Communication by and with Dementia Patients

People with dementia face challenges in communicating with the world. Loss of language skills and memories severely impair their ability to convey ideas. It is also a challenge for those caring for dementia patients to communicate effectively with them.

Stage-specific changes in communication ability
People with early-stage dementia experience a mild loss of short-term and long-term memory, which may not be apparent in everyday conversation because they are able to cover up memory problems. Patients typically have difficulty understanding complex or rapid conversations in distracting environments. They lose the ability to comprehend humor and sarcasm, but they can still follow clearly stated or written directions. Language processes slow down, as they need to asses what they are about to say or have difficulty naming an object. At this stage, they often correct their own errors. In most social situations, early-stage dementia patients manage to get along adequately, but they may digress from topics, repeat themselves, and rely heavily on clichés.

In middle-stage dementia, there is increasing loss of short- and long-term memory, with difficulty disguising memory problems. Learning new material becomes very hard, as they are not able to use uncommon concepts, words, or names.By this stage, processing even ordinary conversations becomes challenging. They have trouble focusing attention and require repetition of even simple directions. They may not understand verbal cues, but remain aware of emotional meaning. They also experience significant loss of word-finding abilities and often use gibberish or repeat words. Reading and writing abilities are significantly reduced. Overall, conversation becomes vague, marked by inappropriate or fragmented sentences, perhaps because they forgot the question or what they intended to say.

Individuals with late dementia are unaware of time and surroundings, and do not recognize family members. Memory, comprehension, and social skills are lost permanently. Because of these losses, they may withdraw completely from any form of interaction.

Guidelines for communicating with dementia patients
Inevitable progression of dementia, plus normal age-related losses in hearing and vision, add to communication challenges. These suggestions will help in understanding and being understood.

Treat with respect and dignity
Call the resident by name and gently repeat until they notice. Some people may respond better to their nickname than proper name. Never use derogatory terms such as “honey” or “pops”. Establish eye contact when culturally appropriate. Explain who you are, why you are there and what is going to happen. Speak in an adult tone of voice, do not use baby talk.

Use short sentences
Don’t string along several statements by using “and”, “or”, “but”. Avoid long explanations.

Use concrete ideas and common words
Avoid clichés, sayings, or idioms. People with dementia lose abstract thinking abilities.

Use names or nouns
For example, say “Jane is coming today,” rather than “She is coming.”

Use gestures and visual aids
Show a toothbrush when you ask them to brush their teeth. Move hand to mouth to illustrate “eat”.

Avoid open-ended questions
Instead of asking, “Do you want something to drink?” ask questions that limit the number of possible choices, such as “Do you want tea or coffee?” At the late stage, yes/no questions are best, like “Do you want the black coat?” This reduces confusion and stress.

Respond on a “feeling” level
Verbal communication may be impaired, but feelings largely remain intact. They respond to the emotions of voice and face. If a person says, “You stole my sweater,” respond by saying, “I know you are upset because you can’t find your sweater. I’ll help you look for it.” Avoid logical explanations or orienting to reality by saying, “No, it is not stolen.” This will only cause more anxiety. Address the feelings being expressed.

Use positive statements
It is easier for them to understand what you want them to do instead of what you do not want them to do. Telling someone what not to do leaves many other options available, and does not make it clear what you want. “Please stay in the house” is a better alternative to “Don’t go outside.”

Use appropriate touch
A gentle touch on the shoulder expresses caring and support. It is a way to communicate when verbal communication is no longer possible. People have different levels of comfort with touch and need should be met on individual basis.

Dementia patients gradually lose the ability to remember and use words, but they still can communicate emotionally. Thus, they respond to your nonverbal facial or bodily cues. They may not understand “How are you?” or “Do you remember me?” but they can respond to a handshake or a hug. Gentle, respectful approach is the key to successful communication. This takes awareness and practice. Don’t get discouraged. Every occasion is a learning process. Let’s learn together!