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Communication As Dementia Progresses

son and his elderly father have a discussion on the couch

Loved ones living with Alzheimer’s disease or other forms of dementia often lose some or all capacity for language and communication. These individuals may also lose the ability to recognize words and names — even their own — so normal conversation can be challenging or impossible. It’s not uncommon to see them clap their hands or even hum in lieu of conventional speech. Learning how to communicate with someone suffering from dementia and understanding the barriers to communication with dementia patients will help keep you connected to the people in your life with memory problems who may be progressing through the stages of dementia.

What to expect

How dementia affects your loved one’s ability to communicate may reflect his or her unique personality, but there are commonalities to watch for. Anyone attempting to converse with a dementia patient should anticipate seeing some of the following:

  • Difficulty finding the right words
  • Using familiar words and phrases repeatedly
  • Not always speaking logically
  • Relying more on gestures than descriptive language
  • Choosing not to speak as often as they once did

People who learned English as a second language may revert to using their native language. To converse successfully with someone living with dementia, you’ll need to anticipate these barriers to communication, and exercise patience, understanding and good listening skills.

Early-stage communication challenges

Loved ones in the early stages of Alzheimer’s or dementia may still be able to participate in meaningful conversation and social activity. But you may start to notice they’re repeating the same stories, having difficulty finding the right word, or becoming agitated for no apparent reason. These are common signs and barriers to communicating with someone with dementia. . How should you respond?

  • Speak directly to your loved one
  • Use short sentences
  • Never be patronizing
  • Don’t exclude them from conversations
  • Don’t peak about them in their presence
  • Allow them whatever time it takes to express themselves

Don’t make assumptions about an individual’s ability to communicate. Dementia  affects each person differently. Listen carefully without interrupting. Try to determine which forms of communication may be more or less successful with this individual. Is face-to-face communication the best, or only option? Remember, It’s ok  to laugh. Good-natured humor can help lighten the mood and make communication easier.

As clinical signs become more serious

In the case of Alzheimer’s disease, your loved one’s difficulty with cognitive ability and verbal communication will likely become worse over time. It’s important to anticipate this. Loss of one’s ability to communicate can be devastating. Confusion and misunderstanding are common and can lead to frustration for you and especially for your loved one with dementia. Understanding and positivity are vital in all facets of caregiving, but especially with communication.You may inadvertently “test” your loved one by asking if they remember this or that event, or certain familiar people from their past. Avoid doing this, as it doesn’t help. It’s also not helpful to address your loved one as you might speak to a child or baby. The person’s language abilities may be compromised, but they still feel the same as anyone. If you remain relaxed, you’ll help your loved one remain relaxed. Here are more specific recommendations, some that go beyond words alone.

How to listen

Be patient. Let your loved one think and speak without interrupting. Expressing impatience or frustration will cause more frustration. It’s ok to repeat information and questions. If your loved one doesn’t respond, wait a moment and ask again. Try saying, “It’s important to me to hear what you have to say. Just take your time.” Be agreeable. Arguing with someone who has dementia is pointless and counterproductive. Even if you disagree, be agreeable and just change the subject. Don’t point out when words or names are used incorrectly, just go with it. Focus more on the overall message than the literal words being spoken. Learn to read your loved one’s emotions and body language.

Going beyond words

As your loved one’s dementia progresses, it will become increasingly important to communicate with hand gestures, body language, facial expressions, eye contact and touch. Give visual cues. If, for instance, you’re talking about food or meal prep, point to the refrigerator or pantry to reinforce the message. Express agreement by nodding yes or shaking your head with a smile to indicate no. If you can make your point without words, do so. Demonstrate a task to encourage participation. If written notes seem to aid understanding, try that.

Here are 10 specific tips from the Family Caregiver Alliance for communicating with a person with dementia:

1. Set a positive mood. Your attitude and body language communicate your feelings and thoughts more strongly than your words do. Set a positive mood by speaking to your loved one in a pleasant and respectful manner. Use facial expressions, tone of voice, and physical touch to help convey your message and show your feelings of affection.

2. Get the person’s attention. Limit distractions and noise — turn off the radio or TV, close the curtains or shut the door, or move to quieter surroundings. Before speaking, make sure you have your loved one’s attention. Address them by name, identify yourself by name and relation, and use nonverbal cues and touch to help keep the person focused. If the person is seated, get down to their level and maintain eye contact.

3. Be clear. Use simple words and sentences. Speak slowly, distinctly, and in a reassuring tone. Don’t raise your voice. Instead, pitch your voice lower.

4. Ask simple, answerable questions. Ask one question at a time; yes or no questions work best. Don’t ask open-ended questions or give too many choices. If possible, show the choices — visual prompts and cues help clarify your question and can guide response.

5. Listen with your ears, eyes and heart. Be patient in waiting for your loved one’s reply. If they’re struggling for an answer, it’s ok to suggest words. Watch for nonverbal cues and body language. Listen for the meaning and feelings that underlie the words.

6. Break down activities into a series of steps. This makes many tasks more manageable. Encourage your loved one to do what they can, gently repeat the steps they tend to forget, and assist with steps they can no longer accomplish on their own. Use visual cues when possible, such as pointing to where to place a dinner plate.

7. When necessary, distract and redirect. If your loved one becomes upset or agitated, try changing the subject or the environment. For example, ask them to help you with something different and easy, or suggest going for a walk. It’s important to connect with the person’s emotions before you redirect. You might say, “I see you’re feeling sad and I’m sorry about that. Let’s go get something to eat.”

8. Respond with affection and reassurance. People with dementia often feel confused, anxious, and unsure. They often distort reality and may recall things that never actually happened. Don’t try to convince them they’re wrong. Focus on the feelings they’re demonstrating (which are real) and respond with verbal and physical expressions of comfort, support and reassurance. Holding hands, touching, hugging and praising may get a positive response.

9. It’s OK to reminisce. This is often a soothing, affirming activity. Many people with dementia may not remember what happened 45 minutes ago, but they can clearly recall their lives 45 years earlier. Don’t ask questions that rely on short-term memory, such as asking the person what they had for lunch. Instead, ask general questions about the person’s distant past — this information is more likely to be accessible.

10. Maintain your sense of humor. Use humor whenever possible, though not at the person’s expense. People with dementia tend to retain their social skills and are usually delighted to laugh along with you.

Find help for loved ones with dementia at Freedom Village.

Memory care at Freedom Village of Bradenton provides the safety, security, and programs to help preserve the things that bring meaning and order to your loved one’s life. Our mission is to enrich the lives of residents with Alzheimer’s disease and other related dementias by creating success stories and celebrating the abilities that remain. Learn more about our memory care services by calling ​941-219-5294.