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Communication in Dementia

“The most important thing in communication is hearing what isn’t said.”
– Drucker P.

Communicating with those who have Alzheimer’s disease can definitely be a challenge. Alzheimer’s disease impairs their ability to understand what your words mean, and to form them into ideas that they can understand. This creates a very frustrating situation for both the elder and their care partner. It can cause the elder to feel increasingly isolated and fearful, since they cannot understand what’s going on around them. Their attempts to make sense of it all can cause a large amount of stress and frustration, which can result in challenging behaviors, as well. This frustrating situation can create a serious healthcare problem, as it can result in a decline in the elder’s quality of life, and cause depression and increasing isolation.

Much evidence-based research shows that cognitive decline worsens faster in those elders who are unhappy, depressed and not participating in quality of life activities. In addition, if an elder becomes uncommunicative, you’ll have increasing difficulties in determining if there is a medical problem that needs attention, such as pain.

Throughout the stages of dementia, there will be changes in how the elder may be able to communicate. With Mild Cognitive Impairment (MCI) or early dementia, the elder may have some difficulty concentrating or finding the right words. At this stage, the elder is often aware of the problem and may try to over-compensate. This is also the stage where depression may become more noticeable.

During the moderate stage of dementia and cognitive decline, the elder may lose a train of thought or get lost in the communication process and may use gestures to communicate. At the severe stage of dementia or severe cognitive decline, the elder may have an increased loss of vocabulary and inability to recognize loved ones. It will be at this stage where the inability to communicate may result in increased challenging behaviors. Finally, at the end stage of dementia or very severe cognitive decline, the elder may have an inability to speak or respond and may only respond non-verbally. As a care partner, you are concerned with providing companionship and ensuring the elder’s safety while managing their daily routine. Communicating as well as you can with the elder is very important in meeting care goals. Regardless of how the elder reacts, you need to communicate with them at every opportunity. This is because they need that human interaction as much as anyone else. Even if they don’t react or don’t seem to understand what you are saying…chat with them anyway!

When a person has memory loss, his life is made up of moments.

Create opportunities for interaction by understanding their past history. People with dementia often remember songs or important seasonal events that may spark a memory and an opportunity for interaction. When a person has memory loss, his life is made up of moments. In fact, our lives are made up of moments. In that frame of reference, then, it is absolutely possible to create a meaningful day by creating moments that will put a smile on the elder’s face or trigger a memory that will bring joy. Within a few minutes the elder may not remember what you did or said, however, the feeling you left with them will linger.  Research also indicates the value of holding the elder’s hand or touching them on the arm or shoulder as you speak, to further show interest in them and their well-being. How do we communicate with an elder who has dementia?

First step: Be a good listener.

This is probably one of the most important skills in communication. By listening, you will accomplish two things: you will learn many interesting things that are important to the elder and you make that elder feel valued. Experts in the field of communication tell us that effective conversationalists will listen approximately 85% of the time and will talk on 15% of the time. Certainly, we will need to adapt our communication style to the elder’s stage of dementia or level of cognitive ability. Should the elder have trouble communication, give them time to gather their thoughts. An effective approach is to allow them around 90 seconds between communicating thoughts with you. This allows them to come up with the right word or response. If the pause goes on too long, you may want to add a word to let the conversation continue.

Second step: Be observant.

Pay very close attention to what the elder is saying as well as anybody movements that may indicate something important. These will alert you to make a determination about the elder’s needs. Skilled observation is one of the most important skills in care provision especially in the later stages of dementia.

Third step: Be aware of your communication “appearance.”

How you appear during a communication event with the elder can make a difference in how effective your interaction with them will be. Consider the following tips from the National Council of Certified Dementia Practitioners (NCCDP):

  • Be happy and pleasant. Smile a lot. Have a pleasant facial expression.
  • Show very attentive interest in the elder. Look them in the eye, don’t allow yourself to be distracted by talking to others or looking absentmindedly out the window. Give them your undivided attention and interest.
  • Use a moderate tone of voice. Don’t shout or talk loudly.
  • Use gestures as necessary to make your point. Touch them, or hold their hands whenever appropriate.

As the disease progresses, meaningful conversation becomes more difficult and challenging. Utilizing the following basic tips may help you communicate more successfully with those elders in the more advanced stages of dementia.

One-on-One meaningful tips

  • Gain their attention. Approach them from the front, identify yourself, and call by name.
  • Maintain eye contact. Facial expressions and body language gives you clues about what the elder may be thinking or trying to convey to you.
  • Choose simple words or short sentences.
  • Use a gently, calm tone of voice.
  • Reduce background noise.
  • Always be attentive. Try to understand what is being communicated.
  • Be prepared to repeat yourself and rephrase as necessary but avoid repeating things too much. If the elder has difficulty understanding what you’re saying, find a different way to say it.
  • Be patient and plan ahead.

Dr. Jeff A. Beaty, DHEd, LMSW, MSHA, CCTP, CADDCT
Chief Research Officer