Dementia is an umbrella term used to describe a group of symptoms. Those symptoms can arise as any negative change related to thinking, including; difficulty with memory, language, reasoning or problem solving. Those symptoms, commonly referred to as cognitive changes, may affect the way a person communicates.
Program Director for the DENT Integrative Center for Memory, Sarah Harlock, explained over Facebook Live why these communication breakdowns happen and techniques you can use to improve communication between you and the person in your care.
Importance of Communication:
It is important to note that there are many types of dementia, including but not limited to; Alzheimer’s disease, Lewy Body dementia, and Frontotemporal dementia. That being said, it is important to understand that communicating with someone with Alzheimer’s disease may be different than communicating with someone with frontotemporal or vascular dementia. Approaches in communication may need to vary from person to person, dementia diagnosis to dementia diagnosis.
“It’s helpful to think of dementia communication as a continuum. The person you’re caring for with Alzheimer’s may not be able to communicate the same way as the person sitting next to them who also has Alzheimer’s,” said Sarah Harlock, program director for the DENT Integrative Center for Memory.
“Communication, at its core, is about connecting with another person,” said Harlock. “Although, sometimes communication may be about giving an instruction or direction, try to remember that communication is about making emotional connections and that is what the person with dementia is trying to do.”
In the later stages, dementia can be accompanied by changes that may impact a person’s ability to communicate.
Vision changes are a large part of a late stage dementia diagnosis. A person with late stage dementia may experience significantly diminished peripheral vision.
“For example, if you put a cup of coffee on the side of their place-mat and they keep asking ‘where’s my coffee,’ you, as a care partner may be frustrated and keep saying ‘it’s right there, it’s right there’. It’s important to remember that they are not asking to annoy you, or be difficult, the loss of peripheral vision has made it so they really can’t see it,” added Harlock.
Depth perception and the ability to discriminate colors can also diminish as a dementia diagnosis progresses.
As dementia progresses, hearing changes can occur making it difficult for a person with dementia to hear certain pitches, particularly higher pitches.
In addition, as the disease progresses it can be hard for a person to distinguish between background noise and foreground noise.
“Whereas our brains can tune out background nose and focus on the conversation at hand, that can become increasingly difficult for a person with dementia, making it hard for them to follow a conversation,” added Harlock.
Creating a quiet and calm environment can be helpful when trying to communicate with a person in that stage.
The importance of sensory perception can often be overlooked. However, sensory perception can be very important for people with dementia. Often they can become too hot or cold, and even the feeling of clothing can be uncomfortable for the person, so try to be mindful of that.
When having a conversation with someone we expect them to respond back in a timely manner or give us non-verbal clues that they are thinking about their answer. This processing time can change significantly for a person with dementia.
“Processing time for someone with moderate to late stage dementia can take up to 90 seconds,” said Harlock. “In that case, repeating what you said louder again and again won’t help, it will only frustrate the person. Slow it down and give them a chance to process the information,” said Harlock.
“Many times, in the late stages, a person with dementia may revert back to their primary language. For instance, if a person’s first language was Spanish, and they learned English later in life, it is not uncommon for a person to begin solely speaking Spanish,” added Harlock.
Emotion can play a large part in communication for someone with a memory or mood disorder. For example, if a person is anxious it causes them to be distracted, which can affect their ability to retain information.
“It is important to recognize that a person’s emotional state will impact their ability to communicate,” said Harlock.
Verbal vs. Non-Verbal Communication:
There are many things you can do as a care partner to make communication easier for you and the person you’re caring for, both verbally and non-verbally.
When speaking, avoid slang or jargon. Remember to slow it down, including both talking slower and allowing for a longer processing period.
Tone of Voice:
“If you want someone to do something, make sure you are saying it in a way that makes them want to cooperate with you. If you are gruff, unfriendly, or you’re stressed out, the person will pick up on that and be less likely to do what you are asking of them,” said Harlock.
“Most communication that happens is non-verbal. Body language, facial expressions and eye contact, all play a big role in communication,” said Harlock.
Facial expression can play a huge role in communication with a person who has dementia. “If you looking for someone to do something, make sure you are making the correct facial expression that will get you the cooperation you need, “ said Harlock.
“If you are acting aggressive or assertive a person with dementia will pick up on that and think ‘Whatever he/she wants me to do doesn’t look like fun, so I’m not going to do that.’ So make sure your body language is really calming.” added Harlock.
“If understanding language has become very difficult, we can use gestures to get our point across,” said Harlock
“Due to the vision loss, make sure you are in their line of sight and engage them in conversation,” said Harlock.
Effective Techniques will vary from person to person and type of dementia to type of dementia, however generally these tips can be very useful for creating meaning and effective communication.
1. Speak slowly and calmly
2. One question or instruction at a time, keep it clear and simple.
3. Allow time for a response. *remember it can take up to 90 seconds to process the information and respond
4. Tell the person what you want them to do, not what you don’t want them to do.
5. Be more positive in your communication. Avoid using the word no (unless safety is at risk, then use the words you need to
6. Simplify questions, don’t make them too long, keep them clear and concise
There are a few additional techniques that can help have more positive and productive communication with the person in your care.
Validation is a way of opening up communication lines.
If the person you are caring for keeps saying ‘I want to go home now’ rather than saying something terse, like ‘you are home’ over and over, try a different approach like, ‘tell me about your home or what home are you thinking about.’
This method will open the door and allowing for meaningful and productive communication.
Described as a detour from the truth, this technique can be very helpful and very kind for the person with dementia. This technique is best used when telling the truth will be more hurtful than helpful.
“I once worked with a woman who had dementia and would get very upset that her mother didn’t know where she was. She would become agitated wanting to get in touch with her mother. Unfortunately, the woman’s mother had died many years ago, however, instead of saying ‘your mother passed away’ only creating further agitation. we would use therapeutic fibbing to say something like “Your mother called, she wants you to stay for dinner,” and immediately the woman would calm down and be so relieved that her mother was no longer worried,” said Harlock.
Watch the full presentation below:
The content of this post is intended for general educational and informational purposes only; it does not constitute medical advice. Readers should always consult with a licensed healthcare professional for diagnosis and treatment.