Most of us will know or encounter someone with dementia in our lifetime. Researchers predict that by 2030, nearly one million people in Canada will be living with some form of the disease (Alzheimer’s, Lewy Body, Frontotemporal, etc.).

A person with dementia may not be able to carry out a conversation in the typical way, making communicating with them challenging. But this doesn’t have to impact your ability to connect with them in a meaningful way. Being empathetic, respectful and sensitive to their cognitive abilities will help you communicate effectively and cultivate a meaningful relationship with them — one that is incredibly impactful for both of you.

Here are some helpful strategies for communicating with someone with dementia.

MEET THEM WHERE THEY ARE

First, it’s important to understand that the person’s cognitive ability may change from day to day. Take a few moments to assess how they are doing before diving into a conversation. This will allow you to adjust your approach as necessary.

Next, use what you know about the person to help you engage and connect with them. Suggest activities and topics of conversation that you know will interest them — like their favourite hobbies, music, people or pets. These topics are more likely to be in long-term memory and easier for them to recall.

If they say something that doesn’t match reality, avoid correcting or contradicting them. Instead, accept what they’ve said and integrate their reality into your conversation.

Example:

If you mention that it must be nice to be retired, a person with dementia may respond with, “I’m not retired yet!” Instead of correcting them, say, “Oh, of course. My mistake. What do you love most about your work?”

If they are upset or scared about something, validate their concerns and demonstrate that you are on their side and willing to work together to fix the problem. It can be easy to dismiss their fears by saying, “Don’t worry about that; everything is fine,” but feelings of anxiety and fear can persist even if they can’t remember what they were concerned about in the first place. The best way to reduce their anxiety is to allow them to express it and then help to solve the problem and redirect it.

Example:

A person with advanced dementia may not remember that their wife has passed away and be feeling anxious about where she is. While being honest can feel like the right thing to do, it would be better to ask the person if you can sit with them and listen to their concerns. Paraphrase what they are saying to show you understand and are listening (validation), then ask questions to help redirect the conversation:

  • Does your wife do the grocery shopping? I heard it’s busy at the store tonight, and lineups might be holding people up.
  • What sorts of meals does she like to cook? Do you have a favourite meal that she makes for you?
  • I’m getting hungry. Should we find a snack and watch TV while we wait?

Approaching the situation this way will help calm the person and relieve their anxiety.

It is essential to help people with dementia maintain a sense of self-efficacy and dignity by allowing them to keep doing as much in their daily lives as possible. It will take them longer and they will need your help — even for things they used to do easily — but the cognitive challenges and stimulation will help them maintain a sense of purpose and slow their cognitive decline. An effective approach is to demonstrate a task in stages and let them follow you one step at a time.

Example:

You could wash dishes together by showing them how you want the dishes scrubbed, then move on to rinsing and drying. The key is only to do one part of the task at a time. Try to avoid correcting mistakes and instead offer encouragement.

PRIORITIZE RESPECT

It can be incredibly frustrating trying to communicate with someone who can’t remember parts of your current conversation. Short-term memory loss may cause them to repeat themselves often or ask you to repeat yourself. It is entirely reasonable to be frustrated, so it’s vital to have strategies that keep you from taking your frustration out on the person with dementia.

Example:

If they have asked you the same question several times, use your answer to steer the conversation elsewhere and change the topic. “Yes, we are on our way to the restaurant for dinner. What do you think of the song on the radio?”

Redirection is also more effective than arguing or methods of force to prevent a person with dementia from doing something problematic. Invite them to do something with you or have a conversation about something they’ll enjoy as a way to distract them.

Try to avoid giving commands and instead word your requests as invitations. A person with dementia is much more likely to resist if you are firm and commanding than if you make the request seem enjoyable.

Example:

Instead of “sit down here,” try “Do you want to get comfortable on the couch with me? I saved you a spot!”

Remember, if you become overwhelmed, it’s okay to step away from the conversation to reset and relax before continuing.

COGNITIVE CONSIDERATIONS

A person with dementia takes three to five times longer to process information than the average individual. Having patience is key! Speak slowly and clearly and use concise sentences whenever possible. Be sure to wait quietly for their responses; filling the silence will disrupt their thinking process.

Try to avoid phrases like, “Remember this?” or “Do you remember when…?” Depending on the person’s cognitive ability, they will likely not remember, and these phrases could trigger a negative emotional response.

Reducing distractions is also essential. Turn off or move away from stimulating visuals or background noises, choose communication methods that consider the person’s visual or aural impairments, and make eye contact when speaking to help them focus on you.

Visual cues are beneficial for people with dementia. If you need them to make a choice, like what they want to eat for a snack, it may be overwhelming to ask whether they want “an apple, banana, grapes or an orange.” Instead, put the options in front of them and let them choose by pointing to the one they recognize as their favourite. It is also helpful to use strong nonverbal cues like body language, gestures and facial expressions to help make yourself clear.

Even though it is harder for a person with dementia to make choices, it is crucial to maintain their sense of autonomy by giving them options whenever possible.

Example:

If they struggle with making decisions, providing only one or two options at a time can be helpful.

  • “Would you like some banana or apple? No? How about cantaloupe?”

Using visual cues can be a great way to facilitate this process.

  • When asking, “Do you want coffee?” point to the pot on the counter or hold up a tea bag if you’re asking about tea.

Your patience and empathy are vital in maintaining a healthy relationship with the person in your life with dementia. Don’t forget to take care of yourself and live a balanced life as much as possible — it’s easy to become burnt out as a caregiver, which can lead to diminished compassion. Give yourself grace if you make mistakes, lose your patience or struggle with implementing these strategies. Sometimes, it will feel like nothing you do is working or helping, but your presence and connection (even if flawed) make a big difference for the person with dementia.

As always, don’t hesitate to ask for help when you need it. Pilgrims Hospice Society’s Adult Day Program provides opportunities for individuals with dementia and other health challenges to connect, socialize and participate in a variety of activities while giving caregivers the respite they need.

References:

Communicating with people living with dementia | Alzheimer Society of Canada