By Christine Taylor
Conversing with someone who has dementia can be a difficult task and the symptoms of the disease can make for a long, slowed pace of conversation. Here are some tips to help you communicate with someone who has dementia.
1) Short and simple. Depending on the level of cognitive impairments, some seniors take longer to process information and have difficulty tracking your verbal communication. For this reason, use simple and concise sentences when communicating with someone with dementia, especially when giving instructions or encouraging behaviours. Instructions should be broken down into simple and precise language. Avoid using “um” and “uh,” and stay away from complicated language. Long sentences and lengthy verbal instruction can result in confusion and irritation.
2) Nonverbal communication is key. Use positive and healthy amounts of nonverbal communication and be careful not to look agitated, frustrated or rushed. Communication relies heavily on nonverbal behaviour, and our body language and facial expressions can send strong messages to those with dementia. Tapping your fingers or foot will appear as though you are in a rush and want to be elsewhere. Demonstrate your interest by making eye contact. Bend down to seniors in wheelchairs and converse on their level. If you are rushed or frustrated when conversing with a person with dementia, be careful not to show it. Your facial expressions should be congruent with your verbal speech. If you say that you are happy, look happy. Naturally, someone with dementia will be confused if you appear upset or mad.
3) Repeat using the same words. As it takes longer to process information, you may find that you have to frequently repeat yourself by asking the same question or providing the same information several times. If you reword your sentence, someone with dementia may interpret your communication as a new question or sentence, leading to confusion. It is best to repeat yourself using the exact same words at least a few times.
4) Be patient and move slowly. Give someone with dementia ample time to respond to a question or participate in the conversation. Allowing time to formulate their thoughts is essential. Communicating with a person with dementia requires patience. Sentences that may seem simple to you may not to the recipient. Avoid the tendency to try and finish their sentences to speed up the conversation. Allow them to converse at their own pace without added frustration.
5) Positive words and a friendly disposition. To cite one example, let’s say a senior with dementia is struggling to access food from their fridge as they pull on the fridge door at an awkward angle. Rather than interrupt with, ‘Stop yanking on the door!” in an angry and frustrated tone, step over to open it, demonstrating how it was done, and allow them to see where you gripped the handle and the angle and direction which you pulled. As hard as it may be, try to smile while doing it. Allow the senior to access food and take over the food retrieval from there so that they can retain their dignity and independence. Using a calm gentle voice will keep the situation positive and relaxed. Avoid negative connotations and instructions which a senior may internalize. And, rather than telling them not to do something, tell them what to do—“Pull the door gently.” Telling them to stop doing something will lead to confusion because they may be unclear as to what is the desired behaviour.
6) Tone. Always be careful to maintain a gentle and calm tone. This is not always easy as communicating with someone who has dementia requires a lot of patience. Take a breath, be cognizant of your tone and remind yourself that a patient and tranquil tone will help the conversation peacefully proceed. Angry, frustrated or anxious tones may trigger agitation and aggression.
7) Choice at the end of a sentence. As much as possible, try to maintain their sense of dignity, personhood and self-esteem. A great way to accomplish this is made available through the element of choice. Choice can relate to which clothes they will wear, in which activity they will participate, and what they will watch on television. But be careful how you phrase your choice-based question. Leave the choice at the end of the sentence. For example, “For dinner, would you like chicken or beef?” Stay clear of extra verbiage after the choice question, as in this example: “We can have chicken or beef for dinner tonight. Which one would you prefer?” To avoid additional confusion, do not add a secondary question at the same time. These questioning techniques should be used by all care providers whether they be homecare or long-term care, retirement home employees or family members.
8) “Evidence of listening” strategies. Eye contact, a gentle stroke of the hand and nonverbal expressions that match the conversation topic are reassuring and important. Regardless of cognitive ability, people get easily hurt and frustrated when their conversational counterpart’s attention drifts. The same is heightened when dealing with individuals with dementia. Practice active listening with eye contact and reassure them that you are listening by occasionally nodding your head. Every so often repeat back some of their own comments and make sure your facial expressions provide consistent evidence that you are engaged.
9) Employ empathy. Simply put, conversations with someone with Alzheimer’s disease can be frustrating. Dialogue can be repetitive and circular. It is at these times that we must place ourselves in their shoes. Doing so will foster patience and a sense of empathy. Remember that they don’t want to be asking you the same questions over and over again and they certainly don’t want to forget what you said mere moments ago. Participants will need empathy to get through the conversation.
10) Avoid or minimize distractions. Individuals with dementia are easily distracted, so help your loved one focus on the conversation by minimizing background noise. If your visit is in a long-term care home, find a quiet area. In busy or loud residences, this might be best served with a spot outdoors. Avoid communal areas with other people and employees. Remember to silence your phone, avoid taking calls and delay responding to texts. Taking the time to carve out a quiet, calm and serene place for your visit will make for a more enjoyable time together.
Communicating with individuals living with dementia can be incredibly therapeutic and stimulating for them. The above techniques can help the conversation flow more smoothly so that you can both focus on enjoying your time together.
Chistine Taylor is a college professor and owner of Taylored Consulting—helping seniors downsize, age in place, relocate and navigate the healthcare system, www.tayloredconsulting.ca.