We take part in conversations with family, friends, and colleagues every day. We exchange ideas, provide support, and build relationships with each other. However, suppose your loved one or patient with dementia doesn't feel understood in a conversation. If there were a way to make communication a little easier for them, wouldn't you want to make that happen? By learning the stages of dementia and some essential tips, you can improve your interaction with your loved ones and their sense of well-being.
Dementia is not one disease but a broad term describing a group of symptoms of progressive memory loss and cognitive function. There are several types of dementia, with Alzheimer's being the most common. This progression of memory loss occurs in stages that may last from weeks to months to years. Communication at each level requires adaptation by family and caregivers to be more effective.
In the early stage of dementia or mild cognitive impairment, your loved one may have minor changes in language depending on the type of dementia. You may find they repeat stories and become overwhelmed when unable to find the right words. You may notice them "substituting" an incorrect term, such as calling a newspaper a book. They may also talk "around" a word by describing what they want to say. For example, if they talk about a "bicycle," they may call it "The thing you ride on with wheels."
As dementia progresses, language difficulties can also increase. All the characteristics found in early-stage communication intensify. This middle stage can sometimes last for months or years, depending on the type of dementia and progression. This can contribute to anxiety and frustration for the person who has difficulty communicating or the ability to understand.
The later stages of dementia may be the most challenging and can last several weeks to years. There may be very little to no verbal communication at this stage. You may be uncertain how much someone with more severe dementia understands what you are saying. It is essential to take note of their body language and nonverbal communication at this stage. Your body language is also important, as it will set the tone of your interaction.
How we approach communicating with someone with dementia can affect their overall mood and physical well-being. Setting the tone and ensuring the environment is conducive to communication will assist in a positive interaction. Above all else, have patience and respect for the person you are communicating with. They will pick up on the cues you present, such as your body language and tone of voice.
Also, ensure that your patient or loved one's hearing and eyesight are at optimal levels with clean glasses and functioning hearing aids. The primary factors in communication are the ability to hear pitch and tone of voice and see body language and facial expressions.
Face the person you wish to communicate with and position yourself at their eye level. This is a less threatening posture than standing above them and speaking “down” to them.
You need to ensure the conversation centers on the individual.
Make eye contact and speak directly to the person. Resist the impulse to talk only to their caregiver or family member.
Set the tone
Ensure a quiet environment. Background noise can be distracting and hinder communication and understanding.
Keep your tone friendly. Use humor and laughter to lighten the mood.
Speak slowly and one sentence or thought at a time.
Resist the impulse to speak too loudly unless the person has a known hearing impairment.
Patience and respect
Avoid speaking "down" to the person in a “childlike” manner or using patronizing language.
Avoid addressing the person as "dear" or "hon." While you may believe you are being kind, the salutation can seem demeaning to the person.
Don't debate or argue with their answers to your questions. However, you can use some gentle corrections for some conversation. For example, suppose the person is awake in the middle of the night and believes it’s morning. In that case, you can gently mention that it’s dark outside and people are sleeping.
Avoid asking open-ended questions. You may need to ask questions that only require a "yes" or "no" response.
Give the person time to respond to your question or statement. Resist the temptation to fill moments of silence with your words.
Use eye contact, facial expressions, and nodding.
In the later stages, you may need pictures or written words to present choices.
Use hand gestures and pointing.
Sometimes, a light touch on the back of the hand or shoulder can provide comfort but be mindful and respectful of their reactions like “pulling back.”
Avoid crossing your arms or showing signs of frustration, like sighing.
When your loved one has dementia, this can present challenges with communication. Each stage of cognitive decline will offer opportunities to adjust your approach. Using a person-centered communication style will help them to feel respected and valued.
Effective communication and conversation with your loved one can be vital to share issues regarding their general physical and mental health. This will help them to feel included as a valued member of your family or group and preserve a sense of well-being.
Conversation with a person with dementia needs adaptation at each stage of the disease.
Communication must always have a person-centered approach, with patience and respect.
Effective communication can increase the sense of security for someone with dementia.
Being mindful of body language and vocal tone is vital in communication, representing a significant part of a conversation.
Dementia Journal. Methods and approaches for enhancing communication with people with moderate-to-severe dementia that can facilitate their inclusion in research and service evaluation: Findings from the IDEAL program.
Social Care Institute for Excellence. Having a conversation with someone with dementia.
National Institute on Aging. Alzheimer's Caregiving: Changes in Communication Skills.
Alzheimer’s Association. Communication and Alzheimer’s.