As a person’s dementia progresses, difficulties with conversation and communication develop. It can be harder for the person to express what they want to say as well as harder to understand what is being said to them. This can cause frustrations for both the person with dementia and the person they’re communicating with. The following tips provide some ideas that may help with communication.
The Four S’s of positive communication
- With dementia it takes longer for the brain to process information so it’s important to slow down to give the person time to absorb what’s being said and to come up with a response. Too much information given too quickly can be overwhelming
- Ensure you have the person’s attention before you start communicating. It can also be helpful to introduce yourself so the person doesn’t have to struggle to remember your name, “Hi Alison, I’m your friend Jean, it’s great to see you again”.
- Use clear, direct language that makes sense easily and removes any ambiguities. Use names rather than general words like ‘he’, ‘she’, ‘it’, ‘this’ or ‘that’. For example, try “put the cup on the table” rather than “put that over there”
- Simplify choices or instructions if the person appears to be struggling. Break instructions down into small steps
- Keep the environment (and you!) calm and relaxed. Too much sensory stimulation, such as noises or crowds, can easily become overwhelming as the brain’s ability to filter out distractions begins to struggle.
- Use concrete rather than abstract language, for example, “sit on the chair” instead of “take a seat”
- Forced questions are also helpful, for example, “Would you like to wear your blue shirt or your red shirt?” instead of “What would you like to wear?” Having the options in the question makes it easier to answer.
- You needn’t rely on verbal information alone. Where possible make use of other sensory cues like vision and smell. For example, if you are offering a person a muffin you can let them see and smell the muffin rather than just hearing the word ‘muffin’
- At times touch can be appropriate, for example, guiding a person by the elbow if they are willing
- Sometimes demonstrating the action you want the person to do can help them to initiate it.
- Visual cues like whiteboards and diaries can be helpful
Things to try and avoid
Sometimes what we don’t do can be as important as what we do in maintaining positive communication.
Even if you are certain that what the person is saying is wrong from a factual point of view, arguing will only make the situation worse. People with dementia are unable to reason and problem solve as they once did, arguing only increases the agitation and frustrations of both parties. Instead try responding to the emotions behind what the person is saying, and respect that as dementia progresses people may inhabit a more personal reality that is different to the everyday factual reality.
This may undermine a person’s self-esteem as well as causing them to lose their train of thought.
This draws attention to the person’s memory problems and can affect a person’s confidence.
Keeping communication alive
Even though a person’s ability to recall recent events and everyday facts may be limited this does not mean that the person’s emotional world is impaired. People with dementia are often very sensitive to feelings especially those of failure and inadequacy. Positive communication therefore involves being sensitive to the emotional world of the person with dementia and treating them with respect and dignity.
Short term memory is often more affected than long term memory, so conversations that recall important past events may meet with more success. Conversations that are based on opinions and feelings rather than ‘the facts’ may also be more enjoyable for people with dementia.
The part of the brain responsible for understanding language is different to the part of the brain responsible for producing language. So just because someone struggles verbally doesn’t necessarily mean that they are not understanding what is being said, or the intention with which it is being communicated.
Communication can still be rich with meaning, warmth and humour even without words. Facial expression, tone, pitch, posture and gesture all convey meaning. Meaningful communication imparts a sense of rapport, respect and belonging that greatly enhances a person’s sense of self-worth. It may be easier and more enjoyable to share an activity like going for a walk or doing a jigsaw where companionship rather than conversation is the focus.
Quotes from people with dementia and their supporters
”Treat them like you normally did, just accept they’ve got a disability, but don’t feel embarrassed or anything like that, they’re no different from normal inside, they still think they’re the same”.
“Names don’t stay there, so please tell me who you are and when you meet me again remind me of who you are because I cannot, the name doesn’t stay”.
“It’s no good getting angry … I spend days sometimes looking for things like jewellery. I’m at the stage now where I think ‘oh well, sooner or later it will turn up’ and it usually does”.
“Treat them as you would like to be treated, don’t make a big thing about it. Sometimes people with Alzheimer’s or other dementias behave in a way that is unexpected and just to accept that that’s what it is”.