Additional strategies for communicating with a person who has dementia
| Physical problems | Verbal communication |
| Non-verbal communication | In the later stages of dementia |
If the confused person has stopped speaking suddenly, it could be possible that the cause may be illness, pain, depression or badly fitting dentures. These problems may go unnoticed, as the impaired person might not be aware of them, or be unable to tell the carer. Many families express concern over this.
If the person cannot hear very well or see the person who is speaking, it is natural that there will be problems understanding what is being said. If necessary, ensure that the person’s hearing aid is working properly and their glasses are of the correct prescription.
Always adopt a positive approach and maintain a calm environment. Provide plenty of support. Holding the person’s hand, while you are speaking can help them focus on what is happening, and what you are saying. Eliminate background noises such as the television, radio and other people moving around or talking at once.
Impaired people communicate better when they are relaxed. Never to rush the person if he is trying to make himself understood. This may cause a catastrophic reaction. When possible eliminate background noise such as television, radio or other people talking. Although you may be tired or upset, remember the problems a confused person has to deal with. Try to be patient and have a non-critical attitude. The person is more likely to attempt to communicate and be less likely to feel embarrassed.
Encourage communication so that the person does not become apathetic or stop speaking all together. As a dementing illness damages the brain, the ability to think suffers. It becomes difficult for an impaired person to understand complex speech. Use family sayings or pet names and adapt language with the impaired person’s abilities. Names will help the person keep track of who is speaking.
Always keep sentences or questions straightforward and simple. Questions requiring a clear yes or no are easier for an impaired person to answer as there are only two possible answers. For example, ‘Would you like a hot drink?’ requires a yes or no answer. "Would you like tea or coffee?" gives the person a choice to two drinks, both of which are named. Always ask the person one question at one time.
Although the impaired person may have difficulty speaking and understanding, take care not to talk down to them. Even when the impaired person might not be paying attention or capable of understanding, carers should not talk over them as if they were not in the room.
Sometimes the impaired person will be ‘stuck’ in a conversation. Remain matter of fact and gently repeat the last words. If the person still does not understand, say the same thing in a different way. If the person becomes upset, then try again later.
Ensure that you always leave enough time for the impaired person to respond. Confused people will need more time to grasp information and prepare an answer. Sometimes the person may forget what was happening and is simply unaware that you are waiting for a reply. You could try to give the person a subtle prompt.
Lower the ‘tone’ of your voice. Even if the person has difficulty hearing, a high-pitched tone is difficult to hear and may be distressing. Facing the impaired person when speaking can help them concentrate and perhaps even lip-read. Many people lip-read without even realising that they are doing it.
Sometimes the impaired person is unable to find correct words. They may use alternative words that are linked by meaning (Such as ‘thing’ for ‘ring’) or sounds (Like ‘Cat’ instead of ‘Mat’) A confused person can still make themselves understood this way. It may be better to respond to the feelings behind the words rather than correct the person. Make friends and family aware of these problems.
If the carer is assisting the confused person in an activity, break it into separate tasks and ask them to do one step at a time.
Confused persons often have difficulty understanding what they hear. Bear this mind, if the person appears unco-operative or does not act on instructions. Confused people often have problems with understanding written information, even when they can still read the words correctly. Reading words and understanding them are two different skills; one may be lost without the other. It is also important to remember that although the person can understand information spoken in person, they may not be able to comprehend the same thing spoken over the telephone.
Impaired people will often repeat a question or phrase a number of times. Constant questions can relate to poor memory, boredom and perhaps a general feeling of insecurity or loss. It is important to remember that the person finds it very difficult to understand what is going on around him. Always try to remember that this is a symptom of the disease, rather than the person acting awkwardly. Reassure the person and tell them that everything is fine. If there is one particular question or phrase that continues despite answers and reassurances, try to distract them by suggesting an activity, changing the subject or giving them a hug. If the person seems upset, this behaviour may be an indication of illness or pain.
It might not always be possible to understand exactly what the confused person is trying to say or demonstrate. Actions and words are not as important as the feelings expressed. If you think that you understand those feelings behind the actions, respond to those, rather than trying to establish the exact meaning.
You can communicate with the confused person without spoken conversation. Everybody uses body language to communicate what he or she is saying. Confused people remain sensitive to these signals even when they can no longer understand language. Many carers tell of the impaired person becoming upset in the evening, when they are most tired or busy. The person can read these signals in the carer’s body language.
Remain calm and supportive. You may feel tired, but your body language will help keep the person calm. Take the person’s hand and smile or express affection in other ways.
Look directly at the person and see if they are paying attention. If the person is distracted, try again later. Ensure that the person is not hungry, thirsty or sleepy.
As language skills gradually deteriorate, combine speech and signs. Simple nods and shaking the head can be a great help. This has the advantage of providing clues or visual prompts. Pointing, touching or handing the person an object are excellent ways of communication. Demonstrate the everyday tasks the person may need to do, like brushing teeth or shaving.
In the later stages of dementia
Communication is perhaps the most human of skills. When a person loses this skill, families and carers often grieve this loss. If a person is very confused, they may only be able to say one word, mumble or make sounds. However, the carer may still be able to identify needs by using these clues.
Make sure you have a regular routine of checking the person’s wellbeing. Speak to them softly as the sound of your voice may feel familiar to them.
Communicate with the very impaired person by touching, holding hands, sitting together, hugging and showing affection. Stroking the person’s hands can be very reassuring or listening to music together.
The day to day care you are giving an impaired person communicates your concern, and they are secure in your care.
January 1998
http://www.poptel.org.uk/cab/cabhp.html
Page Text supplied by The Alzheimer's Disease Society of Great Britain