Dementia | Tips for Communication
Dementia--A Rising Epidemic
Do you know someone with dementia? Chances are that if you don't, you will soon. Dementia, according to the Alzheimer's Association, affects almost 1.5 million people in the US alone.
Nearly 70% of those with dementia are cared for at home by friends or family. Many caregivers will have little-to-no training in the medical field. They may have little experience with the elderly. Even if you don't have a loved one affected by this condition, you may know:
- A friend
- A relative of a friend
- A neighbor
- A co-worker
- A supervisor
- A client
Who either have dementia, or who are affected by dementia in some way. It may be a complete stranger, or someone you deal briefly with at work.
No matter the situation, communication issues caused by dementia can be problematic for everyone involved. As dementia progresses, communication can become harder, but there are still ways to make speaking and listening to a person with dementia both pleasant and effective.
How Does Dementia Affect Communication?
Dementia is not a disease in and of itself. It is instead classified as a series of symptoms related to other disorders and diseases. Alzheimer's disease is the most common cause of dementia in the elderly.
Since dementia targets the brain, it affects how people think, remember, behave, perceive and communicate. Those with cortical dementia (the type that affects Alzheimer's sufferers) experience memory loss and the increasing inability to understand language.
People with sub-cortical dementias usually do not suffer from memory loss. They can still effectively communicate, but have delays in thought processes that slow down their ability to speak and act at a normal pace.
Early Signs Of Dementia
- Forgetting a word
- Forgetting what a word means
- Using the wrong word
- Difficulty with concentration
- Trailing off mid-sentence.
- Forgetting names
Communication and Dementia--Early Stages
Often, the signs of dementia go un-noticed in the early stages of the disease. The occasional memory slip or forgotten word is chalked up to being tired or preoccupied.
If this happens frequently, the person with dementia may be aware that something is wrong. They may either hide these issues, or excuse them.
These are communication issues that happen to everyone at some time or another. If you know that the person has dementia, don't treat them as though they have a disease. Acknowledge that you know the diagnosis, but don't keep the conversation focused on it.
Don't exclude those with dementia from your conversations, either. They still have an identity and deserve to be treated with the same respect as always. If you know them well, ask them if there is anything you can do to help them understand you better.
Using Body Language For Communication
Be aware of your body when speaking to a person with dementia. Before you speak, make sure that you are calm and prepared to be patient. Approach from the front, and try to gain their attention and maintain eye-contact.
While speaking, make sure your facial expressions are in sync with what you are saying. If you are asking a question, raise the eyebrows slightly and tilt the head in an expectant manner. Lean slightly forward. These visual cues help the dementia patient understand that you are are seeking an answer.
If possible, try to sit or stand in a way that is relaxed. It helps to be at, or below, eye-level, as well. Don't loom over someone with dementia. Don't position yourself across the room, or with other people; sit down and focus on the person you are trying to communicate with.
10 Dementia Communication Tips
- Speak clearly and calmly.
- Use short, simple sentences.
- Use easy words.
- Use labels when appropriate. (your red robe)
- Answer questions.
- Use touch to reassure.
- Don't argue.
- Use proper body language
- Use visual cues and signs.
Communication In Middle Stage Dementia
The middle stage of dementia can be the longest. During this time, the person with dementia will be more forgetful of names. They will have more difficulty recalling correct words to use. They may repeat themselves frequently.
At this stage, a person with dementia is still aware that they are losing their ability to communicate and remember. They may desperately try to remain focused by asking the same question, such as what day of the week it is, over and over.
During this stage, caregivers may notice obsessive behaviors, such as checking the clock repeatedly. The person with dementia may over or under-medicate themselves as they struggle to recall when they took their last dose.
Using static objects and pictures can help in middle stage dementia. Everyday, write the date (day, month, year) on a large board. Include the day of the week, the season of the year, and whatever other information that the person with dementia seeks to validate most often.
Use signs on doors to guide and remind the dementia patient of where they are, or where they need to go. A combination of both pictures and words works well. Answer questions that are asked frequently, even if the task becomes exasperating.
Silence Is Golden
Those with dementia are no different than other humans. Sometimes they need peace and quiet. They may communicate this by becoming agitated during social activities or conversations. Allow them to have "alone" time if they seem to need it.
Companionable silence is helpful too. Sit beside them and hold their hand or just reassure them by being within their line of vision. If they cannot see, but can hear, hum to yourself to allow them to note your presence.
Speak Effectively And Slowly
After you have gained the attention of a person with dementia, you need to communicate either a question or a statement to them. To do this, you need to be concise. Too many words can confuse them, and cause you both un-necessary frustration.
Speak slowly and smoothly. This doesn't mean you need to sound like you are in slow-motion. Simply slow down your normal speed of speech a bit. If they still do not understand, try again a little slower.
Don't ask multiple questions then expect an answer. Ask one question at a time. State one phrase at a time.
- " It is a beautiful day. We are all going to the park. Do you want some fresh air? Would you like to go to the park?"
This can be confusing. Someone with dementia may not know which part to answer. Instead, ask:
- "Would you like to go to the park?"
If you are trying to communicate with someone who is also hard of hearing, you may want to make certain their hearing aids are working. Speak louder, or use visual cues.
Advanced And Late Stage Dementia Communication
Once dementia has reached the advanced stage, communication may no longer be possible. The patient may no longer recognize herself or loved ones. She may:
- Revert to baby-talk
- Use incoherent speech. (babble)
- Lose her ability to speak altogether.
During this stage, the muscles may stiffen and contract, making it impossible for her to use gestures to communicate her needs. Depending on how advanced this stage of dementia is, she may be able to recognize her name.
For the caregiver, communication at this stage is extremely difficult and heartbreaking. With only the occasional grunt or moan, it may be impossible to understand what the patient needs or wants.
At this time, the best way for the caregiver to communicate is by using a soothing, positive tone. Use the patient's name frequently. The patient may take comfort in having familiar faces and voices surrounding them.
Dealing With Difficult Questions and Statements
There are alternate approaches to re-orienting a patient. These include:
- White Lying
Distract by changing the subject or focus. This may or may not work every time.
Validate by accepting their concerns. Talk to them about the issue. Reminisce if it seems to soothe them.
Lie only when there is no other option. Too many lies, even harmless ones can have a negative impact on your loved one's trust in you. If you are speaking with someone whom you do not know well, a white lie may be the only way to extricate yourself from an awkward situation.
Re-orienting Those With Dementia
Advice differs on whether or not you should actively and consistently try to re-orient a person with dementia.
If you ask a health provider, they may advise the use of re-orientation to try to help the dementia patient identify with themselves. They may also tell you that this technique can help delay the progress of dementia.
On the other hand, another physician may tell you that attempting to re-orient someone with dementia may be ineffective and frustrating for both of you. Sessions of re-orienting may turn cause agitation in someone with dementia.
When I worked in care facilities, we were under strict orders to re-orient residents, regardless of their stage of dementia. If a resident happily told us that she heard birds singing in her room, we had to tell her that "No, she did not hear birds singing in her room. There were no birds in her room."
If we were overheard saying something to the effect of "Oh, that's nice! Do you like birds?" we would earn a citation. As one fellow worker, learned; you could also be fired for inappropriate conduct!
What was the result of this constant re-orientation? That depended on the resident. Some would become hostile and argumentative. Others would be heartbroken. Still others would either understand, or ask why there were no birds.
If you are caregiving for someone with dementia, the decision to re-orient should be discussed with your loved one's physician. Or it should be a personal choice based on your own judgement.
In my experience, correcting a dementia patient was unpleasant and frustrating. The process rarely seemed to have any positive long-term effect.
Alternative Approaches To Re-orientation
I can't afford to pay for the food in this hotel!
The food is paid for by us. This is your home.
Do you like eating in this room?
I know you are worried about the cost, but it is free.
It is a complimentary meal.
Why can't I go home?
This is your home now.
Would you like to go for a walk?
I know you miss home. Do you miss your old bedroom?
Maybe we can go home later. After our walk.
Using Visual Cues
Take good photos of common objects. Use these as visual cues for communication. Objects that are easily identified by photo can include:
- A toilet
- A bed
- A dinner setting
- A variety of foods
- A cup
- A bathtub or shower
- Clothing items
- Family and friends
- A church
- Animals or pets
A dementia patient can point to the flashcards to ask for certain things.
Listening As A Communication Skill
It is easier to speak to someone than it is to listen to what they are saying. This is even more so in cases of dementia, when hurried caregivers may give an instruction, then become frustrated when the patient balks or begins a line of questioning.
Because those with dementia forget words or thoughts, we may be tempted to finish sentences for them or guess what they are trying to say before they are finished speaking. This may work in some circumstances, but more often than not, it will cause frustration or agitation.
Take the time to listen attentively to what someone with dementia is trying to express. They may not be able to use the correct words. For example, they may say:
- I want to take a coke.
This sounds like nonsense, but we may assume they are thirsty. Their body language may say otherwise. They may be trying to say that they need to toilet. They simply cannot recall the correct words.
Watch for gestures and visual cues to better understand what they are trying to say. Don't hurry them, as this can can lead to more confusion.
Do you know or care for someone with dementia?
Patience, Kindness and Common Sense
Good communication skills are important in all aspects of our lives, but never so much as when dealing with dementia. A person with dementia depends on others for their care, and if we don't understand what they are saying, their health can be jeopardized.
Kindness, patience and common sense are the three main skills for speaking and listening to someone with dementia. By using these, anyone can understand even the most cryptic message. People with dementia are still human beings, and the need not only to be heard, but to have others desire to understand their thoughts, wants, needs, and fears.