Communicating with loved ones with dementia may be challenging for families and caregivers. Preparing and using communication techniques may help improve communication and foster deeper connections.
Alzheimer’s disease and other disorders that cause dementia cause severe nerve cell loss. They damage neurons and slowly destroy their connections with the parts of the brain responsible for memory, language, social behavior, and reasoning.
When it comes to communication, loved ones will notice various changes in a person’s ability to communicate. The severity will vary depending on the stage of their disease. This may range from mildly inconvenient changes, such as difficulty finding the right words, to a total inability to communicate.
Caregivers and loved ones will need patience and understanding to communicate successfully. Because each person’s experience of dementia is unique, some tips and strategies may work for one person but not the other.
This article explores how to communicate with a person with dementia and how to prepare. It also discusses possible topics for conversations and things a person should avoid saying to people with dementia.
Providing an optimal environment for communication, knowing what to expect, and preparing before engaging a person with dementia can all help make conversation easier.
Try to make sure the person is comfortable before approaching them for a conversation.
- know the time of the day when the person can communicate most clearly
- think about whether they have any needs that need attending to, such as eating and washing
- engage with the person during their “good” days
- find ways to adapt to their “bad” days
Assess the environment
Trying to converse with someone with dementia in an unfamiliar or busy space may be overwhelming. To help them feel comfortable, find a place with a quiet, calm environment with good ventilation and lighting. Additionally, turn off or remove any distractions, such as noise from a TV or radio.
Think about conversation topics
Coming up with conversation ideas beforehand can help the conversation move more easily.
- think about topics to talk about and specific ideas under the topics
- look for cues from the environment
- ask for help from their family, friends, or caregivers about things that interest them
A person should consider their mood, body language, and temperament to avoid conflict.
- relax any bodily tension by dropping the shoulders and unclenching the jaw
- take a deep breath, exhale slowly, and do not talk too quickly
- think about how the person is feeling, and try to empathize with them
- plan enough time or block out a schedule to prevent feeling rushed
- review previous conversations and incorporate practices that helped when communicating with them before
- if a person communicates with their first language and you do not speak it, consider asking other people familiar to them to help or use translated materials or translation apps
- think about how to greet and address the person
- find out if they have seeing or hearing difficulties
- plan how to approach them
The ability of people with advancing dementia to communicate may decrease as their cognitive and language skills decline. Adopting certain skills and strategies can help a person communicate and cope with the disease’s progression in someone with dementia.
Here are some tips from the Alzheimer’s Society.
Communicate and express ideas clearly
There are certain techniques a person can try. These include:
- speaking in short, simple sentences
- using basic, commonly used words
- speaking slowly and clearly
- using a calm and friendly voice
- avoiding speaking in a raised voice or using a sharp tone
- introducing oneself by using one’s names or others’ names instead of referencing their relationship (e.g., say “Hi, I’m Marie” instead of “Hi, I’m Marie, your wife.”)
- calling them by their preferred name rather than their title
- talking with them as adults and not as one would with a child
- being patient and treating them with respect
- including them in conversations
It is also important to consider how to respond to someone with dementia, especially if they are confused or say something unusual.
- give them time to respond
- do not patronize them or ridicule what they say
- acknowledge what they say to show that you heard them, regardless if it is out of context or does not answer the question
- encourage them to tell stories or say more about what they shared
- be sensitive to the person’s mood
Here are some more techniques to try for better conversations.
- use available information about the person, such as their interests
- focus on what they can do instead of dwelling on the things they cannot
- avoid talking with the person when they cannot see you
- communicate through other methods like singing or flipping through old photo albums
- be aware of one’s body language and tone of voice
- ignore the person’s mistakes
- focus on connecting with the person instead of correcting the person
- use humor to relieve tension
- do not shy away from tears
- learn to interpret based on context
- avoid criticizing, arguing, or correcting mistakes
- take breaks when things get overwhelming or frustrating
Consider pace when talking with a person with dementia.
- go with a slightly slower pace to ensure that they can follow the conversation
- pause between sentences to give the person time to process the information and respond
- keep the conversations short and regular if they tire easily
- keep the discussion focused on one thing at a time
- do not ask too many questions at once
- allow the person to complete their sentences
Communication involves listening from both parties. Caregivers should listen and attune themselves to the person with dementia. This includes paying attention to their verbal and non-verbal messages.
- use eye contact and squarely face them
- encourage them to establish eye contact when speaking or listening
- do not interrupt them or finish their sentences
- give them one’s full attention by stopping other activities
- minimize distractions that can make it difficult to focus on the conversation
- clarify and repeat what the person said or ask them to repeat what they said
- give them a nod to affirm that you are listening
- notice their facial expressions or how they hold themselves to determine how they feel as they communicate
- if they are upset, let them express their feelings
- listen to their worries and do not dismiss them
Tips for conversation topics
Conversation topics can range from memories to hobbies.
- draw from their long-term memory “treasure box”
- use photos to encourage sharing of wonderful long-term memories
- bring up their favorite songs
- use jokes and bring up things they think are funny
- use their senses as conversation starters, such as what they can see, taste, feel, or hear
- follow the lead of the person with dementia instead of sticking with a planned idea
- do not switch topics too soon and wait for the person to say what is on their mind
Asking questions can be confusing for people with dementia, so it is a good idea to think about how to phrase them.
- avoid asking too many questions
- avoid asking complicated questions
- try to stick to one idea
- use actions while talking to help give meaning to the words
- avoid overwhelming questions or those with too many options
- ask open-ended, observational questions
- break down thoughts or topics into more manageable chunks
- consider close-ended questions that are answerable with a “yes” or “no”
Non-verbal communication is an important part of caring for people with dementia.
- talk with them at a comfortable distance or as close to the person as is comfortable for both parties
- approach them and stay where they can see or hear you as clearly as possible
- be at eye level with them
- interact with them at eye level or lower than they are to avoid intimidating them
- smile at them
- be generous with facial expressions
- hold their hand or give reassuring pats
- incorporate subtle movements, visual cues, and gestures as you speak
- use prompts, such as photos or objects
- exhibit relaxed and open body language
- soften the body posture and avoid crossed arms
Feeling inferior, dismissed, and pressured to provide the correct responses may
- asking questions that make a person with dementia feel as though they are being quizzed, such as saying, “do you remember?”
- correcting or invalidating them with statements, such as “that never happened,” “that’s not what happened,” or “that’s wrong”
- making bossy statements, such as “you need to go take a shower now”
- replying with “they passed away” when a person asks about their late loved ones
- repeating things and saying, “I already told you”
- asking questions that are too open-ended, such as “where do you want to go?” or “what do you want to eat?”
- making statements with too many commands or using overly long sentences, such as “let’s go to your room, get the towel, and go to the bathroom”
- talking about a person as if they are not there and making statements to others, such as “they are getting worse”
- saying “dear” and “honey,” which can be condescending
- saying “let me help you,” which may limit a person’s independence
- using negative words associated with dementia, such as “aggressive,” “losing their mind,” and “sundowner”
- using metaphors and modern slang
There are various support pathways available for people with dementia, including:
- in-home help
- adult day care programs that offer dementia care
- in-home respite services
- nursing homes
- residential care facilities
How do you talk with someone with dementia on the phone?
Talking over the phone with a person with dementia can be challenging. It is ideal to call at a time of day when they are at their best. Join them in their topic and listen actively to what they say. Be prepared with topics, but let them lead.
How do you get someone with dementia to understand?
It can be challenging to expect a person with dementia to understand, especially in the later stages of dementia.
Planning for communication, speaking slowly, using simple language, and using active listening skills can help people with dementia and loved ones better understand each other.
How do you talk with someone with dementia who is angry?
Try not to get upset with the person with dementia. Instead, be comforting and speak in a soft, calm manner. Do not confront, reason, or argue with the person.
Angry and aggressive behaviors in a person with dementia may happen without an apparent reason or as a response to physical discomfort, frustrating event, or other causes.
Reassure the person and divert their attention to another activity.
People with dementia will gradually lose their cognitive skills, including their ability to communicate effectively. Communicating with a person with dementia requires understanding and a great deal of patience.
Preparing ahead, using various communication strategies, being conscious of non-verbal communication, and practicing active listening skills may all help improve communications with a person with dementia.