Dementia and communication
Losing the ability to communicate can be one of the most frustrating and difficult problems for people with Alzheimer's disease or other dementias which affect language. As the disease progresses, the person experiences a gradual lessening of their ability to communicate. They find it more and more difficult to express themselves clearly and take in what is being said, and carers find it an increasing struggle to understand what the person with dementia is feeling or trying to say.
Some changes you may notice in a person with dementia
- They may have difficulty finding a word and say a related word instead of the one that is lost.
- They may not be able to understand what you are saying or only be able to grasp part of it.
- They may talk fluently but not make sense.
- Writing, and understanding of the written word, will deteriorate.
- They may be able to talk of the distant past but not of recent events.
- They may lose the normal social conventions of conversation and interrupt, ignore another speaker, not respond when spoken to or become very self-centred.
- They may have difficulty expressing emotions appropriately.
Suggestions to help with communication problems
Be flexible
- Remember that each person is unique and each relationship is different so it is a question of trying things out to discover what works best for you.
- Talk to other carers and health care professionals and see what works for them.
- Don't expect too much: keep modifying your expectations at each stage so that they remain realistic.
- Remember that words are not the only form of communication: you will need to rely more heavily on non-verbal cues such as the tone of voice, touch, and the way you move to convey how you feel when the person you are caring for begins to have difficulty understanding conversation.
- Listen for and learn to recognise the feelings and emotions rather than the words.
Preserve self esteem
- Try not to talk down to the person or to treat them as a child: conversation should be simple, but remain on an adult level.
- Continue sharing activities and pastimes with the person and show them you value them.
- People still retain their feelings and emotions even though they may not understand what is being said, so do everything you can to preserve their dignity and self-esteem.
- Never discuss the person in front of others as if they were not present, even if you think they do not understand.
Ways of talking
- Remain calm and talk in a gentle, matter-of-fact way; keep sentences short and simple, focusing on one idea at a time, talk about specific events that may be remembered or everyday things like weather.
- Allow plenty of time for what you have said to be interpreted.
- Speak slowly and clearly without raising your voice.
- Repeating a point using different words can be helpful.
- Incorporating information in your conversation which tells the person where they are, what is happening around them and who they are with, can make them feel more secure and less confused.
- Use orienting names whenever you can such as 'your son, Jack'.
- Try to tune into the feelings rather than the content of the conversation; don't attempt complex discussions: keep information simple.
The right environment
- Avoid competing noises or activities such as TV or radio.
- Make sure glasses, hearing aids and dentures are all correctly prescribed and well-fitting.
- If you are able to remain still and with the person while you are talking to them, it will be easier for them to follow you and will show you are prepared to work at trying to understand them.
- Always try to move slowly and quietly.
- Maintaining regular routines helps minimise confusion and this can assist communication.
- Sit or squat beside a seated person - never stand above; make eye contact.
- When talking in a group make sure the person is not on the end of the row. It is better to place the person so that the conversation is around them and they will not feel 'left out'.
Simplifying activities
- Break down an instruction into simple activities: for example, name the next item to be put on as they get dressed rather than suggest they put on their clothes.
- As the condition worsens, break tasks into even smaller steps; explain what you are doing at each step along the way.
- Focus on familiar tasks: introducing new tasks can be confusing.
- Make it easy for the person to join in a conversation by asking questions that need only a 'yes' or 'no' answer, e.g. 'It's very cold for this time of the year isn't it?'
Finding words
- If the person has difficulty finding a word, ask them to explain in a different way or guess at their meaning and ask if you are correct.
- If they can't think of the right word, try giving clues instead of immediately supplying it, e.g. 'cup of ....'. You can also try giving a description, e.g., 'You clean your teeth with it'. You can ask them to show you what they are referring to. Pointing to something will often help the person get the message across.
Verbal abuse
- Avoid upsetting arguments or allowing your own stress and exasperation to show.
- Use distraction when possible to help overcome upsets and frustration.
- Arguments over mistaken ideas should be avoided. If the person insists they have seen a TV program a million times before, even after you have pointed out that it is a first run, say something such as 'Oh, well, I don't think I have seen it before. It's interesting, isn't it?'. Your arguments will only end up frustrating you and probably upsetting the person.
Encourage laughter
- Use laughter: humour is a great safety valve to overcome a mistake or misunderstanding.
Body language
- Pointing or demonstrating can help a person to understand what you are saying; touching and holding their hand may help keep their attention and show them you care.
- Try to maintain eye contact when speaking and listening.
Asking questions
- Avoid too many choices: present only one option at a time.
- Ask questions which require only yes/no responses and give them plenty of time to respond.
- Try to be tactful when the person asks the same questions over and over again.
Aids to communicating
- Showing and touching physical objects and pictures may help with memory and assist conversation.
- Music can be an excellent way of communicating, it can help a person recall words and express feelings.
- Old photos can be used to stimulate memories and recall events.
Last Reviewed: 09 March 2001
Sponsored links
