The language of dementia

What you need to know about communicating with a person with dementia

Communication is an inherent mutual activity and we cannot be truly in relationship with others if we are not communicating with them.

When communicating with people with dementia, caregivers need the flexibility to be able to communicate on several different levels. Many caregivers report feelings of frustration, inadequacy in understanding and responding to the person with dementia’s attempts to communicate.

Many problem behaviours exhibited by people with dementia can be attempts to communicate — feeling hungry, want to go to the toilet. Grabbing, moaning, pointing, is often incorrectly interpreted as the dementia rather than the failed attempt to communicate.

Facilitating communication for every-day purposes requires a great deal of sensitivity and patience and a determination not to give up on someone whose speech may be slow or difficult to comprehend.

Communication Strategies:

• Ensure person can see you (glasses on)
• Ensure person can hear you, wears hearing aid; try to reduce background noises — radio
• Sit close to person, reassure by physical contact — touch arm or shoulder
• Speak in a gentle, caring manner
• Keep it simple, ask one question at a time
• Try not to interrupt the flow of conversation by asking questions requiring a response
• Allow time
• Limit choices: people with dementia are often confused by direct, open-ended questions such as “what would you like for lunch?” Or by rapid fire presentation of several choices, “would you like soup, salad or a sandwich?” 
• Point to, or show the item you are talking about 
• Ask the person with dementia to point or show you
• Be conscious of your clothing. As we age, the lens of the eyes start yellowing, and for many people with dementia, it can cause colour agnosia. This, along with impaired perception, causes them to misinterpret sharp colour contrast and patterns especially busy patterns, which can cause dizziness and may even appear to move.

Common problems:

Perseveration

• Repeats phrases, questions or key words over and over
• Person may be worried about something and need reassurance or want something to change. For example, when’s Joan coming? The message may be as simple as I’m lonely and I want to see my wife.

Paraphasia

• Speech is inconsequential, vague, and go around in circles
• Try to go with the flow
• Pick up on any phrases at which the person seems to become excited/animated and respond to these.

Nominal dysphasia

• May call you by the name of someone else
• The person with dementia may think you are someone else because your mannerism or appearance reminds them of someone.

Echolalia

• Repeats your own words back to you when you ask a question
• This could be a request for clarification, or for you to slow down a little
• Or, it may be just a game. If the person with dementia seems to enjoy this kind of interaction, then go along with it

Confabulation

• Covers up memory problems by turning questions back to person or gives inaccurate information
• The person may enjoy story telling, or may feel need to make self more interesting. 
• If information is required for official purposes, then accuracy of information should be verified with another person.

Aphasia 

• Rarely or never speaks
• Ensure you are waiting long enough for a response
• Watch for non-verbal indicators of what the person may be feeling or trying to tell you

Dysphasia

• Difficulty selecting the right words and becomes easily anxious/frustrated
• Try to respond to the sense of what the person is saying and give positive, non-verbal signals
• Ask person to show you
• Offer cues, rather than being tempted to speak for the person.

Each person with dementia is different, therefore, some of the following suggestions will work for some, but not for others: 

• Don’t argue or confront the person with dementia. You will never win the argument. Instead, you will end up feeling stressed and frustrated and the person with dementia may become upset and angry
• Don’t tell the person what they can’t do. Reframe in a positive light by emphasizing what they can do
• If the person is struggling with a task or appears lost, do not say, “what are you doing?” instead ask, “can I help you?”
• Don’t be critical, condescending, or judgmental. Even if the words don’t make sense, the tone of voice and facial expressions can be picked up by the person, and people with dementia seem to have a heightened awareness of body language
• Don’t talk in front of the person as if he/she is not present. The person with dementia does not have to be able to participate in a discussion actively to enjoy it and benefit from it
• Don’t remind the person that something was forgotten or repeated
• Use “therapeutic fibbing.” People with dementia struggle with logic, rational thought, sequencing and emotional content. When telling the truth would cause pain, anxiety or increased confusion or the person is experiencing life in a different time era, it is kinder and more respectful to redirect and distract person and to be present with them in their world 
• The arts: painting, music, dance, colouring books, provide people with dementia who are unable to communicate verbally an outlet to express their thoughts
• When all else fails, take a deep breath, keep trying, and try to find humour in the situation and laugh with the person with dementia.

This article is written by or on behalf of an outsourced columnist and does not necessarily reflect the views of Castanet.