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Communicating with someone who is living with Alzheimer’s disease or another dementia can sometimes be a challenge. That's because one of the hallmark symptoms of dementia, along with memory loss, is difficulty expressing ideas (such as in word-finding problems) or in understanding them (often called receptive communication).
Here are a few tips for success when talking with someone who is living with dementia.
Don’t talk down to the person or treat them like an infant. This is sometimes called "elderspeak" and it's got to go.
Have you ever observed how people talk to babies? They might use a high pitched tone and get close to the baby’s face. While this is appropriate for infants, it’s not fitting for communicating with adults. Regardless of how much the person with dementia can or cannot understand, treat them with honor and use a respectful tone of voice.
Learn what the person’s preferred name is and use it. Be careful with using "honey," "sweetheart" or similar terms. You may mean it genuinely in affection, but it can also come across as demeaning or patronizing.
While some people might get defensive if you break their bubble of personal space around them, many appreciate a gentle touch. Knowing how someone responds to physical touch is important. You might want to give a little pat on the shoulders or hold her hand as you talk with them. Personal touch is important and can be an effective way to communicate that you care.
Not every person with dementia has a hearing impairment, and using a loud tone can make them feel like you are yelling at them. Use a clear, normal tone of voice to start a conversation with someone.
If the person doesn’t respond or you become aware that they have a hearing problem, you can increase your volume. Speaking in a slightly lower register can also help if someone has a hearing problem.
As dementia progresses, it can become harder for someone to understand what you’re trying to tell them. For example, telling a loved one with Alzheimer’s disease that it’s "no use crying over spilled milk" might result in him looking to see where the milk has spilled, rather than end up comforting him or encouraging him not to focus on a past problem.
In fact, the proverb interpretation test, which asks the test taker to interpret abstract ideas such as the spilled milk reference above, is one way to screen for symptoms of dementia.
If you have a question, ask the individual first to give him a chance to respond before turning to their family for an answer. Also, don’t talk about the person as if they're not there. They might understand more than you give them credit for, so convey your respect by addressing them directly.
Rather than standing up straight and looking down to someone who may be seated, bend down to be at the same level as they are. This might make you less comfortable physically, but it will facilitate a more comfortable and respectful conversation.
Limit your questions to just a few. Your goal is to encourage and provide encouragement during your visit, not to fire endless questions at them that may be difficult to answer.
In dementia, a genuine smile can reduce the chance of challenging behaviors since the person may feel reassured by your non-verbal communication. Your warm smile and eye contact convey that you are glad to be with them and are two of the most important factors in communicating with anyone.
Infusing your communication with respect and genuine warmth will increase the odds of success, whether the person to whom you're speaking has dementia or not. For their sake, avoid pet peeves when spending time with someone who is living with Alzheimer's.
Nonverbal communication is essential when speaking to someone with dementia. Before speaking, allow the person to see your face to know who is talking. Keep your face and body language relaxed and positive. Do not interrupt a person with dementia or try to finish their sentences. Be patient and calm. Speak slowly and clearly, but do not raise your voice or talk down to someone.
What should you avoid when talking to someone with dementia?When talking to someone with dementia, do not remind them they have memory problems. If they forget something you told them, pretend that you forgot to mention it earlier and apologize. Do not try to reason with someone with dementia and avoid arguing. Do not confront them about memory issues. Avoid asking many questions, such as about recent events or if they remember your name. Most importantly, do not take it personally if they do not remember something or become frustrated. Instead, give short explanations, accept the blame for something (even if it isn’t your fault), reassure them that everything is ok, and distract them by either changing the subject or asking them to engage in simple tasks, like folding laundry.
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By Esther Heerema, MSW
Esther Heerema, MSW, shares practical tips gained from working with hundreds of people whose lives are touched by Alzheimer's disease and other kinds of dementia.
