Alzheimer’s disease and other dementias diminish a person’s ability to communicate over time. This helps explain why communicating with someone battling a form of dementia such as Alzheimer’s can be challenging at times and even uncomfortable for those less familiar with the disease. The list of concerns is long: What if I say the wrong thing? What if I upset her? What if she doesn’t know who I am? What will we talk about? What will we do together?
I have learned from experience with my Mother’s Alzheimer’s journey and through my work facilitating watercolor painting sessions in memory care facilities that communicating with individuals with dementia is really not as mystifyingly complicated as we build it up to be. It begins with taking a deep breath and utilizing some pretty basic communication techniques.
1. Put Yourself in Your Loved One’s Shoes
One of the first pieces of advice that I give to my friends whose loved ones’ memories are failing is to put yourself in your loved one’s shoes. This is an age-old recipe for compassion, which is critical when communicating with someone with dementia.
Let’s play out a scenario: Your loved one is starting to forget pretty familiar things or asking the same question over and over about where to find the scissors in the kitchen. A natural response may be to remind your loved one that her friend’s name has always been Sally (and maybe to remind her that she already knew that), or that the scissors have always been in the drawer next to the stove, or that you’ve told her eight times what time visitors are coming by. But don’t.
Take a deep breath and put yourself in her shoes. Imagine how frightening and humiliating it might feel to have someone become exasperated with you and you’re not sure why. Be patient, be calm, be compassionate and stay positive. Change the subject or make a joke if you have to. Examples: “Those darn keys can be hard to find sometimes,” or “Keeping up with so many names these days can be challenging!“
2. Make Eye Contact and Smile
In my work at memory care facilities, you would be amazed at how much I can connect through eye contact and a good, old fashioned smile. It’s hard not to smile back when someone smiles at you. So when you’re with your loved one, try to slow down, look them right in the eye and smile with love and intention.
Your eye contact let’s your loved one know that you are making the moment about them and speaking to them directly. Your smile conveys that everything is okay, and that you’re not worried or angry (which creates stress for those with dementia).
As with so many things in life, positive attracts positive. The same thing goes when communicating with a person with dementia. Once things turn negative it’s harder to get back on a positive track than it is to stay positive in the first place.
3. Go with the Flow – Rather than Argue
Realize that dementia has affected your loved one’s brain – jumbling the facts and tossing some of the facts by the wayside. He’s not trying to argue with you. Instead, he’s simply going off of what information his brain is providing, which is quite possibly incorrect.
It does no good to argue and go down a negative path that can lead to humiliation or aggravation. Just go with the flow, agree if you need to (even if it doesn’t make sense) and rephrase in a way that is more inline with the actual facts without being condescending.
Here’s a scenario: “This isn’t my doctor’s office. Why are you taking me here? Cheery, non-condescending answer: “Well Dad, maybe he moved but this is where your doctor is now.”
Another scenario: Your Dad says, “I haven’t eaten all day (even though he has). Answer: “That ham sandwich we had earlier sure was tasty. I love ham sandwiches. Here are some nuts and fruit if you’re hungry. Dinner will be soon.“
Don’t argue. I repeat, do not argue. Go with the flow.
4. Talk Slowly and Calmly
Think about when you’ve been in another country with a language foreign to you. Let’s say your cab driver in Italy is saying something that seems important that you don’t understand. The faster he talks the harder it is to understand, right?
Now if that same driver starts getting upset and repeating himself loudly, this creates a stressful, possibly fearful, situation, right? So if you’re loved one is refusing to do something, or seems confused, perhaps she simply doesn’t understand the concept of what you are saying. Refrain from outward frustration, which creates anxiety.
Instead, slow down. Take a deep breath. Take time to understand what is happening. What was the chain of events that might have caused confusion?
Also, get creative. I remember midway through my Mom’s Alzheimer’s journey, when I needed her to sit down in a chair, I would pat the chair and point to her and then to the chair (sometimes more than once and with a smile). That helped her understand what I was trying to communicate. Repeating or raising my voice, or getting frustrated would have upset her and caused her to want to flee from a stressful situation.
5. Refrain from Asking Complicated Questions
Asking someone with memory loss a lot of questions is kind of like putting them in the middle of that dream we’ve all had where we show up to a pop quiz and we’re completely unprepared. It’s not a great feeling.
In my work, I try not to ask questions that need more than a yes or no answer. Sometimes it’s better to just make statements that your loved one can choose to agree with if they wish or that might prompt a memory or discussion.
Example: “Those flowers sure look pretty outside these nice windows. (while gesturing toward the window). Or: “Something sure smells good in the kitchen. I wonder if those are cookies I smell?”( while making a smelling gesture).
6. Break Things Down – Simplify
Try to avoid long, complicated requests or instructions for your loved one. Think about when someone gives you directions. Sometimes being given too many details make it hard to remember the main turns you need to take. This is especially true when remembering is more of a struggle.
Also, think about simplifying anything that seems to repeatedly confuse your loved one. Maybe you need to set the coffee can out on the counter instead of in the cupboard? Maybe you need to set clothes out for Mom or Dad or help them purchase clothes and shoes that are easy to put on and take off. Maybe a shampoo and conditioner and soap in one to make bathing simpler?
The easier you can make your loved one’s life, and your conversations with them, the better.
7. Be Silly
I often say that I am a one-man Three Stooges episode when I am working with my memory care watercolor painters. Humor and silliness can bring joy and lighten a mood better than anything else.
I remember when I used to help my Mom change the sheets and dust her house, I would use funny voices and gestures to make her laugh. Doing so not only lightened the mood, but seemed to also make her feel safer. We began to have a different kind of fun together than we had ever had – all through being silly.
When I show my painters different painting techniques I often use silly sound effects to help explain. If I’m demonstrating to a painter how to use a sponge for the sky of a painting, I dip the sponge in the paint and then repeatedly press the sponge onto a sample piece of paper firmly while saying “ Bonk, bonk, bonk … This makes the sky.” They usually grin and immediately catch on. Then, often after I’ve done this a few times, others in our group will start repeating, “bonk, bonk, bonk” as we all giggle.
8. Positive Reinforcement and Praise
If you can tell that you’re loved one is having trouble communicating or finding his words, let him know that it’s okay. Encourage him to finish by helping him find the words in an upbeat way. Try not to interrupt and instead encourage conversation around the topic at hand.
Offer praise and positive reinforcement for tasks achieved whenever possible. Even if it’s a simple compliment on your Mom’s outfit, or a freshly made bed, positive feedback and encouragement can put your loved one at ease at a time when her brain is sending mixed signals and creating anxiety. Just as positive encouragement can help us achieve a task we find formidable, it can do the same for your loved one.
When I am working with my painters and compliment them on their paintings I make sure to lower myself to their chair level, make eye contact, and smile as I compliment an aspect of their painting. At first they look at me in disbelief and sometimes with a grin, but after a bit more positive reinforcement, the sense of pride and smiles that I witness are a clear example of the incredible impact that positive reinforcement can have.
When your loved one’s brain feels jumbled, it causes confusion. This can lead to frustration, fear and sometimes anger. Often it’s difficult to discern what prompted the negative reaction from your loved one but her agitation is ramping up. This is when the skill of redirecting is helpful. When you redirect, you are literally redirecting your loved one’s attention to something different.
Let’s say your Dad seems angry about something or at someone and they’re getting more and more upset. As soon as his agitation begins to increase or just before (once you learn to anticipate it), you subtly change the subject to something else. You hand him a magazine to look at or compliment the color of his eyes, or suggest a change of scenery.
This also comes in handy if your loved one is doing something potentially unsafe or destructive. I always tried to have photo albums, puzzles and newspapers nearby to redirect my Mom when necessary if she became upset, confused or overly interested in going out the front door.
10. Above All Else, Be Respectful
Try not to ever talk about your loved one like they’re not there. Do your best to refrain from ever barking instructions at them or showing your frustration. Their brain is just not working the same and they can’t help it.
Do your best to never embarrass them or shame them by calling out something that they forgot or for any accident caused by their memory issues. Give your loved one time, give them your love, and give them your respect.
It Takes Time
It takes a while to get the hang of communicating with someone with dementia. I can guarantee you that your loved one will get upset (a lot), they might not remember you, and you probably will probably say the wrong thing numerous times. But the risks of all of these things happening far outweigh the risk of losing emotional connection with your loved one. What’s more, now is when they really need it.
Allison Radcliffe founded Cognitive Art Connections after her mother’s Alzheimer’s diagnosis. She facilitates watercolor art sessions at assisted living, independent living and memory care facilities, as well as in some private settings. Hourly sessions promote socialization, self-esteem and relaxation, and help participants with concentration and motor coordination. For more information, go to www.cognitiveartconnections.com.
Additional help with communication and other challenges with your loved one experiencing memory loss can be found through the Alzheimer’s Association 24/7 help line at 1.800.272.3900. You can also find support groups for caregivers through your local Alzheimer’s Association chapter.