Dementia refers to the loss of brain function – thinking, remembering, and reasoning. That function affects language, memory, insight, judgement, planning and reasoning. Some people with dementia cannot control their emotions, and their personalities may change. It ranges in severity from a mild stage when a person’s functioning is just beginning to be affected to the most severe stage when a person must depend completely on others for basic activities of living.
Jeannine Forrest, Ph.D. R.N., recently talked with Snyder Village staff and shared tips for communicating with someone who has dementia. Forrest explained that communication is more than words. It also includes tone of voice and body language. As it becomes increasingly difficult for someone with dementia to understand and use language, she encouraged caregivers to pay more attention to their tone of voice and facial expressions, even posture, can indicate what message the person with dementia is trying to share. These same strategies are appropriate for family members when communicating with their loved ones with dementia.
She encouraged caregivers and family members to be more aware of their tone of voice and non-verbal behavior. If you are stressed, angry or resentful, the person with dementia will absorb the negative energy, and their demeanor will often mirror your behavior. As the dementia progresses and the person moves from early to final stages, communication can be enhanced by focusing on alternatives to words and language. When communicating, use all of the senses – hearing, touch, seeing, smelling, tasting. Make sure your visits and time together incorporate all of the senses. This is not intuitive to many of us because so much of our “visits” with others focuses on language and talking. Instead, listen to favorite music together; knead bread dough, bake and enjoy homemade bread together; or give your loved one a hand massage with scented lotion. What is your loved one’s favorite food? Ice cream sundae? Chocolate pudding? Peach pie? Hershey’s kisses? Allow them to enjoy a favorite food during your quality time together. These are ways you can experience joy together without having to communicate with language.
Dr. Forrest also shared some Do’s and Don’ts for communicating with someone who has dementia:
- Eliminate or reduce background noise. (Turn off the TV or radio.)
- Face the person at the same level.
- Talk more slowly, allowing your words to be received.
- If the person asks the same questions repeatedly, respond as if it were the first time. The part of the brain that normally records or remembers what someone is saying no longer works properly. The person with dementia cannot control this. Dr. Forrest shared the analogy of a loose light bulb – sometimes it works, sometimes it doesn’t.
- Allow time for the person to answer the question.
- Time travel is a great strategy for communication with those with dementia.
- Allow them to enjoy reliving past memories and stories that are shared.
- Stay calm and apologize if the person become irritated or upset. Most of the time, you cannot “fix” the problem. But you can say, “I am sorry you feel this way…” or “I can tell you’re upset. I’m sorry…”
- Do not quiz or try to “test” someone’s memory. This just creates anxiety, frustration and embarrassment.
- Do not assume that the person is lazy. As dementia progresses, the ability to start or plan an activity becomes more challenging over time.
- Do not speak over or for the person with dementia or act as though he or she is not present.
- Do not ask abstract questions. Instead of what do you want to drink? Ask if they would prefer milk or juice. And instead of “what would you like to do today?”; ask “would you like to listen to music or go for a walk outside?”
- Do not argue or try to rationalize or convince. Remember, areas of the brain responsible for self-awareness and insight become compromised over time. You will never win the argument.
Dr. Forrest shared www.dementiasociety.org, web site for the Dementia Society of America as a good source of information. She is a dementia educator and consultant based out of Skokie, Illinois, whose company is Through the Forrest, LLC.