Tips for Communicating with people with dementia

A dementia diagnosis can lead to a lot of changes in how we behave and communicate. Beyond the increasing impact on one’s ability to recollect past events and life details accurately, it can also lead to issues with anger and frustration, anxiety, mood swings, aggression, accusations, and so on.

To avoid emotional distress and cooperate with your loved one as best as possible, it’s wise to learn what you can about how to communicate more effectively with them. Here, we’re going to share ten tips on how to better communicate with a loved one with dementia.

Don’t argue, instead agree

Agitation is a common issue faced by people living with dementia. Arguing, rather than solving any problems, is only more likely to exacerbate them, heightening that agitation. Disagreements can and will happen with those you love. Dementia can open up new opportunities for arguments, as well. Unfounded accusations, worrying behaviours, disagreements on past events, and trouble with challenging tasks like maths can lead to agitation.

However, arguing with someone with dementia is not going to solve those issues. Any arguments that can be interpreted as doubtful or accusatory will likely be read as such. When that happens, your loved one may instead only anger them, leading to more defensive behaviour, which may get hurtful. You have to be willing to let things go or to agree to their interpretation of events.

Never reason, instead divert

You might be able to maintain your calm and keep your cool when you’re communicating with someone with dementia. If they express a want that you disagree with or two contradicting points clash, you might think to reason with them instead of arguing with them. However, reasoning can be just as ineffective. Lengthy explanations are likely to get lost in the conversation and things may only get progressively worse as new information means a situation gets harder for them to handle.

Diversion can, instead, be an incredibly effective tactic. For instance, if a loved one intends on driving to the shop alone, but are unable to, simply reasoning that they can’t drive or catch a bus may anger them. Instead, you can divert by telling them you were about to go yourself, or offer together, or tell them you will go later, before moving onto a different topic. It doesn’t directly contradict them but does offer a solution, even if you’re not being entirely truthful about that solution in the short-term.

Never shame, instead distract

It is only natural that sometimes a home carer or loved one can be surprised, angered, or otherwise disturbed by changes in behaviour from someone with dementia. The changes can come as a shock and, when it comes to insults, harmful language, and other harmful behaviours, an emotional response might feel like a quick way to gain control of the situation and defend yourself. This can lead to a temptation to shame someone about a mistake they have made, a wrong conclusion they have come to, or something hurtful they have done.

It’s important to remember that your loved one with dementia is not in full control of their emotions and how they express them. Anything hurtful or offensive they do may not be a true reflection of their beliefs or feelings, so moving past them is much healthier for both of you. For instance, you can acknowledge that they are upset, and distract them by changing the topic or environment, such as suggesting going for a walk or asking for help with a household task.

Never lecture, instead reassure

People with dementia will make mistakes, just like anyone else. They may make a mistake with something that they were once very familiar and competent with or may respond to mistakes with confusion, anxiety, and uncertainty. These mistakes can be inconvenient for you, if they make a mess, damage property, or do something potentially harmful. You may be tempted to help ingrain a lesson by lecturing them, ensuring that they don’t do it again. However, this doesn’t work.

Lectures are confrontational by nature and people are likely to respond by getting defensive or by shifting blame towards you, instead. Affection and assurance can go a long way. Be understanding, ask if they are okay, and offer comfort and support. If appropriate, holding hands, touching, or hugging can help them get over the real emotions they are going through.

Never say “remember”, instead reminisce

Revisiting memories of the past can be very helpful for people with dementia. It can be comforting and can help them reaffirm their sense of identity, community, and context. However, it can also be a challenge and if they have trouble remembering a detail or an answer to a question, it can become distressing.

If you want to revisit memories with them, it’s wise not to ask them about specific events or details. Instead, start by reminiscing about shared memories. Talk about your own memories of someone you both know or knew, places you have been, or experiences they have shared. This can encourage them to share their own. They may get details wrong but, instead of contradicting, simply agree and move on. Challenging their memories can lead to disorientation and agitation.

Ask general questions about their distant past, such as jobs that they have worked, where they went to school, their childhood, and friends they have had. If you ask them about something from the past and they don’t remember, simply move on. Try not to ask any questions relying on short-term memory, either, as this is the part of the memory that can be most strongly affected by dementia.

Never say “I told you”, instead repeat

As mentioned, short-term memory is one of the parts of the brain most strongly affected by dementia. As such, while your loved one may remember events from 30 years ago with surprising clarity, they might have trouble remembering what they were doing 30 minutes ago. As such, it is not uncommon to ask them to do something only to come back sometime later and discover it not done.

It’s easy to understand how carers can become agitated when this happens. You might be getting everything ready to go on a trip to the shops, but they failed to put on their hat even if you reminded them where it was. However, it’s important to remember that their short-term memory is affected by their dementia and that, as a result, they are often easily distracted. They may not remember you telling them to do something initially. So, saying “I told you” to them may feel like a direct contradiction to them. Contradiction leads to defensiveness and agitation, so it’s wise to instead simply repeat what you asked them to do the first time as if it’s your first time saying it.

Never say “you can’t”, instead say what you can do

As contradiction is one of the leading causes of agitation and defensive behaviour during communication, it’s only logical that directly contradicting their actions can lead to tense arguments with a loved one with dementia. However, that does not mean that you have to simply sit aside and let them do things that are potentially destructive, harmful, or otherwise dangerous.

Instead, it’s wise to rely on the tactic of diversion and deflection once again. Rather than telling them the things they can’t do, you instead offer one or two options of what they can do. For instance, let’s say that they want to go to the park. Instead of saying “you can’t go to the park,” you can offer options that might be just as satisfactory. You can offer to go to the park together with them, to take a walk around the neighbourhood, or to take care of the flowers in the garden, together. They may instead be distracted by the options you have provided and move completely from the prohibited actions.

Never demand, instead ask

Although dementia can affect someone’s cognitive abilities, memories, and capacity for independence, it does not affect their ability to feel shame or to be belittled. As a carer or a loved one who takes some responsibility for their care, you do have to exercise some authority over them, but it does not mean that you should treat your word as an absolute that they must follow. If you want or need them to do something, then it’s best to treat it as a cooperation rather than a delegation.

For that reason, you should never demand that they do something or tell you something. This can easily lead to them feeling like they are being undermined or condescended to. Not only does this not get you closer to your intended objective, but you can find them becoming agitated, hostile, or disorientated. Instead, ask them your request kindly. Phrase it as if they are doing a favour or helping you in some way. It’s also a good idea to refer to them by name, as it can aid their concentration and means they’re more likely to be listening. When asking for help or for them to do something, keep the point short and concise, as long, complex sentences can be hard to fully grasp for people with dementia.

Never condescend, instead encourage

Many people fall for the temptation of treating those with dementia as “child-like.” From mood swings to irrational responses to memory issues and vocabulary problems, their behaviours can sometimes resemble those of children. However, they are not children and should not be treated that way. People with dementia can tell that they are being condescended to. Even if their perception of events isn’t always based on reality, their feelings are real, and they can easily be hurt or insulted by condescension or feel robbed of their dignity.

Don’t use childish language like “bib” instead of “apron.” Similarly, don’t use terms commonly referred to as elder speak (such as calling them dear, instead of by name.) When it comes to activities or requests, don’t dictate them point by point as if explaining a chore to a child. Instead, ask them to do something and gently remind them of steps that they may commonly forget or use visual cues, such as pointing to a destination, that help them. If they find it challenging, be understanding and give them encouragement. Let them know that they are being heard and listen to their feelings rather than simply dismissing them.

Never force, instead reinforce

A loved one with dementia may not always be cooperative. You may be helping them get ready to do something, even something they enjoy like taking a walk in the park, and they may still resist you. Acting or speaking in frustration is tempting and you may think that it would simply be easier to take charge of the issue and force them to do something if they are not cooperating. However, forcing them robs them of their dignity and can make them feel frightened, angry, and ashamed.

Do not take any “no” from them personally. Instead, reinforce what you intend to do and how you need their help. If they are getting agitated, take a break, divert their attention to something more positive. You can help them cooperate by offering choices, as well. For instance, if you’re trying to get them to put on a coat to go outside and they fuss with one, you can offer different coats and jackets they might want to wear, instead. The “rule of three” can help, as well. If they decline the first time, you can make it personal by referring to how much they enjoy an activity, or make it a request as if they are helping you by cooperating. The third time, offer a physical or visual cue, such as pointing or showing a picture and don’t be afraid to offer a reward, such as going for a treat.

Get the help you need from Dementia Caring in Sydney, Brisbane and Melbourne.

If you want any more information and advice on how to care for a loved one with dementia, or you need help with dementia care services in Sydney, get in touch with Dementia Caring. Besides dementia care at home, we also offer a host of carer support services to help you live your life a little more flexibly without worry about whether or not the needs of your loved one are going to be me.