How to Best Communicate with People Living with Dementia

The Art of Conversation (a memory of the past)

It is 6:30 in the morning, many years ago, and I’m sitting in my kitchen holding a warm cup of tea, looking outside the glass doors into my backyard. In a few minutes I will wake up the kids and this quiet moment will be lost in the chaos of getting three young kids ready off to daycare and school. But for now, I enjoy a few precious moments of serenity. Or maybe not.

She comes into the kitchen, makes herself a cup of coffee, sits next to me, looks outside the glass doors into the backyard, and says “Don’t you think that squirrel is too skinny?”
What The &*!%??

My (then) mother-in-law! I love her to pieces and I admired her ability to never let anyone experience the ‘uncomfortable moments of silent.’ But at 6:30 in the morning, when I’m slowly waking up to my day, it is not the time to start a (trivial?) conversation about the health and nutrition of the squirrels in my backyard.
 
Nowadays, as I sit with her holding her hands, telling her about her grandkids, I miss the chattering. Conversation once came easily to her. She had the ability to start a friendly conversation with anyone about anything.

My ex-mother-in-law, who is now in the late stage of Alzheimer’s, lost all ability to communicate; talk or understand any conversation.

 
What is Verbal Communication

Verbal communication is the ability to form and understand logical speech. But when we have a conversation, it is more than words that the person with dementia has difficulty with.
The ability to remember details - events, people’s names - to follow the flow of conversation, to think and reason, these are all skills required in a conversation. And these are the skills that the person with dementia slowly loses. In the early stages, they may develop coping skills; they may smile a lot and nod their head as if they follow the conversation or, they may turn to their spouse to answer for them. But as the dementia progresses, the ability to communicate is more adversely affected.
 
When verbal communication becomes difficult, it can be frustrating and upsetting for both the person with dementia and their family and friends. But, in my opinion, the worse outcome is that it leads to social isolation. When we try to have a conversation with someone who is not responding in a ‘normal way’ of communicating, we end up pulling away from this person, mainly because most of us don’t have the skills to communicate with the person with dementia.

If that person is someone we live with - a spouse or a parent we can’t avoid them and may become frustrated and less patient
 

Tips for Communicating with the Person with Dementia

There are two types of verbal communication relating to people with dementia: communication for the purpose of daily function and communication as social interaction. 
1.) Communication for the daily function is important for the person who lives with or cares for a person with dementia.
2.) Communication for social interaction is also for the people who come to visit the person with dementia and are part of their social circle.

General Rules Good for Any Type of Communication

Use a respectful tone of voice
Many times, we tend to talk to older people in a tone of voice as if they are young children. Just because the person with dementia may have difficulties in understanding or expressing themselves, it doesn’t mean we need to treat them like children. They are adults and should be addressed as such.

Use clear pronunciation and a clear voice
Don’t talk too fast, or cover your mouth to hide your lips or muffle sound, don’t talk while you’re eating or chewing gum. All of these will make it hard to understand you. Use a loud enough voice if the person is hard of hearing, but don’t yell at them. You don’t need to over-pronounce every syllable, but make sure you speak clearly.

Stay focused on the person
Don’t talk while doing other things, such as looking at your phone, walking around the room (cleaning or cooking), or talk with your back to them.

Connect through eye contact and touch
When you create eye contact or you put your hand on their arm you get the person’s attention and you have the ability to see when you lose their attention. You also communicate to them “I am with you. You have my full and undivided attention as long as needed.”

Talk in short sentences
The person with dementia loses the ability to follow lengthy conversations or multi-step instructions. Instead of, “You need to wash your face, brush your teeth and when you’re done, put the towel in the laundry basket because I want to do the laundry before I make breakfast”, say “here is your toothbrush, brush your teeth”. When brushing teeth is done, you say “please put the towel in the laundry.”

Take your time
Don’t jump from one sentence or topic to another as the person with dementia has difficulty following lengthy and complicated conversations. If you go from one topic to another, stop, wait, take a little break between sentences of previous and new topics. When asking a question, give the person time to answer it, since it may take longer to process the question and to come up with an answer.

Use familiar and simple language
This is not the time to show off your knowledge of big words that require a dictionary. Regardless of the education of the person with dementia, use day-to-day simple words in uncomplicated sentences.

Don’t ask them to remember
A sentence that starts with, “Do you remember where….?” Is a useless sentence for the person who experiences memory loss. Instead, you can say, “Can you help me find…”
 
Be patient
The most difficult time to be patient is when the person with dementia asks you the same question for the fifty-seventh time. It’s not easy to keep your calm and avoid saying, “I already told you that…”.  Just answer the question - yes, again - or try to redirect the conversation and possibly get the person occupied with an activity that will capture their attention and distract from asking the question again.

Tips for Communication as Social Interaction

It’s very common that friends start to withdraw from people with dementia. They feel uncomfortable. They don’t know what is appropriate or inappropriate to say. They don’t know how to have a conversation with a person now different than the person they knew before. It is particularly difficult when that person is still living at home with his or her spouse, as the spouse also experiences the social isolation when their friends withdraw and stop visiting or inviting them to social events.

It is the same person
Inside, the person with dementia is the same person. Remember what you loved about that person and keep it in mind when you look at them now.

Talk about yourself
While in normal conversation we don’t want to only talk about ourselves, in this case, instead of asking questions about the person’s life, tell them about yours. It will not challenge their memory and they will enjoy your stories, as long as you stick to the same rules of communication above.

Be patient
The person with dementia may need extra time to respond to questions. As long as they have the ability to talk, don’t answer for them, unless you can tell they are asking for your help to find the word or the name they forgot.

Bring props
Use letters, photo albums, or small objects as a ‘conversation piece’. You can look at the pictures together while telling the stories that are behind them. You can read a letter that you received a long time ago from your friend. You can recall a memory about the object that has meaning to both of you.

Final Word

My ex-mother-in-law has lived in a memory care facility for a few years now, but unfortunately, visits are infrequent as we’re half a world apart - I live in the US and she lives in Israel. Through the years, I’ve seen her decline to the point of needing full assistance with every physical function. She slowly lost her ability to understand or talk and now she’s not able to even make eye contact.
 
I visited her recently, not for the purpose of making a conversation, but for me to honor who she will always be for me; a woman who loved me, the grandmother of my children, the person who was able to talk about anything, including the health and wellness of the squirrels in my backyard.

*Since I wrote this post, my ex-mother in law is no longer with us, but the memory of the many conversations we had through the years, will forever stay with me.