Dementia Communication - An Evolving Process
It is truly painful and stressful to witness the deterioration of a loved one with dementia. Communication is a common challenge for many loved ones and care partners! We are here to help in decreasing stress by providing helpful techniques to move forward effectively.
Please see our helpful communication strategies below to limit frustration and connect more effectively with your loved one! These strategies can assist in minimizing frustration for those with dementia and help the care partner maintain a positive connection on their terms and in a way that brings both parties happiness.
Please also read our other blogs on our FAACE approach to Dementia for scenarios and more which can be easily found through the search area.
Let us begin with some of the basics and why communication becomes a challenge overtime.
Dementia effects communication in several ways:
Although clearly different for everyone based on their specific diagnosis, presentation, and challenges, changes in the brain cause worsening and deterioration in terms of many broad aspects:
Memory
Attention
Focus
Overall cognition and visual perception
Communication and language skills
Problem-solving
There are many supportive and communication techniques one can use to improve communication and interactions with a loved one.
Some general guidelines to follow:
Never rush your time, stay patient.
Speak in short, simple sentences.
Allow additional time for processing word forming as this can be a challenge.
Give simple choices with clear visual cues.
Use visual cues as an additional support when speaking.
Limit distractions when possible. Find a quiet and comfortable location to meet and to talk. Ensure that any background noice is limited - turn off televisions or background music. Simple background noice can serve as a major distraction and make conversations even harder.
Speak naturally, yet clearly and slowly.
Make eye contact, and use body language, facial expressions and gestures when possible. Non verbal aspects and visual cues are going to often times become even more important.
Aside from using your voice, communicate using your body by incorporating subtle movements as these help to provide visual cueing and help to convey meaning. For example, perhaps say, “Let’s go for a walk,” and extend your arm while stating. Or, “Lets sit down” and pat and leave your hand on the chair.
Use music to connect, tap into preserved memory, and guide.
Talk about one simple topic or item at a time. Simple is key as due to short term memory impairment they often times forget past the third or fourth word and cannot reason and maintain multiple conversation points.
Use open ended questions that tap into their preserved longer term memory and current environment and situation is best. Using mem pic books (thebcat.com), photo albums, or other materials from their past in their native language may be helpful and provide comfort and talking points for expression. Photos can be powerful and again music as a means to tap into emotions and feelings as they often transcend time and language barriers.
Provide simple choices, not complex. "Do you want this shirt or this shirt?" Less is often more!
Key into and focus on words when possible if conversation is fragmented and then given them time to express themselves, but draw on the word or words conveyed to then carry the thought forward for them if unable over reasonable time or if frustration noted. This will bring them comfort as they may be unable to fully express and this will allow them closure and help them to understand that you understand and they have been heard.
All behavior is purposeful and all people want purpose. Find ways to acknowledge all communication . Find safe ways on their terms to stress what they can still do and to give them purpose.
Identifying yourself and others by name rather than by relationship as this draws on long term memory aspects and will provide them with comfort.
Do not get too focused on the words when conversing as this is no longer the only way or at times the most effective way to converse or convey meaning and understanding.
Actions truly speak louder than words with dementia in forming a connection. This is especially important when dementia is more advanced, as utilizing nonverbal communication skills drawing on basis instinctual comfort, etc.
Be in the moment when visiting and connecting on their terms. Maintaining eye contact, holding their hand, smiling and nodding understanding, and just sitting quietly with them with soft music on can make all the difference.
Again, provide them with extra time to process what is being said. If you ask a question, patiently wait for their response and avoid rushing their answer. This is very hard, but become comfortable with silence while sitting with them and communicating as overtime language skills will again decline. This can be very difficult, as when they are struggling for a word, it can be easier and at times very tempting to jump immediately in to answer for them. This can unintentionally derail their thought process and lead to frustration and even agitation. It is all about balance and patience. Given them time to express needs and thoughts and then if they appear distressed tap into what they are saying and try to simply carry the communication forward and on. Give them time and then help to bring things forward and give them a sense of closure.
That being said if one way to communicate does not work try another. Each day is a new adventure with dementia and sometimes an approach will work one day and not on another. This can be also very frustrating for caregivers and family. Communication again can be done in may ways always tapping into preserved long term memory aspects- Draw on smells, music, and other creative methods when possible. Again, this is going to be important for the advanced and later stages of dementia. Try singing favorite songs in native language or playing music or tapes of stories in native language, flipping through old photo albums, photo books of native country or past experiences, placing different smells in small dishes to experience together, such as freshly cut grass, ground cumin, cinnamon, orange slices, or flowers. Some of these things will be more possible post covid.
Recognize that some visits are not going to be good ones sadly. While dementia is a progressive disease that gradually worsens, people with dementia will have ups and downs just like we all do. Embrace and try to focus on the good days, and do your best during the more challenging ones.
As always reach out for guidance along the way. We are always happy to discuss more techniques and approaches as things evolve and change.
In terms of additional supportive resources that may help along the way, there are many online! Below are some local the we highly recommend:
Caring for Your Parent Support Group through Insight Memory Care
Third Mondays
7:00 pm to 8:30 pm
This group is specifically designed for those who are caring for a parent. Get to know others in this unique situation while sharing practical caregiving tips, personal concerns, and celebrating successes with others in the same boat.
General Community Support Group
Every Thursday
2:00 pm - 3:30 pm
All are welcome to attend this group meeting bi-monthly for family and friends of those with Alzheimer's disease or other memory impairments. This group allows caregivers to share practical advice, discuss frustrations and fears, and connect with others on a similar journey.
For more information, contact Markita Brown by markita.brown@insightmcc.org or at 703-204-4664. Most programs virtual at this time.
Please reach out along the way with any needs as we are here to guide, advocate, and help!!!