How to communicate effectively with someone who has dementia

By Tom Asker
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If someone close to you has dementia (Alzheimer’s Disease is the most common type) you will know that communication gradually becomes more difficult and at times frustrating. This jargon-free article explains why this happens and how you have to rethink your whole approach by:……………..

Although communication in the broadest sense goes far beyond spoken words and conversation, they do nonetheless constitute a very important element of communicating with a person with dementia. As time goes by, though, conversation will become less rich. There will be less vocabulary, less skilful development of arguments, more chopping and changing of topics.

You will of course recognize what has been lost but that is now in the past and you have to let it go – and not continue to try to get the person to recapture the old ways of conversing. This will only lead to stress and frustration. This is all part of recasting your approach to communication.

TALKING TO SOMEONE WITH DEMENTIA

If you meet up with a friend you might have an idea of a few things you want to discuss or you might just start things off by saying, ‘So what’s been happening?’ Either way, you will soon be chatting away nineteen to the dozen. When you talk to a person with dementia things are different; it is a good idea to have some kind of conversational plan – an idea of topics that are likely to work best.

In order to facilitate verbal communication of every kind there are a number of guidelines to bear in mind. Their relevance will vary according to the person as well as their stage in the dementia journey. You should ensure that what you expect of a person is within their current capability. While of course you respect the person and treat them as an equal, the truth is that you will sometimes have to engage in a little subterfuge and manipulation. You will deploy strategies and tactics in order to make things happen in the most suitable way.

You should not worry about this, as long as whatever you do, you do with respect and consideration, in the best interests of the person.

Bear in mind, too, that conversation with a person with dementia will almost invariably require more effort and energy than would be the case if you were having a relaxing chat with a friend over a glass of wine. Don’t be surprised or resentful about this.

Whatever you do, keep the amount of mental processing required of the person – consulting memory, reasoning, explaining and understanding – to a minimum.

Before saying anything, make sure you have the person’s attention. You can do this by:

  • Saying their name.
  • Being at the same level as them.
  • Gently touching their arm.
  • Making good eye contact.
  • Allowing them time to tune in.

The whole process might only take a few seconds but it will prepare the ground.

Here is an example of how you might propose an outing to a person who is around the middle stages of dementia.

YOU: ‘Mum . . .’
PAUSE. As you make eye contact, smile, touch her arm, tilt head slightly to one side, and ensure you have her attention before proceeding further.
YOU: ‘I thought it would be nice to do something together.’
PAUSE. Ensure this idea has registered (Mum might say, ‘Oh yes’) then move on.
YOU: ‘Go and see a film.’
PAUSE. Check this has registered (Mum might say ‘That’s nice’).
YOU: ‘I see Titanic is on, the big ship that hit the iceberg – you liked that film.’
PAUSE. Look for facial or other reactions that indicate understanding.
YOU: ‘Would you like to go and see Titanic?’
Note that it is a good idea to move from the more general to the more specific.

IMPORTANT POINTS TO OBSERVE DURING CONVERSATION

Avoid the use of unnecessary words

You could say:

‘Mum, do you fancy a piece of that apple pie Jane made yesterday – you said you liked it even though it was a bit sweet – I could heat it up and maybe have it with some cream, or I could make some custard. What do you reckon?’

Most people with dementia, certainly those in the middle stages and beyond, would find this hard to follow. They would understand that they are being asked a question, something to do with food, and that they need to make a decision, but mostly they would just be reminded of their failing mental powers. You could make it much easier.

Having made sure you have her attention say:

‘Mum . . . apple pie?’ Once you have an answer to that say, ‘Hot or cold?’ and then ‘Cream or custard?’

Always think a bit ahead and ask yourself if you can say what you want to say in fewer words. You usually can.

If the phone or doorbell rings, a person with dementia might be alarmed. This unexpected intrusion might generate a range of questions in their minds. Don’t say, ‘Oh don’t worry, it’s just the phone.’ It is far better to provide a full and logical explanation – if possible. This gives reassurance and an explanation at the moment the issue arises. ‘I think that will be Mr Smith the window cleaner, he said he might phone this afternoon.’ Confirm the position once you have taken the call.

Similarly, if a person is frustrated by their inability to, say, recall the name of a family pet from the past, you could just dismiss the question: ‘It doesn’t matter, it’s not important.’ Far better would be to say, ‘He was called Buster. I’ll write it down and see if I can find some old photos.’

If you talk at a rate faster than they can process, this will make it difficult for a person with dementia to keep up. Always try to go at their pace or a little slower. This can be hard. The way you are used to conversing, as compared with talking to a person with dementia, is a bit like the difference between driving fast on a motorway versus dawdling along a country road.

The person can’t change, so you have to. Pull off the motorway and get behind their car.

Don’t finish a person’s sentences for them

Despite the temptation, it is a bad and patronizing communication technique at the best of times; and don’t forget that a person with dementia will need extra time to gather their thoughts. Giving gentle cues if the person seems to be losing their thread is, however, fine.

Allow silences; this is very important

It is almost certainly the case that you will be the only one who will feel uncomfortable – as you would if a chatty friend suddenly went quiet for no apparent reason. A person with dementia needs time to formulate what they want to say; and they will become less and less bothered by the demands of social graces, for example the idea that you should always try to keep a conversation going. If there are silences, you should continue to pay attention with eye contact and perhaps slightly raised eyebrows to show that you are available.

This can be quite hard – you probably have a good idea of what the person is wanting to say, might well have heard it many times before and your attention might wander.

You might spend much of your time in a fast-moving world of offices, task-oriented work, emails, texts, and the internet, where communication occurs in split seconds. But you should try to step out of that world and into theirs and let them say things in their own way and in their own time. It is different from how you are used to carrying on a conversation – once more it’s a case of all change.

Perhaps, before spending time with a person, you should find a quiet space, breathe deeply and take a few moments to get yourself into the right frame of mind.

Deliver one point at a time

When it is you who is speaking, deliver one point at a time and try to ensure that it has been understood before moving on to the next one. Keep your sentences reasonably short and do not digress. Consider repeating some of the main points by saying them in different ways. The need to do this will increase with the passage of time.

Always remember that the person will probably struggle to retain details of long stories, so avoid these – keep them short and to the point.

Stephen Miller is a retired speech and language therapist with a particular interest in dementia and the way it affects communication. He has seen first-hand the difficulties and frustrations people with dementia and their families experience. As part of his job he gave talks to people newly diagnosed with dementia and their carers, explaining how dementia affects memory and communication.