Communicating with someone with Dementia
Let’s talk the talk
Dementia causes changes in the brain that can make it difficult to communicate effectively. So, speech pathology intervention should target memory and communication skills, right? Of course! To have the most impact, therapy also needs to consider the environment and communication partners.
Chances are you know or knew someone with dementia. You may be already adapting your communication style without realising it, or perhaps you are fully aware of the ways you try to assist your loved one to communicate.
Let’s look at how a thoughtful and skillful communication partner can assist in everyday interactions.
When helping isn’t helping
One of the most common things we do to assist communication is to provide words when our loved one is having trouble finding the word they want to say. There are situations when this is necessary, such as providing accurate information to a health care professional. However, in general, it is counterproductive. What does this mean? Providing a word is a little like cheating on a math test. You’ll get the answer right, but you won’t learn anything.
Given that dementia is a progressive disease, we want to provide our loved one with opportunities to exercise their brain. Just like they would in the therapy room.
It doesn’t have to be complicated, and we don’t need a degree to do it. As a tip, rather than providing the word, provide a scaffold to help them find the word independently.
For example, your mum wants you to buy something from the fruit and vegetable shop. Rather than listing the things she usually buys, you can assist her to find the word by asking questions like:
What colour is it?
What do you do with it?
Do you eat it raw or fresh?
Even if you know the name of the food, you can still scaffold this way, asking about the taste, the texture.
Why it works for people with Dementia
Our brains store information in semantic maps. Everything we know about a word or object is linked to the other things we know about it. All the qualities of this food and memories she has of the food are stored in mum’s brain along with the name. If she begins to access other things about the food, it becomes more likely she will also recall the name.
This is excellent therapy and good for the self-esteem of the person with dementia. It is important, however, to ensure we don’t do this for every word every time. That would be too much work and likely to become frustrating.
Do you remember the time…
Another common thing we tend to do in conversations with people with dementia is request confirmation that they remember something. You know the kind of thing: “That’s Tom, Valarie’s husband, you remember him, don’t you?” or “You ate fish yesterday, don’t you remember?” These kinds of requests or questions are very confronting for a person with dementia. They may just not remember, and this can cause distress, anxiety, confusion and result in aggression and communication breakdown.
A kinder phrasing could be, “You haven’t seen Tom, Valerie’s husband for a while. He’s changed a bit.” or “The fish you had yesterday looked delicious.” These statements place zero demand on the person and assist them to orient themselves to the conversation and events.
Small changes can make big impacts
There are many things we can do to support everyday conversations with our loved one. Some of the simplest things could be ensuring the room is quiet and free from distractions, before entering a conversation. Making eye contact, talking directly to them and using a calm voice and facial expressions. Some people with dementia will respond more to facial expressions and intonation than to the content of the words, making your expression just as important as what you say.
Keeping sentences short and asking simple questions can support conversation. Questions can also be phrased, so only a yes or no response is required. For example, “What did you watch on TV last night?” becomes, “Did you watch any TV last night?” Providing choices when asking questions can support both word recall and reduce the demand placed on the person.
To use the examples from earlier:
“What colour is it?” becomes, “Is it red, or green, or yellow?”
“What do you eat it with?” becomes, “Do you bake it or make soup out of it?”
Prop it up
If conversations are getting harder, it might be time to introduce some props or prompts to assist your loved one to participate. Music often triggers memory and this can be a great way to connect. Photos and scrapbooks can also prompt your loved one to have a conversation. Reminiscing about shared experiences, even if it’s old territory, will help your loved one to communicate and feel connected.
Things to keep in mind:
Dementia may not be the whole story. Consider whether a hearing or vision test may be necessary.
Infections (such as UTI) can often result in an increase of dementia symptoms.
Dementia Australia has free webinars on communication and dementia.
At OSCAR Care Clinic we currently have qualified and passionate speech pathologists with immediate capacity to provide evidenced based therapy and support for people with a range of communication difficulties, including dementia.
