Dementia- Coping with Decline in Communication

By Sofia Magnifico, BSN, RN-BC, Manager at Ramapo Ridge Behavioral Health at Christian Health

When caring for and caring about loved ones with dementia, it’s important to understand things from their perspective. Communicating difficulties can be one of the most distressing aspects of caring for someone with dementia – and can be frustrating for those with the disease and for their loved ones. According to the National Institute on Aging, communication difficulties related to dementia vary, and are based on the person and where he/she is in the disease process. As the disease progresses, the ability to initiate and maintain communication is often a struggle. Exploring ways to cope with changes in communication skills can make caregiving less stressful and lead to more meaningful interactions with your loved one.

Some common communication challenges throughout the progression of the disease include:

• difficulty finding the right words;
• using familiar words repeatedly;
• describing familiar objects rather than calling them by name;
• problems paying attention during long conversations;
• loss of train-of-thought when talking;
• problems blocking out background noises from TV, radio, or conversations in the room;
• reverting speaking to native language;
• speaking less often;
• relying on gestures more than speaking; and
• non-verbal communication, such as facial expressions or vocal sounds.

Tips for effective communication with someone with dementia

• Approach the person from the front, at his/ her level, if possible.
• Speak slowly and clearly while maintaining eye contact.
• Use different words if he/she does not understand what was said the first time. For example, stating: “Breakfast is ready now” or “Let’s eat” would be an alternative option if initially there is no response from the person when asked if he/she is hungry.
• Ask yes or no questions. For example, “Are you sleepy?” instead of “How do you feel?”
• Limit the number of choices. For example, “Would you like to drink coffee or tea?” rather than “What would you like to drink?”
• Allow time for response so that person can think about what he/she wants to say. Try not to interrupt or “fill in the blanks” too quickly.
• Offer simple, step-by-step instructions.
• Use visual cues to reinforce a verbal message. For example, show him/her the bathroom when asking if there is a need to urinate.
• Avoid correcting or completing his/her thoughts. Instead, listen and try to find the meaning in what is being said. If necessary, repeat what is said to clarify.
• Try not to say, “Don’t you remember?” or “I told you already.”
• Offer positive reinforcement as often as possible.
• If there are any signs of frustration or irritability, acknowledge the feeling. For example, “I see that you are upset.”
• Try distraction if communication creates problems. For example, offer a diversional activity, such as taking a taking a walk, switching to more pleasant topics, etc.
• Be aware of your loved one’s feelings since his/her emotions are what’s most important. For instance, the tone of voice may tell more than what he/she is actually verbally saying. Any signs of aggression may be a way of communicating that there is an unmet need.
• Pay attention to non-verbal cues. For example, facial expressions may show sadness, discomfort, or frustration.

It’s important to keep in mind that even though the person with dementia may not be able to process verbal communication, he/she retains his/her feelings and emotions. It’s important to maintain his/her dignity and respect by honoring his/her unique needs and preferences.

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