Dementia - communication

Losing the ability to communicate can be one of the most frustrating and difficult problems for people with dementia, their families and carers. As the illness progresses, the person with dementia gradually loses their ability to communicate. They find it more and more difficult to express themselves clearly and to understand what others say.

It is important to check that communication problems are not due to impaired vision or hearing. Glasses or a hearing aid may help some people. Check that hearing aids are functioning correctly and glasses are cleaned regularly.

Communication changes in dementia

Each person with dementia is unique, and the difficulties experienced in communicating thoughts and feelings are different. There are many causes of dementia, each affecting the brain in different ways.

Some changes you might notice in the person with dementia include:

• difficulty in finding a word – a related word might be given instead of one they cannot remember
• the use of speech that does not make sense
• an inability to understand what you are saying or the ability to only grasp a part of what you are saying
• writing and reading skills that have deteriorated
• loss of the normal social conventions of conversation – an increasing tendency to interrupt, ignore a speaker or fail to respond when spoken to
• difficulty in expressing emotions appropriately.

Suggestions for communicating with a person with dementia

Carers need to pay attention to how they present themselves to the person with dementia.

The three factors that make up the messages we communicate are:

• body language (the message we give out with our facial expressions, posture and gestures), which accounts for 55 per cent of communication
• the tone and pitch of our voice, which accounts for 38 per cent of communication
• the words we use, which account for seven per cent of communication.

These statistics highlight the importance of how families and carers present themselves to a person with dementia. Negative body language, such as sighs and raised eyebrows, can be easily picked up. There are a number of strategies or approaches you can use to communicate positively with a person with dementia, to make yourself understood and to show you care for them.

Caring attitude

People retain their feelings and emotions even though they may not understand what is being said, so it is important to always maintain their dignity and self-esteem. Be flexible and always allow plenty of time for a response. Where appropriate, use touch to keep the person’s attention and to communicate feelings of warmth and affection.

Ways of talking

When you talk to a person with dementia, try to:

• remain calm and talk in a gentle, matter-of-fact way
• keep sentences short and simple, focusing on one idea at a time
• always allow plenty of time for what you have said to be understood
• use orienting names or labels whenever you can, such as ‘Your son, Jack’.

Body language

You may need to use some hand gestures and facial expressions to make yourself understood. Pointing or demonstrating can help. Touching and holding the person’s hand may help keep their attention and show them that you care. A warm smile and shared laughter can often communicate more than words can.

The right environment

When communicating with a person with dementia, try to:

• avoid competing noises, such as TV or radio
• stay still while you are talking – this makes it easier for the person with dementia to follow what you are saying
• maintain regular routines – this helps to minimise confusion and can assist communication
• keep a consistent approach – it is much less confusing for the person with dementia if everyone uses the same style of communication. Repeating the message in exactly the same way is important for all the family and carers.

What NOT to do when communicating with a person with dementia

When communicating with a person with dementia, try NOT to:

• argue with the person – it will only make the situation worse
• order the person around
• tell the person what they can’t do – instead, state what they can do
• be condescending – a condescending tone of voice (talking down to people) may be picked up, even if the words are not understood
• ask a lot of direct questions that rely on a good memory
• talk about people in front of them as if they are not there.

Therapies and communication strategies for people with dementia

A number of alternative communication approaches have been developed, which attempt to provide the trust and support so necessary to a person’s wellbeing. Many family members and carers will be instinctively using some of these techniques without realising their formal names.

Validation therapy and dementia

Validation therapy teaches that, rather than trying to bring the person with dementia back to our reality, it is more positive to enter their reality. In this way, you can develop empathy with the person, and build trust and a sense of security. This, in turn, reduces anxiety.

As an example, if a person with dementia believes that she is waiting for her children (all now middle-aged) to return from school, family and carers who use validation would not argue the point or expect their relative to have insight into their behaviour. They would not correct the beliefs of the person with dementia.

Instead, with the validating approach, carers would acknowledge and empathise with the feelings behind the behaviour being expressed. In this way, the person with dementia has their dignity and self-esteem maintained.

Music therapy and dementia

Activities that involve music are another effective way of communicating with a person who has dementia. Often when other skills have gone, the person can still enjoy old familiar songs and tunes. A certain piece of music can unlock memories and feelings. It is important to be prepared to respond to the release of these feelings.

Knowing a person’s musical likes and dislikes is vital for this to be a successful approach. Music can be used as a formal therapy or simply for enjoyment. It can also help in the management of difficult behaviours. Music therapists have training in the use of music with people with dementia, and can address some very complex behaviours.

Reminiscence and dementia

Reminiscence is a way of reviewing past events. This is usually a very positive and rewarding activity. Even if the person with dementia cannot participate verbally, reminiscing and reflecting on the past can still give them pleasure. It can also be a means of distraction if the person becomes upset.

While reviewing past events can provide a sense of peace and happiness, it can also stir up painful and sad memories. It is important to be sensitive to the person’s reactions if this happens. If their distress seems overwhelming, then it is better to use another form of distraction to reduce anxiety.

Making a This is your life book and dementia

Making a chronological history of the person with dementia can help with reminiscence and provides information for people who may interact with them. It can also help carers coming in to the home or residential care facility to get to know about the person and their life. A This Is Your Life or memorybookis a visual diary, similar to a family photo album. It can include letters, postcards, certificates and other memorabilia.

A large photo album with plastic protective sheets over each page can withstand a lot of use. Each photo needs to be labelled to avoid putting the person with dementia on the spot with questions such as ‘Who is that?’ It is best to limit the information on each page to one topic, and to have a maximum of two or three items on each page.

Where to get help

• Your GP (doctor)
• Your local council
• Your local community health centre
• National Dementia Helpline, Dementia Australia Tel. 1800 100 500
• Aged Care Assessment Services Tel. 1300 135 090
• My aged care Tel. 1800 200 422
• Cognitive Dementia and Memory Service (CDAMS) clinics
• Carers Victoria Tel. 1800 514 845
• Carer Gateway Tel. 1800 422 737
• Dementia Behaviour Management Advisory Service (DBMAS) Tel. 1800 699 799 – for 24-hour telephone advice for carers and care workers