Jayme is an artist, blogger, and freelance writer with professional medical training and experience.
Dementia--A Rising Epidemic
Do you know someone with dementia? Chances are that if you don't, you will soon. Dementia, according to the Alzheimer's Association, affects almost 1.5 million people in the US alone.
Nearly 70% of those with dementia are cared for at home by friends or family. Many caregivers will have little-to-no training in the medical field. They may have little experience with the elderly. Even if you don't have a loved one affected by this condition, you may know:
- A friend
- A relative of a friend
- A neighbor
- A co-worker
- A supervisor
- A client
Who either have dementia, or who are affected by dementia in some way. It may be a complete stranger, or someone you deal briefly with at work.
No matter the situation, communication issues caused by dementia can be problematic for everyone involved. As dementia progresses, communication can become harder, but there are still ways to make speaking and listening to a person with dementia both pleasant and effective.
How Does Dementia Affect Communication?
Dementia is not a disease in and of itself. It is instead classified as a series of symptoms related to other disorders and diseases. Alzheimer's disease is the most common cause of dementia in the elderly.
Since dementia targets the brain, it affects how people think, remember, behave, perceive and communicate. Those with cortical dementia (the type that affects Alzheimer's sufferers) experience memory loss and the increasing inability to understand language.
People with sub-cortical dementias usually do not suffer from memory loss. They can still effectively communicate, but have delays in thought processes that slow down their ability to speak and act at a normal pace.
Early Signs Of Dementia
- Forgetting a word
- Forgetting what a word means
- Using the wrong word
- Difficulty with concentration
- Trailing off mid-sentence.
- Forgetting names
Communication and Dementia--Early Stages
Often, the signs of dementia go un-noticed in the early stages of the disease. The occasional memory slip or forgotten word is chalked up to being tired or preoccupied.
If this happens frequently, the person with dementia may be aware that something is wrong. They may either hide these issues, or excuse them.
These are communication issues that happen to everyone at some time or another. If you know that the person has dementia, don't treat them as though they have a disease. Acknowledge that you know the diagnosis, but don't keep the conversation focused on it.
Don't exclude those with dementia from your conversations, either. They still have an identity and deserve to be treated with the same respect as always. If you know them well, ask them if there is anything you can do to help them understand you better.
Using Body Language For Communication
Be aware of your body when speaking to a person with dementia. Before you speak, make sure that you are calm and prepared to be patient. Approach from the front, and try to gain their attention and maintain eye-contact.
While speaking, make sure your facial expressions are in sync with what you are saying. If you are asking a question, raise the eyebrows slightly and tilt the head in an expectant manner. Lean slightly forward. These visual cues help the dementia patient understand that you are are seeking an answer.
If possible, try to sit or stand in a way that is relaxed. It helps to be at, or below, eye-level, as well. Don't loom over someone with dementia. Don't position yourself across the room, or with other people; sit down and focus on the person you are trying to communicate with.
10 Dementia Communication Tips
- Speak clearly and calmly.
- Use short, simple sentences.
- Use easy words.
- Use labels when appropriate. (your red robe)
- Answer questions.
- Use touch to reassure.
- Don't argue.
- Use proper body language
- Use visual cues and signs.
Communication In Middle Stage Dementia
The middle stage of dementia can be the longest. During this time, the person with dementia will be more forgetful of names. They will have more difficulty recalling correct words to use. They may repeat themselves frequently.
At this stage, a person with dementia is still aware that they are losing their ability to communicate and remember. They may desperately try to remain focused by asking the same question, such as what day of the week it is, over and over.
During this stage, caregivers may notice obsessive behaviors, such as checking the clock repeatedly. The person with dementia may over or under-medicate themselves as they struggle to recall when they took their last dose.
Using static objects and pictures can help in middle stage dementia. Everyday, write the date (day, month, year) on a large board. Include the day of the week, the season of the year, and whatever other information that the person with dementia seeks to validate most often.
Use signs on doors to guide and remind the dementia patient of where they are, or where they need to go. A combination of both pictures and words works well. Answer questions that are asked frequently, even if the task becomes exasperating.
Silence Is Golden
Those with dementia are no different than other humans. Sometimes they need peace and quiet. They may communicate this by becoming agitated during social activities or conversations. Allow them to have "alone" time if they seem to need it.
Companionable silence is helpful too. Sit beside them and hold their hand or just reassure them by being within their line of vision. If they cannot see, but can hear, hum to yourself to allow them to note your presence.
Speak Effectively And Slowly
After you have gained the attention of a person with dementia, you need to communicate either a question or a statement to them. To do this, you need to be concise. Too many words can confuse them, and cause you both un-necessary frustration.
Speak slowly and smoothly. This doesn't mean you need to sound like you are in slow-motion. Simply slow down your normal speed of speech a bit. If they still do not understand, try again a little slower.
Don't ask multiple questions then expect an answer. Ask one question at a time. State one phrase at a time.
- " It is a beautiful day. We are all going to the park. Do you want some fresh air? Would you like to go to the park?"
This can be confusing. Someone with dementia may not know which part to answer. Instead, ask:
- "Would you like to go to the park?"
If you are trying to communicate with someone who is also hard of hearing, you may want to make certain their hearing aids are working. Speak louder, or use visual cues.
Advanced And Late Stage Dementia Communication
Once dementia has reached the advanced stage, communication may no longer be possible. The patient may no longer recognize herself or loved ones. She may:
- Revert to baby-talk
- Use incoherent speech. (babble)
- Lose her ability to speak altogether.
During this stage, the muscles may stiffen and contract, making it impossible for her to use gestures to communicate her needs. Depending on how advanced this stage of dementia is, she may be able to recognize her name.
For the caregiver, communication at this stage is extremely difficult and heartbreaking. With only the occasional grunt or moan, it may be impossible to understand what the patient needs or wants.
At this time, the best way for the caregiver to communicate is by using a soothing, positive tone. Use the patient's name frequently. The patient may take comfort in having familiar faces and voices surrounding them.
Dealing With Difficult Questions and Statements
There are alternate approaches to re-orienting a patient. These include:
- White Lying
Distract by changing the subject or focus. This may or may not work every time.
Validate by accepting their concerns. Talk to them about the issue. Reminisce if it seems to soothe them.
Lie only when there is no other option. Too many lies, even harmless ones can have a negative impact on your loved one's trust in you. If you are speaking with someone whom you do not know well, a white lie may be the only way to extricate yourself from an awkward situation.
Re-orienting Those With Dementia
Advice differs on whether or not you should actively and consistently try to re-orient a person with dementia.
If you ask a health provider, they may advise the use of re-orientation to try to help the dementia patient identify with themselves. They may also tell you that this technique can help delay the progress of dementia.
On the other hand, another physician may tell you that attempting to re-orient someone with dementia may be ineffective and frustrating for both of you. Sessions of re-orienting may turn cause agitation in someone with dementia.
When I worked in care facilities, we were under strict orders to re-orient residents, regardless of their stage of dementia. If a resident happily told us that she heard birds singing in her room, we had to tell her that "No, she did not hear birds singing in her room. There were no birds in her room."
If we were overheard saying something to the effect of "Oh, that's nice! Do you like birds?" we would earn a citation. As one fellow worker, learned; you could also be fired for inappropriate conduct!
What was the result of this constant re-orientation? That depended on the resident. Some would become hostile and argumentative. Others would be heartbroken. Still others would either understand, or ask why there were no birds.
If you are caregiving for someone with dementia, the decision to re-orient should be discussed with your loved one's physician. Or it should be a personal choice based on your own judgement.
In my experience, correcting a dementia patient was unpleasant and frustrating. The process rarely seemed to have any positive long-term effect.
Alternative Approaches To Re-orientation
I can't afford to pay for the food in this hotel!
The food is paid for by us. This is your home.
Do you like eating in this room?
I know you are worried about the cost, but it is free.
It is a complimentary meal.
Why can't I go home?
This is your home now.
Would you like to go for a walk?
I know you miss home. Do you miss your old bedroom?
Maybe we can go home later. After our walk.
Using Visual Cues
Take good photos of common objects. Use these as visual cues for communication. Objects that are easily identified by photo can include:
- A toilet
- A bed
- A dinner setting
- A variety of foods
- A cup
- A bathtub or shower
- Clothing items
- Family and friends
- A church
- Animals or pets
A dementia patient can point to the flashcards to ask for certain things.
Listening As A Communication Skill
It is easier to speak to someone than it is to listen to what they are saying. This is even more so in cases of dementia, when hurried caregivers may give an instruction, then become frustrated when the patient balks or begins a line of questioning.
Because those with dementia forget words or thoughts, we may be tempted to finish sentences for them or guess what they are trying to say before they are finished speaking. This may work in some circumstances, but more often than not, it will cause frustration or agitation.
Take the time to listen attentively to what someone with dementia is trying to express. They may not be able to use the correct words. For example, they may say:
- I want to take a coke.
This sounds like nonsense, but we may assume they are thirsty. Their body language may say otherwise. They may be trying to say that they need to toilet. They simply cannot recall the correct words.
Watch for gestures and visual cues to better understand what they are trying to say. Don't hurry them, as this can can lead to more confusion.
Patience, Kindness and Common Sense
Good communication skills are important in all aspects of our lives, but never so much as when dealing with dementia. A person with dementia depends on others for their care, and if we don't understand what they are saying, their health can be jeopardized.
Kindness, patience and common sense are the three main skills for speaking and listening to someone with dementia. By using these, anyone can understand even the most cryptic message. People with dementia are still human beings, and the need not only to be heard, but to have others desire to understand their thoughts, wants, needs, and fears.
What Is Dementia?
Nicole K on April 02, 2018:
Thank you for your hub. My grandfather has moderate dementia and we (my husband and I) are helping to care for him. Your tips helped me know what to expect down the road, if and when his dementia worsens. I like how you said to keep answers concise. That seems to help my grandpa as well. Thanks so much for all your advice!
Joanna McKenna from Central Oklahoma on July 30, 2014:
Just this evening, a first cousin and I were discussing her mother's Alzheimer's and how Cousin handled it in the years before Auntie's death. Auntie was the second of two of my aunts and a cousin to be felled by this mind-robbing disease.
I personally have never been the caregiver for a person with dementia, but what I do know of it, I find the policy of re-orienting a sufferer to be illogical AND cruel to a patient who is already confused. Were I an employee of an institution with such a policy, I wouldn't last past the first day!
Oddly, there is a "bright" side to Alzheimer's. As an incurable history buff, I see the lack of a sufferer's short term memory as a blessing of sorts, because there's little to cloud or impair his/her memories of the pre-Alzheimer's years, especially events from childhood and early adulthood. Such memories IMHO should be encouraged and recorded for posterity (while the patient can still speak coherantly, of course).
Thumbed UP, useful, awesome and interesting! ;D
dementiacaregiver on June 12, 2013:
Great and well written article. I was a caregiver for two family members that went to their late stages, my dad being one of them, and you made a good point about calling their name frequently because it seem like when everything else is forgotten he still responded when his name was called.
FlourishAnyway from USA on May 30, 2013:
Wonderful hub written with such compassion and experience. Voted up and more.
Jayme Kinsey (author) from Oklahoma on May 29, 2013:
@europewalker--Yes, it is very sad. Especially for the caregivers, who have to watch their loved ones become complete strangers. the best we can do is to support them. That is why I am an advocate of not forcefully reorienting them once they pass a certain stage. This can frustrate them and embarrass them. Rather, I believe we have to let go of what we want, and embrace them as the new people they have become.
Jayme Kinsey (author) from Oklahoma on April 21, 2013:
@Peggy W--Yes, it is very hard for the people with dementia. Especially at mid stage, when they are still aware. Very distressing for everyone, as you said. That is why it is important for people not to be afraid or leery of those with dementia, but rather, learn to communicate with them and help them. thank you for reading and commenting!
Claudia Mitchell on April 13, 2013:
Really useful hub with some good tips. It's difficult for everyone when dealing with dementia.
Jayme Kinsey (author) from Oklahoma on April 12, 2013:
@parwatisingari--thank you! Hope it is useful.
Tammy from USA on April 11, 2013:
Excellent and helpful article! It is difficult to deal with someone that has dementia. I seen the signs in a family member years before her children would admit she had a problem. Unfortunately by the time they realized her problem they could no longer help her and she was admitted to a nursing home. It was heartbreaking. It takes a certain amount of patience, care, and love to deal with these situations you mentioned above. Sometimes it is easy to brush of the first signs of dementia, but arming one's self with knowledge will help to ease the frustrations that come from trying to communicate with the loved one. You did a great job here with giving pointers to help deal with the difficulties. Thanks for sharing them.
europewalker on April 11, 2013:
Excellent article with valuable tips. My mom had Alzheimers and the last two years of her life were very sad. It takes a lot of patience to care for your loved ones but they deserve to be treated with kindness. Voted up and useful.
Peggy Woods from Houston, Texas on April 11, 2013:
I have personally known people with dementia and it is as hard on the person who still may realize that they can no longer communicate like they were used to doing as it is for the family members and others who care for them. Close to the end stage they need total care as they can do nothing for themselves. It is a very sad affliction for everyone involved. Up, useful and interesting votes and will definitely share this! It should be helpful to many people.
Jayme Kinsey (author) from Oklahoma on April 11, 2013:
@aviannovice--Thank you. Yes, with dementia on the rise, it is more and more likely that we will meet with and communicate with someone with dementia. Thank you for commenting!
Jayme Kinsey (author) from Oklahoma on April 01, 2013:
@MarleneB--I am glad you found this interesting and useful. Good for you for making an effort to communicate! So many times I see people who try to avoid talking to those with Alzheimer's or dementia because they aren't sure what they should say to them. It can be frustrating, but it is worth the effort to try our best. I really hope this helps. And have fun making the flash cards...they can be laminated too, if you to use them a lot.
parwatisingari from India on March 31, 2013:
I liked the practical handling tips.
Jayme Kinsey (author) from Oklahoma on March 30, 2013:
@mommymay--Your mother is right--most people with dementia are very sweet, although they can be very sulky sometimes. Just like toddlers. Sometimes dementia exaggerates bad personality traits, and we get dementia patients who are always aggressive or always unhappy. It doesn't happen as often though, and it is still important to communicate with them. It is terribly sad to see them forget who they are and who their families are, but I have seen some awesome families who did everything they could to make each day a pleasant experience. Glad you enjoyed the hub, and I do hope it helps others. :)
Deb Hirt from Stillwater, OK on March 30, 2013:
This was beautifully done. I think we will all come in contact with someone like this, be it family, or in a situation out in public. We need to be better prepared, and certainly, more sensitive to it.
Marlene Bertrand from USA on March 28, 2013:
I really appreciate the care that you have given to this topic. I know someone who is in what would easily be classified as the middle stage of dementia. I didn't know how to handle the person and found a lot of helpful information in your article. Now I know that my job is to be mindful, to listen more, to stop trying to anticipate what they are trying to say and to keep them oriented. I love the idea you shared about the flash cards. I think I will go around the house and take actual pictures. That will be extremely helpful. Thank you.
Jayme Kinsey (author) from Oklahoma on March 28, 2013:
@Radcliff--Thank you very much! I agree-we have to understand that it is much harder for those with dementia to deal with their loss of function than it is for us to be patient with them. We should all take the time to try communicating in a better manner. :) Thanks for your comment, and thanks for reading!
Heather May from Ohio on March 28, 2013:
Great article! My mom has worked in dementia units for years and says that she loves it. The people are sweet and if they are mad at you...You are back in their good graces the next day. Joking aside, she said that there are lots of bright spots but it gets sad to see them not remember their families. These tips will really help to cut down on confusion and hopefully extend the great memories that they have and help to see that memories can still be made!
Jayme Kinsey (author) from Oklahoma on March 28, 2013:
@Eiddwen--Thank very much for reading and voting. :)
Liz Davis from Hudson, FL on March 28, 2013:
This article is loaded with helpful tips--we need to be patient and clear in our communication with those who struggle with dementia. That can be a challenge in our society! Thanks for sharing your knowledge on this subject.
Eiddwen from Wales on March 28, 2013:
Well informed and sensitivity written.Will benefit many I am sure. Voted up.