When a loved one has dementia, there will likely come a time when your usual way of talking with them isn’t getting the results either of you hoped for. Maybe your loved one is getting frustrated because you don't understand her, or she's upset because it's difficult for her to come up with the words she's thinking of.
Fortunately, there are numerous ways to make communication easier. Dr. Camp, founder of the Center for Applied Research in Dementia, and partner for implementing the Montessori Inspired Lifestyle approach at memory care communities managed by The Goodman Group, shared some tried and true communication strategies for speaking to a loved one with dementia.
Signs You May Need to Try New Tactics
While everyone is different, there are some common signs that a person with dementia may need a different style of communication:
- If your loved one doesn’t seem to understand your questions
- If they start repeating themselves
- If they ask the same question over and over
- If they become agitated when you try to explain something to them
Talk Face to Face
Always aim to have your conversations face to face and at eye level. No one wants to be “talked down” to, which is what it can feel like if your loved one is sitting and you’re standing. It’s easy to forget this, especially if your loved one is confined to a wheelchair. Take the time to pull up a chair and sit at their level. This shows dignity, respect, and equality. Lean in close as you talk, especially if you know your loved one has hearing loss. Avoid talking to them from the side or behind, which can make it more difficult for them to hear you.
Even if your loved one lives far away, face-to-face interactions are still important. Dr. Camp recommends using a video chatting program like FaceTime or Skype rather than a simple phone call.
Use Pleasant Facial Expressions and Tone of Voice
Most of what we understand in communication is nonverbal. Facial expression, tone of voice, and body language communicate as much — even more — than our words. "A person with dementia may be able to understand your tone of voice and your facial expressions even if they're not understanding your words," Dr. Camp says. Imagine how much easier it is to respond to a smile than a frown — your loved one will feel reassured and respected when you’re aware of how your non-verbal communication can affect them.
Slow Down and Use Short Sentences
Slowing down your speech is important, especially if you tend to be a fast talker. Pay attention to the pace of your loved one’s speech, and try to match it. This will help them take in and process what you’re saying. Try to use short, declarative sentences and phrases rather than long stories or explanations. Pause frequently to let them have as much time as they need to consider what you’re saying.
Use External Cues
If your loved one has trouble knowing who people are or identifying common objects, you can help them by using labels. Encourage visitors to wear a name tag with an identifier — you may need to do this yourself. (i.e. Tom, your son) "They know who you are, they don't remember your name," Dr. Camp says. "That's very different than not knowing who you are. If we supply the name externally, we enable them to call things and people by name." Using name tags gives your loved one the confidence and dignity to connect the face with the name.
People with dementia often have difficulty finding words, even for common objects. Again, you can use labels to help. Something as simple as putting labels on things like salt and pepper shakers, milk cartons, or shampoo can make a big difference. This also gives your loved one the option of simply pointing to something they want — if they’re having trouble saying the word — and knowing they’ll get what they need.
Another technique using external cues can include a message board. Simply writing "I need", "I want" and including words or pictures for common requests like water, food, bathroom, a blanket, can be a big help when your loved one struggles to come up with the right words. You can even use apps for this type of communication.
Look Past the Literal
What a person with dementia says may not mean the same thing to them as it does to us. For example, if a person says, “I want to go home,” they may not be asking to go to a physical place. In fact, they may actually be at home and make that request. "What's happening there is they're communicating an unmet need," Dr. Camp says. "They're communicating the idea that where they are at right now — in this place, in this time in their life — doesn’t feel like home." They want to feel “at home,” in the sense of having control over their routine, things to do, a role to fulfill. The best response is to see what changes you can make in their environment so that their needs are met, they have the opportunity to contribute, and they have more control over their life.
You can apply the idea of looking past the literal to other requests, as well. For example, if your loved one asks when a deceased friend or relative living hundreds of miles away will visit, find a picture of that friend or relative to share. That may well be enough to satisfy the need to connect with someone they love and miss.
Give Them Choices
If you're having a hard time understanding your loved one, start by simply listening and repeating anything you can hear — even if it's only a few words. It's important that you validate their feelings, no matter what they are. If you're still struggling, give them choices. "It's best if the choices are two-pronged," Dr. Camp says. Do you need to go to the bathroom or would you like to get something to eat? Would you like to change clothes or would you like to watch tv? Would you like to do this now or would you like to do this later? Would you like to keep doing this or would you like to do something else? Then, they can just nod or point to an external aid.
Having to adjust to new circumstances can be challenging for anyone. Just keep in mind that your loved one isn’t trying to be difficult. They’re going through cognitive changes they have no control over. So, if your communications aren’t always perfect, just be patient. Sometimes, it’s best to stop talking altogether, hold their hand, and simply be.