Communication with others is so essential to our lives that it’s hard to imagine existence without it. Yet even among adults with no cognitive impairment, achieving true understanding can be a challenge. When communicating with someone who has dementia, the challenge is much greater.
The language skills of individuals with dementia may be adversely affected in many ways. They may have difficulty finding words, substitute the wrong word or use “nonsense words” (neologisms). They can forget the names of objects or the names of friends and relatives. People with dementia often confuse generations, mistaking their wife for their mother, for example. They can eventually lose all ability to communicate verbally. Using non-verbal behaviors, in fact, is critical to effective communication in dementia (see page two for some tips on non-verbal communication).
Dementia sufferers may be trying to grapple with a world that no longer makes sense to them because their brains are interpreting information incorrectly. Misunderstandings are commonplace. Difficulties with communication can be upsetting and frustrating for the person with dementia and for those around them, and they contribute to the difficult behaviors that are often seen in dementia. Fortunately there are many ways to increase understanding.
The first duty of a good communicator is to listen. Listen carefully, and give plenty of encouragement. If the person with dementia has trouble finding words, ask him or her to explain in a different way. Take note of clues. Use what you know about the speaker to help interpret his or her meaning. Self-expression is vital to our well-being, so allow the person to talk without interruption. You may need to suggest words at times, but avoid the tendency to finish the speaker’s sentences. Instead, check for understanding by paraphrasing. Let the speaker express feelings without trying to “jolly” him or her along. Giving the speaker the gift of your time to listen closely shows that you care and can itself be therapeutic.
Attracting and Keeping Attention
It is important to be sure you have a person’s attention before you start to communicate. Make sure he or she can see clearly; turn up the light if necessary. Make eye contact. Avoid distractions such as radio, TV or other competing conversations. Make sure eyeglasses and hearing aides are in place, if applicable. Sometimes pain, medication side effects or other treatable medical situations can interfere with communication, so check with a physician about such issues if suspected.
Be calm and still while you communicate. This shows that you are giving your full attention, and that you have time for the person. Never stand over someone to communicate; it can feel intimidating. Instead, drop below the person’s eye level. This will help him or her feel more in control of the situation. Standing too close can also feel intimidating, so always respect personal space. If words fail the person, pick up cues from his or her body language. Facial expressions, movements and body postures can give you clear signals about how they are feeling. Finally, don’t underestimate the reassurance that you can give by patting the person’s hand or putting your arm around them, if it feels right.
Be Clear and Keep it Simple
The ability to initiate conversation declines as dementia progresses, so you will have to take more initiative. Speak clearly and calmly; avoid sharp or shrill tones, as this may be distressing to the dementia sufferer even if your words are not fully understood. Use simple, short sentences. Allow plenty of time for the person to process information. Ask direct questions, preferably one at a time, phrased in a way that allows for a “yes” or “no” answer. Avoid open-ended questions. Don’t give multi-part directions or plans; instead, break down tasks into simple steps. Try not to ask the person to make complicated decisions. If the person is having trouble understanding, try to find other ways to say what you mean, rather than just repeating the same thing.
As dementia progresses, fact and fantasy can become confused. If the person says something you know isn’t true, try to find ways around the situation rather than responding with a flat contradiction. If the person says “We must leave now − Mother is waiting for me”, you might reply, “Your mother used to wait for you, didn’t she?”
Always avoid making the person with dementia feel foolish in front of other people. Don’t talk down or adopt a patronizing tone. Try to include the person in conversations with others, adjusting your communication style if needed. Socialization can help a person with dementia to preserve his or her fragile sense of identity. It also reduces feelings of exclusion and isolation.