Dementia affects people in different ways. However, changes to the way people with dementia communicate are common. This can be challenging for the person with dementia and their family members, carers and those around them.
People living with dementia sometimes struggle to communicate and understand words said to them, so good communication - both verbal and non-verbal - is very important. Good communication gives reassurance, it signifies safety, and compassion.
When it comes to verbal communication, there are a few things to bear in mind:
- Try to be patient.
- Keep questioning simple.
- Realise some days will be easier than others.
- Minimise noise and distractions when talking.
- Be precise with information and names.
- Do not talk about the person as if they were not there.
- Avoid contradicting.
And here are some positive nonverbal communication skills you can use:
- Smiling.
- Looking at the person when talking - focusing on them.
- Nodding.
- Keeping your posture open and inviting, e.g. avoid crossing your arms.
Good communication also relies on being able to read body language and patterns of behaviour. The person you care for may not be able to tell you verbally that something is bothering them, but there are often signs.
Once you are familiar with the things that trigger anxiety, frustration or other behavioural changes, you can be prepared with distraction techniques and reassuring words. Some of the things that may cause upset or frustration in people living with dementia include the following.
- Feeling overwhelmed in distracting or noisy places.
- Struggling to grasp humour or sarcasm.
- Having difficulty articulating what they want to say.
- Finding it difficult to concentrate due to tiredness or ill health.
How to manage some challenging communication situations
We have identified some common situations and reasons why you may see a change in behaviour in the person you care for. Below are some recommendations on how to communicate positively and handle the situation in the best way possible.
Why?
They may be craving security and familiarity.
Possible response and outcome:
There is potential in this scenario for you to become frustrated because you’re already home. Your frustration will likely cause some irritation and add to their feeling of unease.
Recommended response and outcome:
It is important to give reassurance. Perhaps use a distraction or get them involved with a household task, such as folding clothes. This should reassure them, giving them a sense of security and of being home.
Why?
For most people, the thought of their parents gives them a feeling of love and comfort.
Possible response and outcome:
It would be natural to respond by telling them their parent(s) have passed. But there is a risk here that they will become very upset. It is not uncommon for someone with dementia to grieve multiple times for people.
Recommended response and outcome:
In this situation, it’s recommended to ask them questions about their parents – what were they like? What things did they like doing together?
Talking about their parents should bring them comfort while distracting them from wondering where they are.
Why?
This could be a sign of lots of things but often it’s a sign that they are feeling unwell or are in discomfort.
Possible response and outcome:
It would be natural for you to also become frustrated which would increase their frustration.
Recommended response and outcome:
Check for signs of discomfort – any swellings, rashes, headache, a high temperature or toothache for example.
Try asking them what is bothering them. By checking their wellbeing you can rule out illness or discomfort.
Why?
This could be due to their loss of recognition including familiar faces or places.
If this happens suddenly, it's important to seek medical support to rule out an infection or ill health that may cause confusion.
Possible response and outcome:
It would be natural to feel upset by this and to react by repeatedly reminding them who you are. But reacting like this is likely to cause them angst and may lead to them feeling distressed.
Recommended response and outcome:
In this situation, it is recommended to put yourself in their reality. It may help to step outside of the room for a few moments and to re-enter saying ‘hello, how lovely to see you’.
Although this can be upsetting it is so very important to join them in their reality.
Tried and tested tips from carers
Carers at Carers First have shared with us their top three tips when communicating with someone living with dementia:
At times the person you care for may do or say something that makes no sense - perhaps they’ve put something in the wrong place and you can’t find it or they’ve done a household task wrong and you have to redo it.
As a carer, these things can become frustrating. You can choose which of these to tackle and which to leave. For example, if the person with dementia is saying or doing something that is not a risk to them or someone else, perhaps let it be. This can improve your relationship and will reduce stress for both of you.
The reality of someone with dementia can often very different to your own. Sometimes it can help to stop trying them to understand your world, but making sense in their world instead.
Try putting yourself in their shoes, or their thoughts. For example, if the person you care for is convinced someone is watching them, instead of disregarding what they are saying, put yourself in their world, check to see if there is anything that could be making them feel like they’re being watched and reassure them by saying “it’s okay, I’m here and you are safe.”
As dementia progresses, people can lose their ability to understand different words or their meaning. At this point, it is helpful to become aware of your body language or nonverbal communication.
Body language can show negative emotion that you may feel, even though the words you are saying might be different. This can be mirrored by people with dementia and can make tasks or activities challenging for you both.
For example, if you are helping the person you care for take a shower while you are stressed and apprehensive, they can become stressed too and even refuse to shower. Changing your body language and atmosphere can help reach a better outcome for both of you. For example you can to talk through the experience calmly, play some familiar music and encourage them to shower while smiling and reassuring.