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2021 Crash Course in Dementia-Centric Communication

Dementia-centric communication is the ability to interact with people who have dementia in a respectful and meaningful way. I hear, over and over again, “I don’t know what to say to a person with dementia.” “What if I do something wrong?” Fear not, I am here to help by providing some key points to guide you. The over-riding thing to keep in mind is that our communication patterns respect the dignity and personhood of the person with dementia. In other words, let me set you straight:  the person with dementia is forgetful, NOT stupid. As long as you keep that in the forefront of your mind, you should be OK.

The Need for Meaningful Interactions with Others

People with dementia are vibrant, wonderful people…who happen to have a little, or maybe a lot, of forgetfulness. Here’s the thing…the personality, the drive, the search for meaning, the desire for affection, the desire to be HEARD…remain. What changes is that the OUTLETS for the expression of these important desires and drives get cut off by the dementia…regardless of the type. The loss of these outlets create anger, frustration, irritability, and other behaviors.  Sensitive and meaningful interactions with others can reduce the isolation felt by people with dementia.

Here are 5 easy ways to improve your ability to communicate and interact with someone who is living with dementia.

1. “Chill” Your Vibes

We are energetic beings. We give off energy. We can feel the energy, or the “vibes” of others. Have you ever noticed how some people bring a great deal of positive energy with them? They walk into your office or a room, and everyone’s mood lifts. Then there are others who do the same…by exiting. Emotional “vibes” are contagious–our moods and energy are affected by the moods and energy of the people around us. This holds true for people with dementia. Sometimes, people with dementia may be even more sensitive to the vibes of others because they have less ability to put up defense shields.

You may find that your interactions with a person living with dementia is better if you first level off your own vibes. Some people call this activity “grounding.” You can level off your vibes taking some deep, cleansing breaths prior to interacting with a person with dementia. Breathing is the only bodily function that is under both automatic and voluntary control. By slowing down your breathing and switching to slow, deep breaths (instead of quicker, shallow breaths) you can change your own brain chemicals and instantly start to feel calmer. You will also give off a calming “vibe.”

2. Smile and Introduce Yourself

Smiling helps to raise your frequency. Smiling also makes you look less scary and frightening. Usually, unless you have a creepy “Uncle Fester” smile. It is also a good practice to introduce yourself. If the person you are interacting with is someone who knew you in the past, help them out: “I’m not sure if you remember me, but I’m ….” If you have never met this person, you absolutely need to introduce yourself. Many people with dementia maintain their social skills, even in severe stages.

3. Short, Sweet, Concrete

As I mentioned in other blogs, there are brain changes that cause problems with both short-term memory and memory retrieval. The “shrinking brain” cannot handle long explanations. When people get nervous, they also tend to talk “around” the topic instead of getting to the point. Both patterns of speaking will lose the person with dementia. So, use the “short, sweet (nice), concrete” method. Compare, “Hi, I’m a student and I am working with you today as part of my community service work. I will be coming every Tuesday” with  “Hi. That’s a nice sweater, it brings out your eyes. I’m with you today.”  If the person with dementia wants more information, he or she will ask. And you will answer, using the short/sweet/concrete method. No, you don’t have to throw in a compliment with every sentence; but maybe every third or fourth. Why? Because people with dementia do not get the positive “goodies” that we get as part of our everyday interaction. Think about it. You get compliments and positive “goodies” (or warm fuzzies) from many day-to-day interactions: someone holds the door for you, someone smiles at you, you exchange a laugh with a coworker, you drop your Costco card right in front of the guy checking the cards and you both say “yup its Monday,” and I think you get the picture.

4. Argument-free Zone

Sometimes, no matter how awesome you are being, you may encounter argumentative or refusal behavior. Here are some tips for keeping the communication argument-free:

  • Do not argue back or use logic. The person with dementia forgot that he or she forgot. It will simply escalate.
  • Treat every story, question, and anecdote as if you are hearing it the first time…because you are (according to THEIR reality)
  • Apologize: “I’m sorry, I forgot to tell you…” This is a handy technique when you are trying to get the person living with dementia to a doctor’s appointment. You know you told them every day for the past 2 weeks. You have post-it notes all over the bathroom mirror. You have have a great, big red circle around today’s date on the calendar with the words, “doctor’s appointment at 10 am.” You show up at 9 am and they are not ready and begin to argue that you never told them they have a doctor’s appointment today. Take a deep breath, and simply say “I’m sorry, I forgot to tell you.” And then help them get ready.
  • Distraction: gently change the topic or introduce a new activity.

5. Interactions that Maximize Abilities

A good rule of thumb is to avoid “doing for” someone; instead, encourage them to complete tasks or activities by themselves as much as safely possible. Who cares if the flowers go into the vase upside down. I had a family member become upset because the person with dementia drew pictures on the pages of the adult coloring book instead of coloring the pictures. Who cares???

The sad thing is, abilities that are not consistently used with be lost…forever. Because of the changes in the brain from dementia, new memories may not be able to be created.

One way to support abilities is to “chain,” which means you start the activity and they finish. For example, you could place the colored pencil in a person’s hand and guide their hand to start coloring the picture. Release, and see if the person will continue the activity. It is like priming a pump. And it usually works! Another approach is substitution. Substitution means you modify a previously enjoyed pleasurable activity so that it meets the needs of the person with dementia in a satisfying but safe manner. If a person living with dementia enjoyed gardening but can no longer physically handle kneeling on the ground, you can put flowers and plants in plastic tubs. The person living with dementia can sit near the tub and weed, dig around in the dirt, and engage in gardening activities that are safer and easier for them.

Final Points

  • Respect dignity and personhood
  • Arguing and logic do not work
  • Avoid “remember” because most do not
  • Something that works one day may not work on another…but keep trying!
  • Keep your sense of humor

Categories: Alzheimer's Disease Care Partners Caregiving communication Dementia Help Refusal Behavior Understanding Behaviors Vascular Dementia

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Dr. Rita Jablonski

Rita Jablonski, PhD, CRNP, FAAN, FGSA is a nurse practitioner, researcher, tenured professor, and former family caregiver. Her research and practice involve all aspects of dementia management; she is best known for non-drug strategies to address dementia-related behaviors.

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