Julie Ackley is the Director of VIVA! Life at Pathway to Living. She has her Masters in Special Education and Expressive Therapies and has 18 years of experience in both long term care and acute care environments.
Communication involves the sending and receiving of information—speaking and listening with comprehension. Persons living with dementia have challenges in both areas, so we sometimes have to dig deeper to fully understand what they may be trying to communicate. Communication breakdowns can be a source of frustration for the person living with dementia as well as their loved one. A person living with dementia may struggle to find the right words, or use inappropriate words to explain what they mean. They may need to express what they are trying to say through gesturing, facial expressions and body language. Unmet needs may manifest as undesirable responsive behaviors and significantly contribute to excess disability and lower quality of life. Successful communication with an individual living with dementia requires that we, not the individual, modify our approach. You can retain the ability to effectively communicate with your loved one as they progress in their journey by implementing some adjustments in how you approach communication.
Embracing these person-directed tips to adapting your communication style can improve the individual’s ability to function, increase emotional well-being and quality of life.
Tip #1: Gain their attention
Before speaking and stepping into their personal space (about 6’ out), identify yourself and gain their attention and approval to proceed. This may be in the form of a non-verbal nod, a smile or the establishment of eye contact.
Tip #2: Get at eye level and sit down next to them
Being at, or even just below eye level helps the individual feel safe and in control. Positioning yourself to their side is a supportive stance, verses standing in front of them, which can feel more confrontational. Pay attention to your body language as well as theirs.
Tip #3: Take your time
Avoid long, drawn out directives or descriptions and opt instead for short, simple sentences. Speak slowly and clearly. Give one directive at a time and remain patient, allowing ample time for the individual to comprehend then formulate a response. Try not to interrupt them even if you think you know what they are trying to say.
Tip #4: Avoid pronouns
Referring to an item as “it”, friends as “they” or a grand daughter as “she” may confuse someone living with dementia. Avoid using pronouns (those, them, they, his, her, etc.), rather be specific in referring to items and individuals to avoid confusion and any resulting frustration.
Tip #5: Use visual or tactile cues
Words alone may prove insufficient for effective communication with an individual living with dementia. Supplement a conversation with concrete items, pictures and demonstrations. These will help the individual to better make sense of what you are saying or asking and enable them to feel more successful in their efforts to both comprehend and formulate a response.
Tip #6: Join them in their reality
Persons living with dementia may become confused to time, place and person. Remain sensitive to this and refrain from attempting to challenge or correct misconceptions and false beliefs. Instead, offer reassurance and join them in their reality.
Tip #7: Rephrase rather than repeat
If they appear confused, rephrase your statement or question rather than repeat, e.g., asking, “Did you go?” may elicit the response, “Go where?” when you actually meant “did you take your turn?” Maintain an upbeat, friendly tone of voice if having to rephrase.
Tip #8: Reassure with touch
If the individual is comfortable with touch, when appropriate, holding their hand or offering a gentle pat while talking to them may be reassuring and provide calm and a sense of comfort. Touch, in conjunction with facial expressions and tone of voice can help convey your message while demonstrating your feelings of affection. Closely monitor their body language and listen carefully to what they say for any cues to discomfort.
Tip #9: Pay attention to the environment and minimize distractions
People living with dementia have difficulty with sustained attention and concentration and consequently may be easily distracted by sounds and sights others can easily ignore. Scan your environment and minimize any unnecessary sources of both visual and auditory stimulation, e.g., turn off the TV, shut the door, close the curtains, etc. Stop what you are doing and give the individual your full attention as they attempt to speak.
Tip #10: Ask yes or no questions
Open-ended questions that require abstract thought or the ability to organize and/or categorize information may overwhelm the individual. Instead, ask one question at a time. Asking simple yes or no questions that avoid too many choices will allow for the most success.
As they progress in their journey, the individual living with dementia will experience numerous brain changes that will affect their ability to interact with and make sense of their environment. Practicing these ten tips for effective communication will help ensure you and your loved one maintain understanding and meaningful connection to each other far into the disease process.