How to Effectively Communicate with Clients with Dementia

Dementia isn't a specific disease. Instead, dementia describes a group of symptoms affecting memory, thinking, and social abilities severely enough to interfere with daily functioning.

Dementia indicates problems with at least two brain functions, such as memory loss and impaired judgment, and the inability to perform some daily activities such as paying bills or cooking meals. Alzheimer's disease and other dementias also gradually diminish a person's ability to communicate.

Difficulty with Communication: Look for Clues

Changes in the ability to communicate are unique to each person with dementia. The family and/or caregiver may recognize changes such as:

• Using familiar words repeatedly
• Inventing new words to describe familiar objects
• Easily losing his or her train of thought
• Reverting back to a native language
• Having difficulty organizing words in a logical way
• Speaking less often

Communication During the Different Stages of Alzheimer’s and Other Dementias: What to Expect

In the mild (early) stage, an individual is still able to participate in give-and-take dialogue, have meaningful conversations, and engage in social activities. However, he or she may repeat stories, have difficulty finding the right word, or feel overwhelmed by excessive verbal stimulation.

The moderate (middle) stage is typically the longest and can last for many years. As the disease progresses, the person will have greater difficulty communicating and will require more direct care.

The severe (late) stage may last from several weeks to several years. As the disease advances, the person may rely on nonverbal communication such as facial expressions or vocal sounds. Around-the-clock care is usually required in this stage.

The Best Ways to Communicate

People with Alzheimer's and other dementias have more difficulty expressing thoughts and emotions; they also have more trouble understanding others.

Here are some ways to help you be successful at communicating:

Before You Speak

• Stay composed. Take a moment to calm yourself.
• Remain focused. Consider what you are going to talk about, and what you want to achieve from the conversation.
• Try to always be positive. Show it in your voice and body language.
• Be the main focus. Make sure you have the person's full attention, and that the person can see you clearly. Try to make eye contact, and If the person is seated or lying down, move down to that level.
• Minimize distractions. Get rid of background noise, such as TV, radio, or other people's conversations.
• Match your body language with your words. Make sure that your body language and facial expression convey what you are saying.
• Never stand too close. It can feel intimidating. Instead, respect the person's personal space, and allow the person to feel more in control of the situation.
• Use physical contact. Show that you care by holding or patting the person's hand or putting your arm around him or her.

How to Speak

• Speak clearly, calmly, and without raising your voice. Be aware of speed and clarity. Use a gentle and relaxed tone—a lower pitch is more calming.
• Speak at a slightly slower pace. Allow time between sentences for the person to process the information and to respond.
• Include the person in conversations with others to help to reduce feelings of exclusion and isolation.
• Avoid confusing and vague statements. If you tell the person to “hop in the shower”,  he or she may interpret your instructions literally. Describe the action directly: "Please come here. Your shower is ready." Instead of using "it" or "that," name the object or place. Rather than "Here it is", say "Here is your hat."
• Repeat information or questions as needed. If the person doesn't respond, wait a moment. Then ask again. 
• Turn questions into answers. Provide the solution rather than the question. For example, say "Your dinner is right here," instead of asking, "Are you ready for dinner?" 
• Turn negatives into positives. Instead of saying, "Don't go there," say, "Let's go here."
• Try to laugh together about misunderstandings and mistakes. Humor can bring you closer together, and relieve the pressure. 

What to Say

• Identify yourself. Approach the person from the front and say who you are. Keep good eye contact.
• Call the person by name. It helps orient the person and gets his or her attention.
• Use short, simple words and sentences. Lengthy requests or stories can be overwhelming.
• Offer a guess. If the person uses the wrong word or can’t find a word, try guessing the right one.
• Avoid asking too many direct questions. People with dementia can become frustrated if they can't find the answer. If you have to, ask questions one at a time, and phrase them in a way that allows for a 'yes' or 'no' answer.
• Try not to ask the person to make complicated decisions. Give them a choice. Too many options can be confusing and frustrating.
• Avoid criticizing or correcting. Don't say he or she is incorrect. Instead, try to find the meaning in what is being said, and encourage him or her to communicate their thoughts.
• Avoid arguing. If the person says something you don't agree with, let it be. Arguing usually only makes things worse—often heightening the level of agitation for the person with dementia.

How to Listen

• Listen carefully to what the person is saying.
• Be patient and supportive. The person may need extra time to process what you said. Let the person know you're listening and trying to understand.
• Listen for clues. If the person has difficulty finding the right word or finishing a sentence, ask them to explain it in a different way.
• Remain sympathetic while listening. If the person is feeling sad, let them express their feelings without rushing or dismissing them. This will show that you care.
• After listening, get affirmation. When you haven't understood fully, tell the person what you have understood and check with them to see if you are right. Repeat what was said if it helps to clarify the thought.
• Use your best judgment. Some people won't remember things such as their medical history, family, and friends. You will need to and act appropriately. For example, they might say that they have just eaten when you know they haven't.

Keep Communicating, and Be Respectful

Always remember to treat a person with dementia with dignity and respect. Don't talk about them as if they are not there, or talk to them as you would to a young child and be very patient.

Offer them ongoing comfort and reassurance, too. If he or she is having trouble communicating, let the person know that it's okay. Encourage the person to continue to explain his or her thoughts, no matter what.

References:

Communication and Alzheimer’s. Alzheimer's and Dementia Caregiver Center. Alzheimer’s Association. Web. 2015.
Alzheimer's: Tips for Effective Communication. Healthy Lifestyles, Caregivers. Mayo Clinic. Web. 2013.
Advice for Nurses and Other Healthcare Professionals: Communication”. Alzheimer’s Society. Web. 2015.