Communicating With A Person With Dementia

A Waikato DHB Speech Language Therapist has kindly provided Dementia Waikato with these Communication Tips to share with families/care partners. We hope you find the suggestions useful.

Tips for communicating with a person with dementia:

• Make eye contact. Always approach them face-to-face and make eye contact. Use their name if you need to. It is vital that they actually see you and that their attention is focused on you. Read their eyes. Always approach from the front as approaching and speaking from the side or from behind can startle them.
• Be at their level. Move your head to be at the same level as their head. Bend your knees or sit down to reach their level. Do not stand or hover over them – it is intimidating and scary. They can’t focus on you and what you are saying if they are focused on their fear.
• Tell them what you are going to do before you do it. Particularly if you are going to touch them. They need to know what is coming first so that they don’t think that you are grabbing them.
• Speak calmly. Always speak in a calm manner with an upbeat tone of voice, even if you don’t feel that way. If you sound angry or agitated, they will often mirror that feeling back to you and then some.
• Speak slowly. Speak at one half of your normal speed when talking to them. Take a breath between each sentence. They cannot process words as fast as non-diseased people can. Give them a chance to catch up to your words.
• Speak in short sentences. Speak in short direct sentences with only one idea to a sentence. Usually they can only focus on only one idea at a time.
• Only ask one question at a time. Let them answer it before you ask another question. You can ask who, what, where and when, but NOT why. Why is too complicated. They will try to answer, fail and get frustrated.
• Don’t say “remember”. Many times they will not be able to do so, and you are just pointing out to them their shortcomings. That is insulting, and can cause anger and/or embarrassment.
• Turn negatives into positives. For example say “Let’s go here” instead of “Don’t go there”. Be inclusive and don’t talking down to them as if they were a child. Respect the fact that they are an adult, and treat them as such.
• Do not argue with them. It gets you nowhere. Instead, validate their feelings, by saying” I see that you are angry (sad, upset, etc…). It lets them know that they are not alone and then redirect them into another thought. For example “It sounds like you miss your mother (husband, father, etc…). You love them very much, don’t you? Tell me about the time…” Then ask for one of their favourite stories about that person).

How to communicate with someone who has moderate to severe dementia

Recognize what you’re up against. Dementia inevitably gets worse with time. People with dementia will gradually have a more difficult time understanding others, as well as communicating in general.

• Avoid distractions. Try to find a place and time to talk when there aren’t a lot of distractions present. This allows your loved one to focus all their mental energy on the conversation.
• Speak clearly and naturally in a warm and calm voice. Refrain from ‘babytalk’ or any other kind of condescension.
• Refer to people by their names. Avoid pronouns like “he,” “she,” and “they” during conversation. Names are also important when greeting a loved one with dementia. For example: “Hi, Grandma. It’s me, Jeff,” is to be preferred over, “Hi. It’s me.”
• Talk about one thing at a time. Someone with dementia may not be able to engage in the mental juggling involved in maintaining a conversation with multiple threads.
• Use nonverbal cues. For example, maintain eye contact and smile. This helps put your loved one at ease and will facilitate understanding. And when dementia is very advanced, nonverbal communication may be the only option available.
• Listen actively. If you don’t understand something your loved one is telling you, politely let them know.
• Don’t quibble. Your conversations are not likely to go very far if you try to correct every inaccurate statement your loved one makes. It’s okay to let delusions and misstatements go.

Have patience. Give your loved one extra time to process what you say. If you ask a question, give a moment to respond. Don’t let frustration get the better of you.

Understand there will be good days and bad days. While the general trend of a person with dementia is a downward decline, people with dementia will have ups and downs just like anyone else.