LifeBio

Communication Tips for Talking to People Living with Dementia and Alzheimer’s

Posted On: 12 May, 2020

Do you know someone living with Alzheimer’s or another form of Dementia? If so, it can be difficult to see memories and realities slipping away from our loved ones. However, that does not mean that we no longer want to engage with them. In fact, getting them to participate in conversation can help them to prolong their memories and engage their minds. It can also be an opportunity for them to feel successful, be happier, and even decrease negative health effects like feelings of depression.

It may seem daunting to know where or how to begin though. First of all, it helps to recognize that we all have good days and bad days. For a person living with Alzheimer’s or Dementia, the disease typically gets worse with time, so communication can become more challenging over time too. Some days will be easier or better than others. It helps to approach communication with a positive attitude, a willingness to try, and believing in what can be most successful.

Here we offer suggestions for effective conversation. We give ideas for what to do and what to avoid. We advise how to best communicate, along with some things you might try to talk about.

Preparation

Consider if there is a time of day that is best for them, such as in the morning or after eating lunch.
Make sure that their needs are met first, like having used the restroom and eaten, so that they can better focus.
Allow yourself enough time to spend having a conversation so that neither of you are rushed or feeling stressed.
Perhaps have a topic or two in mind that you could try to talk about, but be flexible if they want to talk about something else.
Be sure to get their full attention. Aid in limiting distractions and providing a quiet, appropriately lit setting. It can help to turn off the television or radio. Perhaps shut the door or window to limit noise or other disturbances. You may want to limit the number of people present at one time, to avoid confusion.
Position yourself so they can see you clearly. Try to get on their level, so you are not looking down on them. Respect their personal space, not sitting too close nor too far away.

How to Speak and Act

Use a warm and calming tone of voice. Do not raise your voice or speak sharply to them.
Keep your face and body relaxed too. Make sure your body language and facial expressions match your voice and what you are saying.
Make eye contact and smile.
Without being so slow as to seem insulting, you may need to speak a little slower.
Give the person time to think and respond. This could mean up to two or three times what once felt normal. After giving time, if they struggle with an answer, then it may be okay to suggest a couple of words to help them.
Speak clearly and loudly enough. Use short, simple sentences. Only talk about one thing at a time, avoiding many tangents or stories that require various threads.

How to Ask Questions

Try to converse back and forth with them as they are able, rather than just asking a string of questions that may feel more like an interrogation.
Keep questions simple and easy to answer. It can help to break things into shorter questions.
It may be less stressful to ask yes or no questions, such as, “Would you like a cup of coffee?” or “Do you want to listen to music?”
You could give two choices to answering a question, rather than asking an open-ended question. For example, they may not easily answer, “What do you want to do this afternoon?” However, it may be easier for them to decide when asked, “Would you rather go for a walk or play checkers?”
If you haven’t fully understood what they said, you might try to rephrase what you believe you heard, and check with them if you are correct.
If you do not understand something, it is okay to kindly state that. For example, you could say, “I am not sure I understand,” rather than, “You aren’t making any sense!” Then ask for clarification or more information.

Keep It Positive

Be cheerful, patient, and calm. Even if they have angry outbursts, remember it’s the disease causing the anger, not the person.
Offer encouragement and be positive. Respond with reassurance and affection, striving to offer comfort and support.
If it is appropriate, use gentle touch to reassure them. It may be okay to hold a hand, pat them on the shoulder, wrap your arm around them, or give them a hug.
Avoid baby talk or condescension. Talk to them respectfully, using their name if you can. Include them in the conversation, and do not talk about them as if they are not there (even if they are not being verbal in the moment).
Do not quibble. It is okay to let delusions or misstatements go. You likely won’t get very far, if you try to correct every inaccurate thing that is said.
Focus on the positive of what they can do and have done. Even if their results aren’t perfect, be gracious and say things like, “Thank you for helping,” or “Thank you for that answer.” Rather than point out a mistake, encourage them by saying something like, “Let’s try doing it this way…” Instead of saying, “Don’t do that,” politely state what you would like them to do, such as, “Please sit down.” Avoid insistence and arguing; you can try again later, if needed.

What to Say

When speaking, refer to people by their names. Avoid pronouns like she, he, and they. It can even help to identify yourself, such as, “Hi, Grandma. It’s me, Sarah.” Or you might remind and clarify who you are, such as “It’s me, your nephew, Tom. I’m John’s son.”
Remember the good old days. They may not remember 30 minutes ago, but they often clearly remember 30 years ago. Avoid talking about short-term memories, such as what they had for lunch. Talk more in general about their past.
Use prompts, such as photos, newspaper articles, or objects to help bring back memories. While looking at a wedding ring, you might question, “Do you like weddings?” or “What was your wedding day like?”
Try talking about shared experiences from long ago, such as a memorable incident, a momentous event, or a vacation. You might start talking about a particular occasion, to see if that triggers any memories that allow them to join in reminiscing.
You could try reading favorite or familiar passages together, to see if that encourages discussion. Or listen to their favorite song or genre of music. Perhaps watch a clip from a favorite movie or television show, to see if that stimulates memories and dialogue. Maybe bring a favorite food of theirs with their recipe, to see if that sparks a conversation.
Talk about things they were interested in previously, such as sports, music, art, traveling, gardening, or cooking. You might use a prompt (a picture, video, object, etc.) and ask them what they think, such as “What do you think of this painting?”

(For additional reminiscence questions, check out our available resources at https://www.lifebio.org, such as our What’s Your Story? cards or Memory Journal.)

What to Avoid Saying

Avoid asking, “Do you recognize/remember me?” Instead give a friendly greeting, and state your name. In case they would not remember, try not to ask about one set memory by saying, “Do you remember when…”
Do not use elder-speak that can make them feel infantilized. Calling them words like love, honey, dear, or sweetie can sound patronizing.
When they forget, do not reply, “I told you…” This does not help them but only reminds them of their condition and can make them feel worse.
Do not use long lists or complex sentences. It can be hard for them to follow. They likely will not understand and remember a list like, “Let’s have tea now, and then we can go for walk before we go to lunch, and you play Bingo this afternoon.” Focus on one or maybe two steps at a time. While preparing them can be good, too much at a time is overwhelming.
Avoid many open-ended questions and short-term memory questions, such as, “What did you do today?” It can help to guide them, such as if you know it is Bingo day, by asking, “Did you play Bingo this afternoon?” Or focus on talking about things they recall and want to talk about.
If they have forgotten that someone passed away, reminding them may cause them to re-live that grief. It may not be best to remind them, but it could be better to come up with another reason for a person’s absence.

How to Respond

Observe their nonverbal reactions, such as their facial expressions or gestures. If they get tired easily, a shorter conversation may be better than a long one. (A side note: As dementia advances, a person may mainly only respond with nonverbal communication.)
Try to understand the meaning and feelings they share, even if their words cannot adequately express their intended meaning. You can help them find the words to express thoughts, without being too quick to put words in their mouth. For example, if Aunt Sally is tearful after forgetting her knitters’ club meeting, and she says, “I wish they stopped.” Then you might help her clarify, “You wish your knitter friends stopped by the house?”
Try rephrasing something, rather than just repeating the same words, if they do not understand. It may help to use non-verbal cues too, if you are able, such as showing a picture of who you are talking about.
Keep a sense of humor, but not at their expense. Be sensitive. It can be okay to laugh together at misunderstandings or mistakes, especially to relieve pressure. Just be sure they are laughing with you and are not feeling laughed at. It can also help to admit something like, “Oh, I’ve done that before! Don’t you just hate that?!”
If needed, you can distract and redirect. First it is important to connect with their feelings though. For example, you could say, “I see you are feeling sad. I am sorry that you are upset. Would you like to go for a walk?” Or you could try something such as, “It seems like you are frustrated. Maybe now would be a good time for a break. Should we get something to eat?”
As dementia progresses, a person may become confused about what is true or not. If they say something that you know is not true, attempt to steer the conversation around the subject and look for the meaning behind what they are saying. Avoid contradicting them directly. As an example, if they say they need to go to work, could it be because they want to feel useful, involved, or like they are contributing? Could you help them find a way to be included or more stimulated?

Having a meaningful conversation with a person living with Dementia or Alzheimer’s requires sensitivity to their needs. By changing your approach where necessary, in order to avoid their needless frustration, you can show empathy. Then be consistent in what you say and do. Watch their reactions and respond accordingly, and thoughtful communication is a possible reality. It’s worth the effort—you’re both worth it.