nearly every type of dementia compromises the ability to process language. It’s harder for the affected person to grasp words, to comprehend their meaning, and to track what’s being said. Communication with your family member may seem a frustrating struggle. Still, aim for interactions that maintain a positive relationship.
People with Alzheimer’s or other memory loss conditions often have trouble expressing themselves, sometimes right from the start of the disease. This can easily lead to confusion and frustration for both of you.
Your willingness to exercise patience is key to successful communication: Patience and calm, over and over and over again.
This is hard! AND it’s essential to keeping a positive relationship.
There are some practical tips, too. Even in the early stages, word finding can be difficult, so they may describe an object rather than name it. They may forget what they just said and say it again. They are easily distracted. You can help by using the following strategies:
- Avoid groups. One-on-one conversations work best.
- Limit distractions. Turn off the TV or radio. Do one thing at a time; for example, converse OR put on shoes.
- Allow time. Rushing creates stress, which makes it harder—for us all!—to find the right words or keep thoughts organized.
- Offer encouragement. Don’t interrupt or try to finish their sentences. Smile and make eye contact. Project reassurance that they can take all the time they need to say what they want to say.
As dementia progresses, you may need to redefine what a conversation is with your loved one. It may be less of an exchange of ideas and more an opportunity for your relative to engage with you. Your focus is on making the exchange a pleasant one.
- Avoid correcting them. It’s okay if the details aren’t right or their logic is “off.” When inaccuracies are pointed out, they may misinterpret your corrections as dislike or disrespect.
- Learn to read their tone and body language. Search for the emotion or meaning behind their words. For example, repeated questions often indicate anxiety. A sudden demand to leave a gathering can be a sign of confusion or overwhelm.
Your emotional tone is key. Pay attention to your body language, gestures, facial expressions, tone of voice, and volume. What will linger for your relative is how they felt about the interaction more than what was said.
Speak slowly, calmly, and patiently. Avoid long sentences, slang, or idioms (“Keep your eyes peeled”). Try to avoid comments that might leave your loved one feeling less-than or stupid.
- Don’t talk as if your relative is not there—for example, at the doctor’s office.
- Avoid correcting or arguing. Unless it creates danger, go along with their view when possible. Pointing out their deficits just engenders shame and mistrust.
- Keep stories or topics simple. They can’t follow a complicated plot.
- Avoid questions about recent events, such as “What did you do yesterday?” Focus instead on the far past and their feelings, as in “What did you used to do for fun in the winter?”
Informing or getting things done
- Do “with,” not “to” or “for.” To support cooperation, sit at the same eye level, make eye contact, touch or hold hands, and share what you would like them to do. They need to feel they still have control in their life.
- Offer binary choices: “yes/no” questions or two choices (“Would you like coffee or tea?”) rather than open-ended questions (“What would you like to drink?”). Consider offering your preferred option last. It’s often the one chosen.
- Visual cues are helpful. Show them the choices so they can point.
- Keep instructions simple, one step at a time.
“When are we going out?”
A reasonable question under normal circumstances. But if the person you care for has dementia, you may get this question multiple times in an hour. Aargh! Family caregivers describe repeated questions as a top irritant.
The repetitive questioning isn’t done intentionally, of course. Your relative simply can’t remember the answer you gave them even just a few minutes before.
- Look for the emotion behind the question. People with dementia don’t understand what is happening. They often feel anxious, confused, and left out. A repeated question is usually a sign they are worried about change.
- Remain calm and reassuring. A frustrated reply makes their anxiety worse. Provide reassurance in a calm voice and with a gentle touch.
- Write out the answer: “At 3:00 this afternoon, we are going to the doctor’s.” Many people at this stage of dementia can still read. Post the reply somewhere easy. The next time they ask, you can say “Check the refrigerator door. The answer is there for you.”
- Remove triggers in the environment. For example, keep “going out” clothes hidden until it’s time to get dressed.
- Avoid discussing an event that is going to happen in the future. Instead, let your loved one know that day or just the hour before.
- Keep simple tasks at the ready as a distraction. Folding the laundry, sorting screws, sweeping the porch. All help your relative feel helpful and engaged.
If you find yourself fed up or angry, leave the room. Take a few minutes to compose yourself. Repetitive questions are normal in dementia. Best to accept the fact and train yourself to safely let off steam away from your relative.
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