Dementia care – Improving communication with a person with dementia.

Dementia is often a heart-breaking disease. If you are caring for a person with dementia you will be all too familiar with the theme of difficult communication. Having a conversation with a person with dementia is often extremely difficult.
Improving communication with the person with dementia will pay dividends. It is often challenging to know how to achieve this.
A typical request for help is often along these lines;

‘I have been looking after my Dad for a while now, actually it’s been five years. Talking to him has become so difficult, I can’t bear to even try to talk to him at the moment. I never know how he will respond. Sometimes it’s like he’s not there. I know he is there physically; but it’s like he is empty, like a shell. Other times, he is angry and gets really agitated. On other occasions, I think we are having a good conversation and then he says something so random that I wonder why I bother. I am really at the end of my tether’. Does this sound familiar?

There are times when it can be very difficult to continue to talk to a person with dementia. Relatives often speak of a loved one as being like an ‘empty shell’. Trying to hold a conversation is often frustrating. You perhaps want to ask what your Dad would like for lunch, he might insist on telling you what he had for lunch during the war.
A person with dementia often has a tendency to mind wander, to be absent, (the empty shell) or to be extremely aggressive. These behaviours are very hard to deal with and when repeated over time can lead to burnout and depression in the carer. Learning to communicate better with the person with dementia is beneficial to you and the person you are caring for.

These simple strategies may help you communicate easier with the individual with dementia.
1) Recognise what you are dealing with.
It will be a great help if you are able to gain information about the condition. A little knowledge will help put the difficulties you are experiencing into context. Acquiring information will help you feel less like you are failing when interactions are stressful.
2) Avoid distractions.
It is very important that when you talk to a person with dementia that you have the time to do so. If you are caring for a loved one, it would be a sound plan to build time where you will not be interrupted, called upon or pressured to be elsewhere. Turn your phone off.
3) Speak clearly and slowly in a calm voice.
Speak clearly and more slowly than usual. Use a calm voice and a warm tone. If you feel nervous or agitated these emotions will be picked up by the person with dementia. They will usually register threat and respond in a negative manner. Keep interactions calm.
4) Use names, be specific.
Rather than say ‘Hi, it’s me’. A more helpful greeting would be ‘Hello Granddad, its Ben, your Grandson’. This type of greeting provides a type of scaffolding to the memory system and can aid the retrieval of information. The result is often less frustration.
5) Stick to one subject at a time.
It is very helpful if you are able to plan the conversation you would like to have with the person with dementia. Take a few minutes beforehand to think about what you wish to say. Think how you could say it clearly, warmly and in such a way that it could not seem confrontational to the person with dementia. This is way harder to do than it sounds. Talking about one topic at a time is a good idea.
6) Use lots of Non Verbal Communication (NVC).
When we communicate 90% of our message is conveyed by non-verbal cues. To the person with dementia who has difficulties in retrieving information, positive non-verbal communication can really help understanding. An open, relaxed and smiling posture conveys safety and reduces the perception of threat. This may seem obvious but it is important that we always checkout our non-verbal communication especially when we are in challenging situations.
7) Listen actively. Regularly paraphrase the essence of what has been said to you. This will facilitate understanding and encourage further dialogue.

8) Don’t argue, quibble or correct. It is often the case that the dementia sufferer will make grammatical errors or confuse words. It’s important that mistakes are ignored and not picked up on. Correcting the individual rarely helps, often it adds to their confusion and increases agitation.
9) Accept there will be good days and bad days.
We all have days that are better than others. It is the same only more pronounced for dementia sufferers. On occasions their mental powers appear better than others. This can be frustrating and heart-breaking for carers. Unfortunately, this situation is attributable to the disease.
10) Consider respite.
Is there any other family member who could give you a few hours to yourself? This may reduce your load. Alternatively, is your loved one well enough to attend a day centre to benefit from reminiscence therapy, perhaps for a few hours once a week? Reminiscence therapy is a structured therapy where the individual is encouraged to reminisce about their past through interaction with various objects or items. This has the effect of stimulating interest and conversation and often makes management of the disease a little easier.

Written by Christine Tizzard, Consultant Chartered Psychologist and Clinical Director of Sheehan Brooke Psychology.
Sheehan Brooke Psychology is an independent psychology provider based in west Sussex.
The organisation provides psychological assessment, interventions and support throughout the lifespan.
We offer a full range of eldercare psychology services supported by a small professional team comprising of psychologists, counsellors, social workers and support staff.
Sheehan Brooke’s elder care services include elder psychological assessment, dementia assessments, treatment and memory interventions, care planning, accommodation selection and support services. www.sheehanbrooke.org
We also provide bespoke training to staff within residential and nursing care settings to enable the provision of professional, compassionate and dignified care to the dementia patient.
Sheehan Brooke has over many years built a reputation for providing highly professional and clinically exacting services delivered in a caring and empathic framework. Our services are broad and advice is always freely available. Our organisational ethos is very simple and that is to provide each client as far as we are able, with the same level of exacting care that we would wish for our own partner, child or parent.