Communicating with someone who has dementia

Communicating with a person diagnosed with dementia can be challenging and the way you communicate with them will need to change as they progress through the disease. 

In the early stages of dementia, a person can usually still participate in meaningful conversation but may experience some difficulty in articulating certain words.  They also can participate in brief social interactions but may struggle in prolonged social settings.  You may find that the longer the conversation goes the worse they become at keeping up with the conversation.  Shorter is almost always better.

In the middle stages a person may still be able to follow simple one-step instructions.  For example, telling someone to make a peanut butter and jelly sandwich may be too daunting a task for them to think through the multitude of steps it takes to make a sandwich.  They sometimes will not even know how to start.  Instead of saying “why don’t you make a peanut butter and jelly sandwich” and expecting them to do it with no help, you might consider saying “let’s make a peanut butter and jelly sandwich, can you get the bread out of that cabinet” then follow up with each step of the process one step at a time.  By the end you will be amazed at how many steps are actually involved in making a peanut butter and jelly sandwich.  A person in the middle stages of dementia may be able to understand written information better than just verbal. So using a recipe for something they may have been able to make from memory in the past is a good way to still involve them in a meaningful activity.  Individuals in the middle stage are also more repetitive at this point and have more difficulty following conversations. 

Communication becomes even more challenging in the later stages of dementia.  For some, the ability to communicate anything verbally may be non-existent.  They may still be trying to communicate things but in the later stages you need to become more of a detective in trying to figure out what it is they are trying to communicate.  Looking for non-verbal forms of communication may tell you that they need to use the restroom, or are hungry or thirsty, or maybe they are in pain.  Whatever the case may be, they don’t have the capacity to tell you what they want or need through verbal means. 

Here are some things to consider when communicating with someone with dementia:

• Communicate clearly and calmly – people with dementia can sense when you are frustrated

• Use short simple sentences

• Avoid asking too many questions, or complicated questions – sometimes yes/no are best

• Communicate with them at eye level

• Try to avoid areas where there may be other distractions that may keep them from focusing on you

• Allow them time to respond.  It may take them a little time to generate a response.

• Use non-verbal techniques such as sight, music, smell, or touch.

As a person progresses through their dementia be prepared for some tough questions to answer.  It is not uncommon for a person in the middle to later stages of dementia to forget that someone has passed away such as a parent or even spouse and will ask where they are.  In the early stages they may forget this as well, but can sometimes still be reoriented with a gentle reminder that they have passed.  At some point they will no longer be able to be reoriented.  Be prepared to know what to say in this scenario.  A person with dementia is not going to remember from one time to the next and it will be like the first time every time you remind them that someone has passed away.  Usually it is best to tell them that the person is out right now, or reassuring them that they are ok.  Many people struggle with this as they feel they are lying to the person.  What you are really doing is going into their reality and saving them from experiencing additional grief each time you remind them.  There may also be a time-shift with the person in that they are now living in the past.  They believe they still have children to raise or a job to get to.  They may also not believe that you are their spouse or child as they couldn’t possibly have someone as old as you as their spouse or child.  If a question gets asked that catches you off guard, don’t panic.  Simply say, “that is a really good question, let me check on that for you”, and move on to something else.  Typically, this will satisfy them and they too will move on to something else.

The most important thing to remember when communicating with someone with dementia is to stay calm.  It is easy to become frustrated with the person for either not remembering something, or asking the same question multiple times, sometimes just minutes apart.  That is part of the disease, they aren’t doing it intentionally to make you upset.  Be patient with them.  Someday they may loose the ability to ask you anything and you will long for the days when they would ask you the same question 20 times.