Communicating with Someone Who Has Dementia

This post is adapted from an article by Shepherd’s Staff caregiver Bunny O’Dell

If someone you love has Alzheimer’s disease or some type of dementia, you may be finding it increasingly uncomfortable to communicate effectively. It is easy to fall back on technology to make the hours pass by more quickly. Putting someone in front of a television set might occupy time for a while, but it will quickly become boring for both of you.

I have been a hospice volunteer since 2008. My first client was a woman in her mid-80s who had been diagnosed with dementia. Not only had she stopped speaking, she no longer interacted with anyone. I was nervous about what I could do to improve her quality of life. I learned that she grew up near the ocean and loved going to the beach, so when visited  her I took a sound machine that played ocean waves and a mesh bag of sea shells, which I placed in her hands. With the background of the waves crashing, we spent an imaginary day at the beach, dipping our toes into the water, building sand castles, eating hot dogs.

Each time I saw her, I held an one-way conversation with her … it didn’t matter that she never responded. I talked about anything that came to mind. I knew she liked ice cream … so we talked about favorite flavors of ice cream.

Any topic will do when conversing with someone who has dementia. Just begin talking … about anything—favorite hobbies, travel, books, music—just begin talking, holding up both sides of the conversation if necessary.

I once spent a day with a client as a substitute caregiver. After the third time she asked my name, instead of repeating my name again, I told her that I often have trouble remembering names myself. My client replied that sometimes she tries to remember something and can’t … only to have it pop into her head later on. That simple statement led to almost six hours of conversation.

Here are some tips I have found helpful when communicating with a person with dementia is still able to speak:

1. Concentrate on the person, not the illness — this is a “person with dementia,” not an “dementia patient.”
2. Don’t yell — but speak a bit louder, if necessary.
3. Speak more slowly — but don’t talk down to the person or use an exaggerated or childish tone of voice.
4. Use language that is simple and concrete. Abstract thoughts might be difficult for the person.
5. Talk about anything you want … even the color of the paint on the wall. Just begin talking. Even if the response makes little sense, you are communicating!
6. Do not worry if the person seems to wander between the present and the past in the conversation. Just listen, accept, and do not correct.
7. Make thoughtful comments. I paused a moment with one client before I said, “You know, I agree with you.” She responded, “Thank you for thinking about what I said before you replied.” I was amazed and humbled.
8. Stay in the immediate moment. For instance, if the person asks, “What do you want me to do?” say something specific, like “Take one more bite of your dinner,” or “Put your arm in this sleeve,” or “Come outside with me.”
9. If the person becomes confused and asks, “Where am I?” don’t offer the name of the town. Instead, say “You are in your home,” … “You are in the living room,” … “You are in a safe place where people love you.”
10. Watch for agitation as the sun goes down. If it happens, speak calmly and try to meet the person’s immediate need. For instance, I found one of my clients putting on a robe at night, saying she “needed to go to the office.” I told her the office was closed now but would be open in the morning. She fretted that she might not remember, so I suggested she kept her “dress” on as a reminder. That calmed her and she returned to bed.

When someone is no longer verbal, there are still ways to communicate:

1. Talk to them! Even if you get no response, you might be the only person who takes the time to visit.
2. Play music from their era. Studies have shown that people with dementia became more alert and aware when listening to music from their youth.
3. Go through photo albums … comment on the pictures … make up stories about what you see.
4. Use physical touch but don’t crowd. Hold out your hand palm up, and allow the person to reach for it. Don’t take someone’s hand unless invited — he or she may feel trapped.
5. Back off if the person becomes aggressive. Don’t insist on what you want done. If practical, offer a stuffed animal to hold — this engages the hands engaged and may be calming.
6. Be creative! I once had a client who grew up speaking French and had liked to pray. I Googled a transliteration of the “Lord’s Prayer” in French and read it to her.

Many years ago I read a story that I will never forget. A wife was at her husband’s bedside. He had Alzheimer’s disease and no longer remembered her name. She was so afraid that he had forgotten who she was. She leaned in and whispered to him, “Do you know who I am?” He looked up at her, hesitated, and smiled. “You love me,” he replied.

Our clients might forget our names; they might forget their stories; they might forget where they are … but each of them knows deep inside when they are loved. If you listen to whatever it is they are able to share, you will be invited into another person’s story … perhaps disjointed in the telling … but a story that you might be the only one to hear.