Communicating with an Alzheimer’s or dementia patient is one of the most difficult tasks a caregiver faces as the disease progresses. This communication requires a different approach than the way we may communicate with others in our life. Alzheimer’s and dementia cause structural and chemical changes to the brain, which impacts a person’s language comprehension, linguistic skills, social communication, memory, behavior, and personality. Most illnesses that cause dementia do their damage gradually, so the symptoms do not onset as suddenly as someone who has had a head injury or stroke. If we can adapt the environment to the person’s needs, as these changes occur, we can reduce many frustrations and behavioral symptoms. No one is born knowing how to communicate with a person with a dementia, but learning these skills can make caregiving less stressful and improve your relationship with your loved one. Here are some tips to get you started:
1. Set a positive tone for each interaction
Your tone and body language often speak louder than your words. Try to approach your loved one with a pleasant tone and positive mood. Be sure to ask, rather than demand or command. Use your facial expressions, tone, and physical touch to help convey your message with affection and respect.
2. Gently get the person’s attention
People with dementia and Alzheimer’s often have difficulty focusing, so limit distractions and noise when trying to communicate—turn off the radio or TV, close the door, or move to quieter surroundings. Address the person by name and use nonverbal cues and touch to help keep them focused. Make sure that you are on their level, if seated, and maintain eye contact.
3. State your messages concisely and clearly
People with dementia often have difficulty with language processing and comprehension, so be intentional about using simple words and sentences. Speak slowly and in a reassuring tone. Avoid raising your voice higher or louder; instead, pitch your voice lower. Ask one question at a time; those with a yes or no answer usually work best. Use visual prompts or clues when appropriate and helpful.
4. Repeat yourself as needed
You may need to repeat yourself and this can, understandably, be one of the most frustrating things for caregivers. Remember that their brain’s “scratch pad” is gone and they are hearing this for the first time. Try to avoid saying, “I already told you,” or “Don’t you remember?” Maintain a calm, respectful tone. If frustration arises, take a break and come back.
5. Avoid reality checking or arguing
Arguing, reality checking, or correcting can often create frustration and anxiety for people with dementia. Instead of correcting the way that they remember an event or arguing about whether you’ve already told them something, try agreeing and joining with them. It’s okay if what they remember isn’t accurate. What matters most is creating as much comfort and harmony as possible in the environment. This will, in turn, greatly reduce stress for the caregiver and behavior problems in the dementia patient.
6. Listen patiently
Be patient in waiting for a response. Observe their nonverbal cues and body language. Listen for the emotions and meaning underneath their words. If they are struggling, it’s okay to suggest words.
7. Break down activities into small, manageable steps
You can greatly reduce overwhelm and frustration by breaking tasks down into a series of steps. Gently remind them of their next step and use visual cues when helpful.
8. Maintain a sense of humor
Using your sense of humor, though not at the person’s expense, is a great way to reduce frustration and create more connection with the person with dementia. People with dementia often enjoy laughing alongside others.
9. Have realistic expectations
People with dementia are experiencing damage to their brains. They will often remember things incorrectly, emotionally over-respond, ask the same questions repeatedly, make decisions that don’t make sense to us, etc. Having realistic expectations can reduce frustration and improve daily life for all.
10. Respond with reassurance
People with dementia often feel confused, anxious, and unsure. Even when they are remembering things incorrectly, the feelings they have are real. Focus on responding to the feelings with comfort, support, and reassurance, rather than addressing the accuracy of the content.
11. When communication becomes difficult, distract and redirect
If your loved one becomes upset, try changing the subject or environment. You can revisit at a later time when they are more regulated. Be sure to connect with their feelings before redirecting. i.e. “I can see you’re feeling frustrated—I’m sorry you’re upset. Let’s go for a walk.”
12. Reminisce together
Remembering the good old days can be a soothing activity. Many people with dementia still retain clear memories of their earlier life. Ask them questions about their distant past and enjoy the stories they have to tell.
13. Pick your battles
Try your best not to sweat the small stuff. Before addressing something, ask yourself, “does this behavior put someone as RISK?” If not, it may be worth letting it go. Some behaviors may cause irritation or embarrassment for a caregiver, but there may be more payoff in finding new ways to relate to that behavior (i.e. use of humor) than the battle that comes with trying to address it.
Sources: Family Caregiver Alliance, Alzheimer’s Association, Memory Care