Dementia care: Communication and dementia

Losing the ability to communicate is one of the most distressing aspects of dementia. It can be especially painful and isolating losing the comfort and intimacy of close conversation with someone close to you.

Dementia and problems communicating 

In dementia damage to the brain affects a person’s ability to send, receive and understand messages.

Communication changes will vary from one person with dementia to the next.

Common problems experienced by people with dementia include:

• Difficulty finding the correct word
• Problems following a conversation
• Getting lost in a train of thought
• Repeating words and phrases
• Misinterpreting signs or body language
• Difficulty reading and writing

At some point in the course of dementia a person will have difficulty telling you what they want or how they feel. They may use other methods of non-verbal communication or express themselves through unusual behaviour. In many cases you will have to anticipate a person’s needs. 

The importance of listening

Caring for someone with dementia and difficulty communicating takes patience and troubleshooting. You will need to be a good listener. Be on the look out for clues that indicate what a person with dementia is trying to say if they can't find the words. For instance, agitation can be a sign of discomfort or the need to go to the toilet.

Sometimes the content of the conversation isn't as important as the exchange itself. Showing concern and giving support to a person with dementia can be more important than making sure a conversation makes sense. 

If you are having a conversation with other people include the person with dementia when you can. Try and acknowledge a loved one's contribution to a conversation even if it's out of context. Try holding someone's hand if they are anxious. The simple use of touch will show someone you care. 

Tips to promote communication

There are many ways you can help promote good communication.

•  Ensure you have a person's attention: Make sure you have eye contact. Use a person's name and identify yourself. Praise a person with dementia and show concern.
   
• Consider your body language and tone of voice: Don't shout and try not to get angry with someone with dementia. Physical gestures can be misinterpreted. Facial expressions, raised eyebrows and scowling can cause misunderstandings. Don’t be patronising or speak in a childlike manner to someone with dementia. Be positive and comforting.
   
• Check the environment: Maintain a quiet environment free of distractions and excessive noise. Turn off the TV when talking to a person with dementia. Ensure a person is wearing their glasses and hearing aids and there is enough light.

• Keep it simple: Speak clearly and give simple messages. Use familiar language appropriate to the person’s level of understanding. Use short concise sentences. Ask yes or no questions (where appropriate) instead of open-ended questions.
   
• Take your time: Don't rush a person and remain calm. Allow enough time for the person with dementia to respond. Repeat a message if no response. Don't give too much choice for someone with dementia.
   
• Communication aids: Make the most of communication aids such as notes, writing instructions, keeping diaries to help with memory loss.
   
• Talk things through: Explain your actions and inform a person of what you're about to do. Prompt a person with dementia by giving them clear simple instructions step by step. Use visual prompts if possible.
   
•  Use humour: Humour can ease tension and people with dementia usually respond well. 

Tip:

People with dementia often mistake the names of objects and use a different word to describe something. It is not uncommon for a person with dementia to forget names of family and close friends.

Communication involves two people. If a carer always asks yes or no questions it can be a form of overaccommodation. This occurs when a carer talks down to a person with dementia. Give the person the opportunity to participate in mutual discussion.

Related articles

• Dementia care: Coping with repetition
• Dementia care: When loss of inhibitions becomes embarrassing
• Coping with dementia and shadowing

References 
Alzheimer's Society UK
Communicating
Accessed 17/09/08