How to Change Your Communication Style with Loved Ones as Their Dementia Progresses
Dementia is a complicated disease that may get shrugged off as absentmindedness or “just age” in its earliest stages. Even when the diagnosis becomes clear, it can be hard to accept that a loved one is suffering from a progressive brain disorder and memory loss. They may look the same outside, but inside, many things are changing mentally and physically, and will continue to do so. Knowing how to communicate with a loved one as their dementia advances can be helpful and even comforting.
Though physicians talk about the stages of dementia, the reality is, dementia doesn’t progress on a definitive timeline — each patient’s experience and advancement are different. That said, at some point those living with dementia and Alzheimer’s disease will lose some or all of their ability to communicate. These are the times when your patience, listening skills, positivity and sensitivity will be needed most.
Whether you’re the sole caregiver, or your loved one is in the care of professionals in a memory care setting, one of the best ways to show your love is by continuing to work at communicating with your loved one in meaningful ways.
Medical experts have developed several strategies on how to converse with dementia patients. But to use these strategies successfully, it’s important to understand what’s different about the way your loved one processes information at different stages of the disease.
Changing Your Communication Style
The following are a few of the most common communications challenges you can expect to encounter as your loved one’s dementia progresses. Also included are dementia conversation starters (identified as talk tips) illustrating how you can successfully manage the challenges in a loving way.
Challenge: In conversation, your loved one begins repeating words, stories and/or statements. They may also have trouble finding the right words, and/or lose train of thought.
Talk Tip — Laugh It Off Together: Repeating words or stories is often the first clue that something is amiss, and as the dementia progresses, it typically gets worse. Early on, laughing together about mistakes can actually help and bring you closer together. Your loved one may feel embarrassed or anxious, and humor can lighten that feeling — as long as you ensure it’s not humor at their expense. It’s also important to avoid reminding them that they just asked the same question. Instead, simply ignore it and redirect to another topic or activity you know they enjoy, like singing.
Challenge: Your loved one begins to withdraw from group conversations and just sits without contributing or interacting.
Talk Tip — Keep It Simple: As dementia progresses, difficulty keeping up with a conversation increases which, needless to say, can be intimidating for your loved one. Be sensitive to that feeling and watch their body language for clues about their emotional state. Don’t let them be invisible by talking around them. Try to include them in the conversation, even if you have to simplify your questions or explain the conversation in simpler terms for them. If they get stuck on finding the right word or finishing a sentence, help them to work through their thoughts in a different way. It’s OK to suggest words or help fill in the blanks. Feeling included helps people with dementia maintain their sense of identity and shows that they are still valued as a person.
Challenge: When you try to engage your loved one in conversation, they are easily distracted by what’s going on around them.
Talk Tip — Run Interference: With dementia, the brain is already working overtime as “information lines” get tangled and twisted. Add in TV noise, bright lights, even too many people milling around, and confusion and agitation can escalate. Choose a calm, quiet spot for chat time with your loved one. Sit close (at their level) and in front of them to maintain good eye contact (without invading their personal space). Be sure to say your name and your relationship to the person. When you ask questions, take time to listen to how they answer, and allow plenty of time for the person to respond. Sometimes touch can help encourage “connection” such as a reassuring pat on the arm or holding a hand.
Challenge: Your loved one experiences increasing agitation, frustration, and/or anxiety over forgetfulness and their inability to communicate what they need or think.
Talk Tip — Respect, Then Redirect: Agitation and frustration are common, especially in the early and middle stages of dementia when patients are more aware of their memory losses. You can help by remaining calm and patient with your loved one during these times. Just as you would with anyone who is upset, first listen and acknowledge their feelings: “I see you’re feeling sad/upset,” perhaps include some reassuring nonverbal communication like a pat on the arm and a smile. Then change the subject. If possible, change the venue — grab a cup of coffee together or take a walk in the sunshine.
Challenge: Phone calls are your primary means of connecting with a loved one who has dementia.
Talk Tip — Make It a Love Line: Though the quality of your phone chats will diminish as dementia progresses, keep in mind that just hearing your voice is enough to brighten your loved one’s day. They can still enjoy listening to what you and your family have been up to (even the little things). Other chat strategies include you retelling precious memories, you starting up a favorite song and encouraging your loved one to join in, you asking leading questions like, “Did you have your exercise class this morning?” This isn’t a time to expect verifiable facts, so focus on just enjoying time with your loved one.
Challenge: Your loved one is having more and more difficulty making simple choices and processing what you’re asking of them.
Talk Tip — Go for Yes or No: Without speaking in a childish tone, keep your questions simple, requiring just a “yes” or “no” if possible — and try to ask just one question at a time. Instead of asking an open-ended question, like “What would you like to drink?” Ask “Would you like soda or lemonade?” Visualizing the options, on a menu for example, can be very helpful for someone with memory loss, and will allow you to guide a response, e.g., “The lemonade looks really refreshing … that might be a great choice!”
Challenge: Even the simplest activities have become confusing for your loved one.
Talk Tip — Take it Step-by-Step: Getting dressed, using the right utensils, brushing teeth … simple tasks can feel complicated to people with dementia. It helps to break down activities into a series of steps. Gentle reminders and encouragement — as well as small signs on cupboards or doors — can also help in the earlier stages of dementia. Let your loved one know it’s OK to do only what they can, and then gently assist with the rest. Again, visual cues can be valuable, such as pointing to utensils or the toothpaste tube, for example.
Challenge: Your loved one begins to speak in “word salad,” where the words don’t make sense.
Talk Tip — Make Music Together: When a loved one can no longer process language, they may put strings of words together that don’t seem to make sense. However, there still may be clues in the words, so listen carefully, and see if you can ask them a question that draws out their real thoughts.
Another loving way to connect is through song. Singing and music are also wonderful ways to connect if conversations are no longer possible. People with dementia may not remember what they had for lunch but are able to sing all the words to a favorite song from many years ago. So belt it together! Note: Be sure to ask about The Ridge’s innovative MUSIC & MEMORY® music therapy program for our residents with dementia. They receive iPods or other digital music playback devices loaded with personalized playlists of their personal favorites.
Challenge: Your loved one confuses their current life with their past life or gets confused about what is real and imagined.
Talk Tip — Go with the Flow: Dementia takes its toll on short-term memory and can also cause confusion over past and present, real and imagined. It’s human to want to correct the confusion, but it’s best to avoid pointing out a mistake and instead, focus on what your loved one is feeling when they, for example, talk about a deceased spouse as if they were alive. Respond with comforting, reassuring words and gestures, and encourage them to talk about the memories in a positive way. To people with dementia, the past is more “real” than the present … typically they can’t recall what happened 30 minutes ago, but clearly recall events of 30 years ago. Even so, keep your questions general so as not to frustrate them.
Summing It Up
Watching your loved one go through the stages of dementia isn’t easy, but it does present many wonderful opportunities for you to help make every moment count together with your caring words and actions. Kindness, patience, gentleness and positivity will be your best coping tools through these times.
Do you have a loved one with dementia? Learn what it’s like living in memory care and how to decorate a memory care room to make it feel like home. Looking for memory care services? The Ridge provides memory care in Salt Lake City and Holladay in Utah, and in Denver, Colorado.