How do you communicate with a person with dementia when they don’t talk much, and you don’t know for sure if they understand what you are saying? Former carer, author and dementia care expert Mary Jordan offers some useful advice.
How to communicate with a person with dementia who doesn’t speak much
Usually the main problem is being able to initiatespeech. My clients usually tell me that the easy day to day conversation has stopped. Talking very generally can often be helpful. For example, when training my volunteers, I suggest that rather than asking ‘How long have you lived in Xtown?’ they substitute ‘Have you lived in Xtown long?’ as a reply to this can be expressed in general terms. In my Cognitive Stimulation Groups, we use ‘props’ such as pictures to get people talking and it is surprising how often a conversation then takes place. Saying: ‘Oh look, that’s a picture of the beach at Margate’ may well get someone talking but saying ‘Do you know what this picture is?’ is a sure-fire conversation stopper.
Why a person with dementia may not say much when you talk
It may not be that they do not understand what you are saying, more a case of them taking longer to absorb the meaning and formulate an answer. If you slow your speech down and talk in simpler sentences this will help. Then allow plenty of time for an answer – research shows that in later stage dementia it can take up to 2 minutes for someone with dementia to understand and answer a question. By this time the questioner has often moved on to other subjects.
Whether a conversation is important or not when visiting a person
It depends on the situation. If the person you are visiting seems to be happy that you are just with them, it is fine to be silent. If you do talk then it is best to (as above) keep your talk rather general and avoid direct questions. Questions are always stressful for someone with dementia. For example, don’t say ‘What did you have for dinner today?’ but instead, ‘I thought the dinner smelled nice as I walked in.’
Tips on relaying information
Keep information simple, slow and repetitive. However, do not speak in an exaggerated ‘baby talk’ manner and do not raise your voice unless someone is actually hard of hearing. You may feel silly repeating information several times but the person with dementia will not – their memory needs the repetition.
Coping when a person with dementia doesn’t understand you
You can convey a lot with body language and touch. Looking interested, repeating key words (if you can grasp them) and keeping your attention focused all count. A hug (if appropriate) or a touch on the hand can be helpful. If you need to get someone’s attention, then a gentle touch will usually make them look at you and listen. You can also use sign language – pat the seat of the chair you want them to sit in, move over to the window if you are drawing attention to the view, hold up the coat if you want them to put it on.
Dealing with the person with dementia contradicting you
You don’t have to tell the person they are right but never to argue the point. In some circumstances, it can defuse a potentially difficult situation if you apologise and back down. This applies especially if the person with dementia is getting agitated. Of course, there is always the possibility that youhave not understood what theyare saying, and they might actually be right. It is never worth arguing about a trivial point just to feel superior.
General advice on communication
Avoid complex questions. Complex questions are ones which involve the person with dementia having to understand more than one point. (e.g. Would you like a hot drink now or do you want to wait until later?) As dementia progresses avoid direct questions at all if you possibly can.
Always get someone’s attention first before speaking. Not ‘Would you like a cup of tea, John? But ‘John (get attention his attention first) would you like a cup of tea? (Yes, this is a direct question, but it is not a complex one).
You can rephrase questions as statements, as follows:
‘We’ll have lunch now.’
‘You must be feeling cold’
‘Let’s put your sweater on’
Never say: ‘Do you remember?’ is the most stressful thing you can say to someone with dementia, as they won’t remember what you previously said.
Mary Jordan has specific first-hand experience of dementia through caring for relatives and through her work for Alzheimer’s Society. She also has many years of experience working for the National Health Service and in the field of medical publishing. She is an associate director of ELM (End of Life Care).
Mary qualified to deliver the Alzheimer’s Society CrisP programme which specifically caters for family carers and is QCF assessor in vocational achievement for Dementia. She is now a director of AdaptDementia Ltd set up to help people develop a better understanding of dementia. Mary’s ability to use her first-hand experience to illuminate points in the training make her an inspirational and motivating trainer.
Mary is also known for her books The Essential Carer’s Guide, the award-winning Endof Life, The Essential Guide to Caring, The Essential Carers’ Guide to Dementia andThe Essential Guide to Avoiding Dementia as well as The ‘D’ Word co-authored with Psychiatrist Dr Noel Collins, all available on Amazon. Visit her website at https://www.adaptdementia.com