Communication and Dementia

“Dementia is a shift in the way a person experiences the world around them.”  ~ G. Allen Power, MD

We all seek community, purpose, meaning, connection. Our need for relationship and social connection is at the heart of being human. That doesn’t change if we are living with Alzheimer’s or another dementia.

Communication aids us in building, maintaining, and strengthening relationships. Social connectedness contributes to our overall social, emotional, and physical well-being.

For individuals living with dementia, changes to the brain affect cognitive abilities such as memory and language. They may experience hearing or vision changes as well, which can add to challenges with communication.

It’s important to recognize that for people with dementia there is a shift, as Dr. Power shares, “in the way a person experiences the world around them.”  As the dementia progresses, there will also be changes in how individuals living with dementia express themselves. Yet, as changes happen, there are many ways to facilitate meaningful connection and communication.

In our work as geriatric care managers and creative engagement specialists, there are certain practices we use that work well to optimize social connectedness, communication, and build relationships.

Before you dive into conversation

Some gentle reminders. These are often referred to as the 10 Commandments for Dementia Caregivers:

• Agree, never Argue
• Redirect, never Reason
• Distract, never Shame
• Reassure, never Lecture
• Reminisce, never say, “Remember?”
• Repeat, never say, “I already told you.”
• Say “Do what you can.” never say, “You can’t.”
• Ask, never Command
• Encourage and Praise, never Condescend
• Reinforce, never Force

A few things you’ll want to consider to create a calm environment and improve communication include:

• Is the person in your care comfortable? Is the space where you’ll be conversing quiet, calm, and free of distraction such as the TV or other background noise? A busy café is not an optimal environment, but a sitting room or apartment with comfortable seating might be perfect.
• Be thoughtful about time. Don’t rush or overstay your welcome. For some, thirty minutes is optimal. For others, two hours or more can be a wonderful morning of reminiscing, singing, coloring, dancing, strolling, sharing. Both short and long stays are okay. As dementia progresses expect that how you visit will change.
• Be flexible, adaptable. We all have good days and bad. Be prepared for either. Go with the flow. Plan how best to connect accordingly.
• Make sure other needs are met. When someone is hungry, or in pain, or needing to use the bathroom, it can be uncomfortable and distracting. Be observant. Watch for cues. Tending to these needs will maximize comfort.
• Have a topic or two ready. Does your mom love gardening? Ask her about her favorite flower or vegetable. Does your grandpa love cars? Ask about his first car. See where the conversation goes. Listen. Be open.
• Ask Beautiful Questions. This is a method developed by Anne Basting, PhD, author of Creative Care and creator of TimeSlips. The beauty of this method is there are no wrong answers and the exchange can be one of joy and wonderment, something we all need more of!

Communication Basics

As an individual’s dementia progresses, you’ll find you may have to initiate conversations. Here are approaches with which we’ve had success:

• Be present, focused. Give yourself permission to be in the moment, the here and now. Focus on the person with whom you are engaging in conversation.
• Eye contact is important. It also helps to be at the same level, physically, with the person with whom you are conversing. Don’t stand or hover over them.
• Do not talk over or on behalf of someone, especially in a social or clinical environment. Give them space and time to speak for themselves.
• Be patient. Slow down. Match your pace to theirs. Be comfortable with pauses, breaks. Don’t rush. Give them time to respond. This may feel uncomfortable at first, but it’s important, and it gets more natural with time. It’s also OK to be quiet and enjoy it. Listen to the birds, the sound of the breeze through the trees, the waves lapping across the beach, the laughter of children at the park.
• Tame the electronic devices. Silence your phone. Turn off the TV. Your attention should be in the present and on the person in your care. You might turn on the radio later to enjoy some music, or watch a favorite TV program later, or share a video of your grandchild from your phone; but for now, silence devices.
• Use prompts such as visual cues. Photos and photo albums are a great launching point for conversation. Avoid using the phrase “Do you remember…?” Instead, try something like: “Look at this picture of the family at the lake. That was so much fun! You always made the best potato salad. What did/do you love most about those trips to the lake?”
• Keep it simple. Don’t ask too many questions or go into lengthy explanations. Keep your sentence short and simple. Make choices easy too, use an either-or approach. For example: “Uncle Paul, I brought some cookies from your favorite bakery. Would you like an oatmeal or a chocolate chip cookie?” or “Mom, it’s a beautiful day outside. Would you like to take a short walk or sit out on the patio?”

An Invitation to Discovery

Understanding that as a person lives with dementia their ability to receive communication and how they communicate changes. We can adapt how we approach them and modify our expectations of these interactions.

As Susan H. McFadden, PhD reflects in her book Dementia-Friendly Communities: Why We Need Them and How We Can Create Them, “Accompanying our friends through dementia and discovering meaningful ways of remaining in relationship requires that we abandon the common bleak narratives about their condition as well as the defensive denial of the losses dementia brings to our lives. It’s hard, but important, to learn to live with our sadness about the changes wrought by dementia while also remaining open to possibilities for love and joy in the moments of connection with our friends.”¹

Struggling to bridge the communication gap? We can help! Click here to schedule a free, get-acquainted call today to explore how we can help you close the gap. 

Endnotes

1          McFadden, S.H. (2021). Dementia-Friendly Communities: Why We Need Them and How We Can Create Them. London, UK: Jessica Kingsley Publishers. (p. 121)