Insightsthe blog of Porter Hills
Communication Techniques for Persons with Dementia
Maegan Garlock, Porter Hills Village, Wellness Director
Click here to watch the WZZM13 Senior Wellness segment on this topic.
According to the World Health Organization, 47.5 million people worldwide have dementia. That is a staggering number! It is quite likely that any of us will encounter someone living with dementia. It may be a family member, a neighbor or a stranger you see on the bus. It is important to remember that dementia is not a normal part of aging. Dementia is also not one disease, but an umbrella term used to describe a collection of symptoms. Alzheimer ’s Disease is the most common form of dementia. Because different types of dementia affect the brain differently, obtaining a clinical diagnostic workup can help to identify which dementia a person has. This, in turn, will help to understand what can be expected as the dementia progresses. There is not cure for dementia, so it is essential that we understand how to help a person live a meaningful life as they experience the dementia journey.
What should we know about dementia and how to communicate most effectively?
As dementia progresses, changes in the brain can affect how a person communicates. The physical structure of the brain does deteriorate, which causes a disconnect from one area to another. In other words, the brain is unable to send signals to make sense of what someone is saying, form a response to a question or perhaps even interpret what the person is seeing. How a person communicates will look different from how they communicated when their brain was healthy. This can sometimes be awkward for the person with whom they are trying to communicate and it can be frustrating for the person with dementia.
Noting these changes, what can we do to communicate more effectively with a person who has dementia?
Remember that this is a person first and a person with dementia second. Use language which reinforces the person’s strengths instead of identifying their weaknesses. A person with dementia is still able to make decisions and still has preferences and dislikes. Include the person with dementia in conversations.
When approaching someone with dementia, it is helpful to “move slow and get low.” Try to approach the person from the front. Make eye contact and greet the person kindly. Offer your hand to the person. Once they take your hand, hold it even for a moment. Even if you have known this person for a while, it is helpful to identify yourself as you greet the person. Always address the person by their preferred name. Try to avoid terms like “honey” or “sweetie”, unless this is the preference of that person. Get to the person’s level. If they are seated, take a seat next to them. If they are lying in bed, move to the head of the bed and bend down so they can see you.
Is there anything else that may cause communication to be a challenge?
Too much environmental stimulation can pose a challenge when communicating with a person with dementia. Be mindful of noise. When there is too much noise, the brain of a person with dementia will have difficulty focusing on one sound, like your voice. This can have an impact on how well the person is able to focus on what you are trying to say. If you are out to a restaurant, try to choose a spot in a corner. Have the person with dementia face the wall, with their back to the crowd. Be aware of other noises like fans, loud talking and other sounds that may distract a person from being able to focus on your words.
Visual distractions can have a similar affect. Keep areas free of clutter. Limit the number of items in front of the person with dementia. For example, when dining, provide one or two items on a plate at a time and only the amount of silverware needed to dine. A person with dementia may have a difficult time trying to figure out what to do first and as a result, not do anything at all. Before jumping in to help, give some simple verbal cues such as “pick up your fork,” or “have a bite of bread.” Lighting may also have an effect on a person’s ability to concentrate on communication. Try to use as much natural lighting as possible. Even turning the lights off may help! Other challenges to effective communication is uncomfortable air temperature, pain and the need to use the bathroom. Use clues that the person is giving to determine their needs.
Sometimes it can be awkward to talk to a person with dementia. What can we do in this type of situation?
When talking with a person with dementia, keep messages short and simple. Provide the person enough time to respond. Think about the communication process. A person must receive the information presented to them, the brain has to make sense of that information, think of a response and then provide a response. When a person has dementia, this process may take a longer than a person without dementia. Make sure not to interrupt this process. A few seconds of silence may seem like an eternity, but if it is interrupted, the process must start all over again. If you are giving directions, keep them direct and simple. One to two steps at a time is all a person with dementia may be able to follow. Instead of giving directions down a hallway, try walking with the person. Give them cues along the way. For example, “turn right” or “open this door” are short and direct instructions.
Use visual prompts to help stimulate conversation. A photo album of old pictures may spark a happy memory. Ask who the people are in the photo or how old the person was at the time. If there is a painting on the wall, ask what they think about it. What does it make them feel? Would they have done it differently?
One of the beautiful aspects of dementia is the person’s ability to live in the moment. Keep in mind that this moment may look different than the moment you are experiencing. Validate the feelings of a person with dementia. For, the person may think that they are looking for their childhood home. Instead of saying that the house is no longer there or that they no longer live there, ask the person to describe the house. What street is it on? What is their bedroom like? Never argue with a person with dementia. You will not win. You may frustrate the person. You may become upset, but you will not win. Instead, validate how they feel about the situation that is their reality. Go along with the story they are telling you. It really is OK for the person not to have to know the real story.
Even if a person with dementia is not able to communicate with words, it is still meaningful to the person that you are there. Feelings of belonging and security will last with that person for a while. People with dementia are still able to feel lonely. But, they are also still able to feel loved. Just being with the person and sharing your stories and feelings will help that person feel connected and feel a sense of purpose.