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Crash Course in Dementia-Centric Communication

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.

“Chill” Your Vibes

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. This holds true for people with dementia. It helps to “chill” your energy or your vibes by taking some deep, cleansing breaths prior to interacting with a person with dementia. Smiling also helps to raise your frequency. 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.

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. 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.

Sometimes, no matter how awesome you are being, you may encounter argumentative or refusal behavior. Some tips:

  • 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, 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…”
  • Distraction: gently change the topic or introduce a new activity.
  • Substitution: This is part of “introducing a new activity.” 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.

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???

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!

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.

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

Other Helpful and Related Posts

10 Commandments of Dementia

Resources for Caregivers New to Dementia

Want more information? I provide monthly webinars and individual coaching for caregivers who would like to learn more about dementia, and how to successfully deal with frustrating or scary behaviors. Click here!

Categories: Alzheimer's Disease Caregiving communication Dementia FTD Lewy Body Dementia 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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