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Communication Tips for Dementia Caregivers

Carrie Steckl, Ph.D., edited by Natalie Staats Reiss, Ph.D.

3D figures with chat bubblesAs dementia progresses, it becomes more difficult for individuals to express their thoughts and feelings, as well as to understand what is being communicated to them. In order to enhance communication with your loved one, try the following tips:

  • Speak slowly, at a normal level (not too loud), using a low-pitched (rather than a "Minnie Mouse") voice. In addition, try to face the person when you are speaking to him or her (rather than carrying on a conversation out of the person's line of sight). Speaking rapidly, loudly, or in a high-pitched voice can be overwhelming or upsetting for someone with dementia.
  • Use short, familiar words and simple sentences that clearly express what you want to say.
  • Allow your loved one sufficient time to respond. If he or she does not respond, it is okay to repeat your question using the same wording as before. If you ask the question in a different way, your relative might think that you are asking a different question and become overwhelmed.
  • Ask only one question or give one direction at a time. Although it seems as though this will take longer than combining questions or instructions, it will actually save time because the person with dementia is less likely to become overwhelmed or confused.
  • Give positive instructions; avoid saying "don't" or giving negative commands. For example, instead of saying, "Don't go in that room," try saying, "Let's go over here."
  • Avoid questions that require a lot of thought, memory, and words, or that put the person "on the spot." For example, asking a person with dementia, "Can you tell your brother about the movie we saw this afternoon?" may be overwhelming, because he or she will either be unable to remember the movie or unable to explain the plot.
  • Avoid instructions that require your loved one to remember more than one action at a time. For instance, tooth brushing is made up of many smaller tasks, such as picking up the toothpaste, taking off the cap, picking up the toothbrush, putting toothpaste on the brush, etc. Dementia affects the brain in such a way that a person may not remember every step or forget the correct order of steps in order to complete a task. It will save both of you time and frustration in the long run if you break tasks down into smaller steps that are more manageable for your loved one.
  • Avoid arguing or disagreeing with your loved one. In order for two people to "successfully" have an argument, both parties must be able to use reason and logic. Because dementia affects reason and logic, arguing or disagreeing with someone with dementia is futile. For example, a person with dementia often becomes confused about the past and think that someone who has died is still alive. It is not helpful - and could actually be emotionally damaging - to try to convince the person with dementia that someone is actually dead. Instead, use the validation techniques described next.
    • Validation techniques involve addressing the feelings of a person with dementia rather than focusing on the facts or accuracy of what the person is saying. For instance, if someone with dementia thinks that the year is 1970, and this is not harmful or hurting anyone else, let it go. Avoid trying to "reorient" the person to the correct year. Instead, try to identify feelings related to 1970. Is the person reminiscing about a pleasant time in his or her life? Tap into this pleasant feeling by asking more about it.

On the other hand, is the person upset, thinking she needs to go "home" because her mother has dinner on the table? Instead of trying to convince her that her mother is dead, try to discern the feeling behind the statement. Does she miss her childhood home? Her mother's cooking? Ask her what her favorite meal was, or ask her about her old neighborhood. Chances are that she will start talking about old memories and forget about being upset. These are ways of validating the person's feelings rather than trying to reorient the person to reality.

  • If your loved one is upset, and validation or other techniques do not work, remove him or her from the upsetting situation slowly and quietly.
  • Redirection techniques can work wonders when other communication techniques are not helpful. For instance, if someone with dementia is upset or preoccupied, try introducing a new activity that you know he or she enjoys, such as listening to music or looking at a photo album. Because of the short-term memory loss associated with dementia, the person will often move on to the new activity and forget why he or she was upset in the first place.
    • Communication is often easier if the environment is calm, simple, safe, and quiet. For instance, if you are trying to talk to your loved one and the television is on, the dishwasher is running, and grandchildren are running through the house, your loved one might be distracted or agitated by all of the activity and noise. Try keeping things more peaceful and simple. Along those same lines, try not to have too many people visit your loved one at once.

Keeping a consistent schedule or daily routine will help keep your relative more relaxed; predictability can be calming and soothing. It can also be helpful to add memory cues around the home, such as pictures of key family members and friends with their phone numbers. You can also add picture labels on drawers or closets to identify where different items are kept. Reducing clutter and removing rugs or wires that could be tripping hazards will reduce your loved one's risk of falling. Finally, keep the home well-lit using soft natural light. Avoid fluorescent lights, which can agitate people with dementia.