How communication is affected by dementia
Dementia can make it difficult to communicate with others. This is because as the disease progresses, dementia can cause people to have trouble with:
- finding the right words
- remembering the names of familiar objects and people
- concentrating well enough to follow a conversation
Eventually people can lose confidence and end up speaking less often. But they can still communicate in other ways such as through body language, gestures, and facial expressions. This means you can still have meaningful conversations with your loved one by focusing on the way you communicate. And, by being patient and listening to them.
Use good communication techniques
Below are some tips you might find helpful to communicate with someone who is living with dementia.
- Remove distractions and noise from TV, radio, or outside traffic.
- Face the person you are speaking to and make eye contact. Use gentle touch to get their attention before you speak.
- Speak slowly, use shorter sentences and give people plenty of time to respond. Living with dementia means it takes longer to process what others are saying and to think of a reply.
- Use their name often, to refresh their concentration and as a reminder that you’re talking to them.
- Try to speak conversationally and avoid asking lots of questions. Questions can make people feel pressured, which causes distress and makes it harder to concentrate on answering.
- When you do ask questions, ask one at a time. Don’t forget to give plenty of time to answer. Ask closed questions that can be answered with a yes or no. For example, ‘Would you like a cup of tea?’ rather than ‘Would you like tea or coffee?’
- Use gestures or objects of reference (hold up the tea cup) to help your loved one understand what you mean.
- Try not to get frustrated if your loved one takes longer than normal to answer.
- Touch can be helpful and reassuring; for example, holding your loved one’s hand while talking if it feels right.
- Pay attention to your loved one’s facial expressions and body language. These will give you clues about how they’re feeling.
- Try to laugh together about any misunderstandings that might happen.
Think about your own gestures and facial expression - your loved one can still read your face and recognise your body language, for example if you look worried or angry, but may not understand what caused you to feel that way.
Don’t forget to consider communication impairments that are not related to dementia but rather the process of aging. This can include hearing loss and visual impairments. Make sure the environment is quiet and has good lighting.
In the later stages of dementia, your loved one may struggle to communicate verbally. You may find it helpful to use visual aids such as age-appropriate picture or cue cards to help them communicate what they want to say. For example, use pictures of food and drinks so that your loved one can make choices by pointing to what they want.
What should you not say to someone with dementia?
You might be thinking of asking, ‘do you remember when...?’ But a direct, factual question like this is likely to provoke anxiety for the person living with dementia. They may be worried about getting the answer wrong or feel under pressure. It would be better to share a memory yourself, to encourage your loved one to do the same.
Also, try to avoid the following when communicating with your loved one with dementia.
- Don’t tell your loved one that you’ve already answered their question – this can undermine their self-confidence.
- Don’t remind them of someone’s death, because if they’ve forgotten this might upset them. If they ask about someone who has passed away, they’ll be asking for a reason. So, try to talk to them to find out what that is. Once we understand the reason we can offer the right support.
- Avoid using long and complex sentences, this can be overwhelming to try and process.
- Try not to use terms of endearment like "love", "honey", or "darling" as these can be patronising.
When communicating is difficult
Sometimes people living with dementia are unable to communicate their needs or don’t know what to do about them. Because of this, they may feel frightened, frustrated, or stressed. This can cause them to behave in a way that is out of character, which can be distressing for you. This could include shouting, making hurtful comments, or lashing out.
The following tips may help with responding to stress and distress behaviour:
- It’s difficult, but try not to take it personally – your loved one is trying to tell you something important
- try and stay calm, even though you may feel frustrated and upset
- avoid shouting at your loved one – it may make them feel threatened which could make things worse
- give your loved one plenty of space and time
- try to be supportive and don’t be tempted to punish unusual or difficult behaviour
- if you’re becoming too upset by the situation, walk away if it’s safe to do so, and return later
If you’re worried about a loved one’s behaviour, contact a GP for advice.