Communication And Dementia- 4 Key Things to Always Remember
My Background With Communication and Dementia
My name is Jennifer and I've been a registered nurse for 10 years. Five of those years I've spent working with many patients with dementia. Communicating with someone who suffers from dementia is the biggest obstacle we face when caring for them. Our facility has spent lots of time and money in educating us as to the most effective way to approach and communicate with these individuals. I'm going to share some of that with you.
What Is Dementia?
Dementia is described as symptoms that affect the communication, intellectual, and social functioning of an individual. It is not a specific disease, rather there are many causes of dementia. Alzheimer's disease is the most common form of dementia.
If you've spent much time around anyone with dementia then you realize what an obstacle communication can be. I'm going to go over five things you should always remember when communicating with someone who suffers from dementia.
1. Get Their Attention
Your first step should be to get the person's attention. Do this before trying to communicate with them, before approaching them, or touching them. Begin by saying the person's name or what they are used to being called. For instance, if you're speaking with your dad and he's used to being called dad and responds to it, then make eye contact, smile, and say "Hi dad, it's me Jane!"
Now if you're speaking to your dad but he no longer answers to dad, say he answers to his first name of Robert, then use that instead. Perhaps he's used to a nickname, like Bob. People with dementia will often begin answering to only a certain name, forgetting at some point that they used to be called dad or Mr. Doe. Whatever name he/she responds to, try to use that name instead of what you may used to calling that person, this can ease communication from the start.
This provides them with a certain amount of comfort as well. It let's them know first you know them and who you are, second you're friendly, and third you have something you want to say to them. Do this type of greeting before anything else. Get their attention.
So, approach from the front, make eye contact, smile, and greet. These things are key in beginning your communication with someone suffering dementia. It can make or break the interaction. If you startle them or they believe you're unfriendly they can and often do immediately retreat and refuse to communicate with you.
Shaking and Holding Hands
2. Approach and Touch
After gaining their attention, as long as all is going well, now you can approach, (always from the front where they can plainly see you), and give them a friendly pat or touch of some kind. A pat on the shoulder, a handshake, or a short embrace are all examples that demonstrate friendly behavior.
If you opt for a short embrace, try to remain side-to-side with the person. Even with proper approach and a seemingly receptive behavior, aggression can be displayed without warning. So when you'd like to give a short embrace to someone you're communicating to with dementia, remain shoulder to shoulder with them facing the same way, and use one arm to wrap around their shoulder for the embrace. This avoids making them feel smothered and keeps you from placing yourself in such a vulnerable position when embracing them from the front. A better option maybe shaking hands or just holding their hand for a bit.
If opting to shake or hold their hand, go for a thumb-to-thumb grasp instead of the common palm-to-palm. Many people with dementia have a tendency to squeeze very hard. If they have your knuckles in their grasp, this can be very painful, and make it difficult to break the hold.
Communicating- Tell Me About It
3. Effective Simple Communication
Now you've gained their attention. You've made sure they are listening to you with a greeting and small touch. It's time for the actual communication. Remember use short simple directions and sentences. For instance, your father must go to the doctor today for his yearly check up and some lab work.
Don't Say- "Dad come on you have to go see Dr. Doe today for your yearly check up and some lab work."
Do Say- "Dad we're going to see the doctor today."
Keep things short and simple so their minds are able to process. If they can understand what you're telling them they are more likely to be receptive to it. It depends on the severity of the dementia as to how simple you should keep things.
Try to ask them if they do or don't want to do something when it's a matter of importance. Such as grooming and bathing. Many elderly people with dementia hate to shower or bathe and would go completely without forever if they could. When communicating with them about bathing try these techniques.
Don't Say- "Would you like to take your bath?"
Do Say- "Would you like your bath now or after lunch?"
If the person's communicating skills are very limited, don't give them a choice in the matter, this could just frustrate them. You may even have to start with simply asking them to stand up and using hand gestures to communicate this as well, motioning upward.
For instance if the person is sitting in a recliner, try kneeling down a bit to get on their level so they don't feel intimidated by having to look up at you. Then work with variations of these statements.
Don't Say- "You haven't taken a bath for weeks. You need to go take your bath now."
Do Say- "Let's stand up."
Do Say- "Let's walk together to the bath."
Do Say- "Let's go to the bath."
Implying that you'll being doing this activity together helps get compliance from the other person. Doing something together is always more enjoyable than doing it by yourself. So using the term "let's" instead of "you" is more effective. Go slow and steady and if the person begins to get agitated or violent, then back off and try again later.
So remember these things when communicating with someone who suffers from dementia:
1. Keep it short and simple as you can.
2. Give them a choice of when not if an activity will be performed. (Not always successful but it does help.)
3. If their dementia is severe, do not give them choices, just simple directions.
4. Use the terms "let's" and "we", not "you".
5. Get on their level, don't make them look up at you.
6. Use hand motions to help indicate what you want them to do.
7. Go slow and steady.
8. If the person becomes agitated or violent, back off. Try again later.
More Tips For Dementia Behavior
4. Dealing With Confusion and Difficult Questions
Sometimes people with dementia ask some very difficult questions and knowing how to handle that can be tricky. Some common questions or statements I hear are "Where's my mother?", "How can I get home?", "Where's my car?", and "Someone has stolen from me!".
Handling questions about parents can be especially delicate because in most cases the parents (perhaps your grandparents), are deceased. Of course you don't want to tell them that all the time, this would cause needless suffering. The way to handle these situations is to show you're listening and that you do care. Reorienting the to reality won't always work and a lot of times causes severe stress to the person.
Telling them they don't drive anymore and that their car has been gone a long time may cause a violent outburst. The person most times will not remember any of this and it's distressing to learn something that drastic may have happened and they don't remember. Often times, they will just sit there and argue with you. Avoid arguing with them. This does no good for anybody, it creates a lot of frustration on both ends.
Distracting from the questions can sometimes be helpful but can be difficult to do. Offering them a snack, or performing an activity together may help to distract them from some of these distressing issues. Here are some examples of what to do when some of these questions arise.
Dementia Sufferer- "Where's my mother? I can't find my mother!"
You- "You're looking for your mother?"
Dementia Sufferer- "Yes I can't find her!"
a. You- "We will watch for her together. Why don't you tell me about her."
b. You- "You miss your mother very much. Let's have some ice cream while we wait for her."
c. You- "I haven't seen her but let's watch a movie while we wait."
Acknowledge the problem, show understanding, and continue to show understanding until they calm down a little. Then attempt some distraction. Dementia is impossible to predict and sometimes none of these methods will work. The person will not give up the issue no matter what you do. In this case, at the facility where I work, we use an anti-anxiety medication to help them.
They are suffering when they are so distraught about certain situations and when no other method will work, calming them down with some medicine is better than letting them remain distraught, agitated, and miserable. Here are some more examples of how to communicate with difficult situations and questions.
Dementia Sufferer- "I want to go home!"
You- "You are missing home?"
Dementia Sufferer- "Yes I want to go home now!"
You- "Well tell me about home. Where did you live?"
Dementia Sufferer- "Well on a farm, yes on a farm."
a. You- "Oh, what animals did you have?"
b. You- "Did you help on the farm?"
c. You- "Did you buy a farm when you got older?"
The appropriate question may be determined by figuring is the person is referring to the childhood or younger adulthood. Continue talking about "home" for awhile, (even if you're at home), until the person is calm and then engage them in some other activity.
Remember to acknowledge their problem, show understanding, and don't argue with them. Allowing them to voice their feelings on the subject may help and gentle persuasion or questions to get them to talk may be needed.
Summary- Communicating With Someone Who Suffers from Dementia
Keep in mind that these things will not always be successful. Starting your communication off on the right foot really helps in maintaining a good relationship and effectively caring for the individual.
First get their attention with a greeting, approaching from the front, and a small touch. Use effective simple communication. Use hand gestures to indicate what you want them to do. Use the words "let's" and "we". If the person becomes agitated or aggressive, just back off and try again later.
When dealing with confusion and difficult questions, acknowledge their problem, show understanding, and do not argue. When the first attempts fail, try again later.
Additional Information on Dementia
- Tips for Coping with your Parent's Dementia
Practical tips for coping with some of the aspects of a parent's dementia from wandering to aggressive behavior...
- Talking to people with dementia
Communicating and talking with someone who has dementia requires a few modifications. Here are a few ideas to help you communicate in the most effective way
- Dementia - MayoClinic.com
Dementia — Comprehensive overview covers symptoms, causes and treatments of this mental deterioration.
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