Communication is important in every relationship and communicating with someone with dementia is crucial to maintain the relationship. In this post I cover ten (10) tips to keep in mind when communicating with an individual who is suffering from dementia.
- As the disease progresses, remember to approach the individual slowly from the front, never behind, and give him or her time to get used to your presence. Maintain eye contact. A gentle touch on the arm may help.
Katherine was a frail 93 year old suffering from dementia. A homecare worker was helping her shower and not thinking too much about maintaining visibility. Katherine lost sight of her and all of a sudden there was this individual in the shower with her. You can imagine how frightening that would be. Katherine reacted how I think most of us would react and punched the women in the nose … breaking her nose. It was an unfortunate incident, but it came from a place of fear.
Keep in mind your location with respect to the individual you are caring for and make sure they can see you from a distance before you get too close. This will help them orient themselves towards you and you will not startle or frighten them.
- Introduce yourself daily and call him or her by name. Do not embarrass the individual by asking “Don’t you remember me?” or “Don’t you remember your grandchildren?”
Giving verbal cues to help the individual orient themselves will help them respond to you with confidence. If you say — “Hey Mom, it’s me Janet,” as you enter the room, they will be in a better position to respond positively to you. You will have reduced their anxiety — they will know your name and the relationship by the cuing you have given them.
This is important for building self-confidence in them so that they can interact with you positively. Often, individuals with dementia withdraw into themselves because they have lost confidence in their ability to communicate with others.
- Treat each individual as an adult and don’t talk down to him or her. Be particularly mindful of this when talking to another individual within their hearing range. Avoid dismissive comments like — “she’s always confused.” Or “he never knows where he is”. An individual with dementia may not remember your words but they will remember the emotional response that came from those words.
The emotional landscape is also important when building and maintaining your relationship. The way you interact with the individual (and how you make them feel) is an important factor in building their self-confidence and reducing anxiety. When an individual feels confused and disoriented they will naturally feel very anxious. Acknowledging this state by making them feel loved and cared for will go a long way to reducing their stress levels.
- When possible, attempt all communication in a calm, relaxed and quiet environment using your natural voice. Shouting only increases agitation.
It is a natural response to increase the volume of our voice when we are not being understood. I remember when I was in high school tutoring a girl from Vietnam. She was having difficulty understanding my explanation and I found myself telling her the same thing — only louder. It was not effective!
Rephrasing information, or giving it in short bite-sized chunks is a better way to approach confusion in a conversation. This requires patience on your part.
Talk About Feelings
- Try and talk about feelings rather than arguing over facts.
You may find it difficult to discuss facts, particularly when you know they are incorrect. The best way to approach this is to focus on what they are thinking or feeling. For example, if they are concerned that something has been taken or is missing you can focus on how they are feeling and then help them look for the missing item.
You can also direct conversations into areas of opinion — what do you think of this picture? That view? This sweater? Encouraging them to tell you how they feel or to share their opinion is also a good way to build confidence in them.
- Invite participation in activities using gentle assertion rather than a question that may be easily refused. Remember, however, that too many people in a room or at an event can be over-stimulating and overwhelming for the individual — so choose your activities carefully.
Instead of saying: “Do you want to go to the coffee shop”; you might say: “Hi Mom! Let’s go to the coffee shop for a coffee.” This gives her a cue about your relationship and encourages her to take part without asking her to make a decision.
Keep Directions Short
- Give short simple directions. Do not overwhelm with too much information at once. Repeat or rephrase the direction if he or she does not seem to understand you right away.
One of the key ideas about giving short, simple directions is to give them time to process the information and react. If you want to go somewhere and they need to get ready, start by asking them to get their jacket. Then say: “Let’s get your jacket on.” Slowly move through the actions you want them to take.
It is also important to give them time to process the information and react to it.
Give Them Time
- Do not rush him or her. Allow enough time to answer questions, follow directions and express themselves at a pace they choose and find most comfortable.
If you try and move too quickly, you will end up creating anxiety and agitation. The individual will become flustered and possibly angry or upset. This means you have to give yourself extra time to get where you need to go. If your mom or dad needs to get ready to leave for a doctor’s appointment, you may need to double the time it used to take to get ready. Keep this in mind when planning so that you can remain calm as well.
- Reduce distractions in the environment and turn down or off the radio and/or television.
One of the problems with the programming of today is that the pace of the information is likely too fast for them to follow. This change of pace struck me when I was watching a recent episode of Sesame Street. I was struck by how quickly images and information flashed across the screen. This was not the Sesame Street of 50 years ago.
Information and images that move too quickly to be understood and processed just adds to the confusion. Playing classical music or looking at pictures is more soothing than trying to follow a television program.
- If the individual seems frustrated and temperamental and you don’t know what he or she wants, try to ask simple questions answerable by “yes” or “no” to try and understand his or her needs. Getting to the root cause of an outburst can help defuse it.
Unrecognized pain can be a cause of distress and angry outbursts. Asking them if they feel sore or uncomfortable can go a long way to identifying what is bothering them.
Sometimes you may feel like a detective, trying to figure out what is wrong, but it is worth the effort to decode the behaviour.
Your relationship with the individual you care for will continue to evolve over the course of the disease. While this journey can be frustrating and overwhelming for both the individual and you, there will be moments of great joy and connection which will add richness to your relationship.
It is my hope for you that you can savour those moments.