Effective Communication & Dementia

The following are changes you can expect to see throughout the disease progression:

● Difficulty finding the right words

● Using familiar words repeatedly
● Describing familiar objects rather than calling them by name.
● Easily losing a train of thought.
● Difficulty organizing words logically.
● Reverting to speaking a native language
● Speaking less often
● Relying on gestures more than speaking
● Problems blocking out background noises from the radio, TV, telephone calls, or
conversations in the room.

Goals of Communication
One goal is to assist the individuals with functioning and performing activities of daily living,
such as bathing, dressing, and eating. A second goal is to gather information about their needs or
wants. Caregivers must know the individuals well and be very perceptive and patient with their
attempts to communicate.
It is also important to monitor how they are feeling and check for any pain or discomfort.
Caregivers should also try to protect those with dementia and provide them with support. When
someone feels confused or overwhelmed, the caregiver may have to help that person to
understand what’s going on. This can be done by simplifying things and providing information
so that the individual can respond appropriately. Or some situations may require that the
caregiver speak on someone’s behalf based on what that person most likely would have wanted
to say. Another important job for caregivers is to help people with dementia remain connected to
the world. Without caregivers who can provide links to the world, those with dementia can
eventually lose connections to their environment, their past, their friends and family, and even
their own sense of self.

Principles of Good Communication

Good communication skills are based upon some basic principles of communication. The first
principle is to show respect. You can do this by addressing individuals by their preferred names
and/or titles and by using good manners. People learn about good versus bad manners in early
childhood and those memories tend to persist into the later stages of dementia. Therefore people
with dementia can usually appreciate good manners, so try to say please and thank you, as you
would when speaking to anyone else. Do not talk down to those with dementia or treat them like
children. Instead, keep the conversation simple, but at an adult level. Avoid using eldertalk,
which is similar to baby talk or the use of a high pitched, sing-song tone of voice. Inviting
individuals to participate in something rather than demanding that they do it. In addition, if
individuals with dementia are in the room, do not discuss them with others as if they are not
present, even if you think they do not understand.
In conversation, it’s best to avoid topics that you know can trigger difficult behaviors. If the topic
is unavoidable, try approaching it in different ways or in different settings that may be more
relaxing. Be sensitive to the early signs of agitation and difficult behaviors. This includes paying
attention to people’s feelings and emotions rather than their words. There may be signs in their
body language or mannerisms that may immediately precede problem behaviors. If you see the
early signs, try to back off or divert their attention onto another subject. Keep in mind that words
are not the only form of communication. It is very important to effectively use non-verbal forms
of communication, such as facial expressions, tone of voice and body language to convey how
you feel. This is especially important when someone is having difficulty understanding the
conversation.
A smile, a gentle touch and a kind voice can express so much more than words.

Caregiver’s Attitude and Approach

First, have a good sense of humor. Laughter is a great way to overcome a difficult situation or
distract someone from negative thoughts or behaviors. Smiling and laughing will also help
everyone feel better. Keep and show a positive attitude. Try to focus on the positives, and pose
things in a positive way. Show a positive attitude in your facial expressions, body language, and
tone of voice, as your emotional tone can convey more meaning than the actual words you use.
Approach caregiving as a collaborative effort between the caregiver and the care recipient.
Communicate as if everyone is an important member of a team. Everyone likes to feel important
and needed. So treat those with dementia as if they can make valued contributions. Let them
know that their remaining abilities are useful and appreciated. Try to encourage and help them to
contribute. For example, if you ask someone to participate in an activity, such as folding laundry,
communicate the request in such a way that the person’s participation is of value. “ I could really
use your help with the laundry. You always do such a nice job with folding the clothes!”
When challenges arise, try to find productive solutions that involve the whole team, including the
person with dementia. Use a non-judgmental approach. Try not to judge or blame the person for
negative behaviors and challenging situations. Remember that the disease is causing the change
in personality and loss of abilities. Remain open-minded and learn about cultural differences
that may affect communication, such as language, symbols, and physical contact. Lastly, give
priority to the person’s wants or needs.
Giving Instructions
In order to increase the likelihood of successfully completing an activity, it is important to give
clear, easy instructions and to simplify tasks. When giving instructions, break down the activity
into one or two simple steps at a time. As the disease progresses, you should break down

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activities into smaller, simpler parts. Focus first on familiar tasks and then encourage the person
to practice new skills by giving specific, simple instructions in a pleasant voice. For example,
rather than telling someone to get dressed, ask the person to put on a shirt. After that is done, ask
the person to put on pants, and so on with each article of clothing. Be positive and supportive by
paying attention and being there to help when needed.
You may have to demonstrate steps for people, or assist them in what steps you need them to do,
but don’t ever force a step. A good way to keep steps moving along is through the use of
chaining, or linking activities together so that one action prompts the next action. One way to
chain is to break tasks into a sequence of actions that lead to task completion, treating each
action in the sequence as an independent activity and assisting the person in performing each
activity. For example breaking down getting dressed by each article of clothing. Another way to
chain is to put sets of related tasks together to provide a regular, consistent situation. For
example, washing hands before a meal.
If coaching is needed, try gentle hand-over-hand guidance, which involves putting your hand
over the person’s hand to guide them as you complete an activity together. You can also use
cuing and prompting to help the person recall the needed behavior. Cueing involves giving a
verbal or non-verbal clue for doing an activity. An example of cueing would be to place a spoon
in the person’s hand to cue that person to eat.
Asking Questions
When asking questions, keep in mind that some types of questions are easier to manage for
persons with dementia than others. First, try to ask easy questions that require yes or no
responses. If there are choices involved, limit the number of choices to two or three if possible,
presenting one option at a time. If the person has significant memory loss, try to provide
information rather than asking for it, as asking too many questions may set them up for failure.
It is also best to avoid using why questions, because they often come across as being critical of
the person’s behavior.

When asking about the person’s well-being, whether it be physical, mental, or emotional, try
using the unfolding technique. To use the unfolding technique, start by asking the person
whether they have a particular symptom or feeling. If the person answers “no,” then ask about
another symptom or feeling. If the person answers “yes,” then ask about the frequency and
severity of the symptom. For example, first ask the person, “Have you been feeling anxious? If
the answer is “yes,” then ask the person to estimate how intense the anxiousness feels. Then ask
how often the person feels anxious. After you have “unfolded” a clear picture about a particular
symptom, move onto another symptom, such as pain. This manner of asking questions allows
you to gather information in an efficient manner.
Creating a Communication-Friendly Environment

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The environment can greatly affect how well people communicate. Decreasing environmental
stress can make it easier for people to focus and communicate. One way to do this is by reducing
noise and distractions, like televisions and other people.
People with dementia feel more secure and comfortable in stable environments. So to maintain
consistent routines and habits, like having meals at the same time every day, or assisting the
person to dress in the same way each time. Maintaining the same bedtime activities each night is
also helpful. Avoid unfamiliar environments and crowds, such as busy shopping malls, which
can be stressful for those with Alzheimer’s.
Use calm voice tones, slow movements, and try to create a pleasant environment. Some good
ideas include playing soft music that the person enjoys, placing familiar objects around the
person, such as photos, memorabilia, or favorite colors and using fragrances like lavender, lemon
balm (also called Melissa oil), and vanilla. All of these things can help reduce agitation and
improve communication by relaxing the person.
Communicating With the Visually Impaired
Visual changes can impair communication. The visual changes associated with aging can cause
difficulty with seeing details, such as facial expressions, reading small print, distinguishing
colors, accommodating to lighting changes, and seeing in glare or backlighting. These
difficulties often lead to the misinterpretation of the visual environment. Some strategies for
improving communication with those with visual problems include reducing the glare from lights
and providing extra light on detailed tasks. Try to use dark color contrasts. Also, try to avoid
standing in backlighting or in shadows when you are talking to someone, making sure that your
face is easy to see and that you are directly facing the person. Provide handheld magnification
and eyeglasses if necessary, and make sure that they are clean and free of smudges. Eyeglasses
should have a proper fit and be placed on the face correctly.
Remember that following instructions may take longer, so allow for plenty of time with
everything. The visually impaired also need extra time to adjust to changes in lighting, so if you
are going to turn a light on or off, tell the person before you do so, and provide time to adjust to
the change.
Communicating with the Hearing-Impaired
Hearing changes associated with aging often occur gradually and can cause difficulties with
communication. Hearing loss can also reduce a person’s physical, functional, emotional, and
social well-being. Some strategies for communicating with the hearing-impaired include making
sure that you have the person’s full attention before speaking. A gentle touch to the arm works
nicely. Also, make sure that you are directly facing the person and not standing behind them, or
covering your mouth when speaking. Make sure to lower your voice pitch and speak slowly and
distinctly. Never shout at the person, as it does not help them to understand and may even cause
them to become agitated. In addition, shouting increases the pitch of the voice, which actually
makes it more difficult to understand. Reduce or remove any background noises and distractions
and make sure that any hearing aids are properly working. This includes checking the batteries

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and the sound level. Make use of non-verbal body language like gestures and facial expressions
to help convey meaning.
Lastly, match the content of your message to the environment in which you deliver the message.
For example, you should ask whether the person has had a bowel movement while you are both
in the bathroom, but not while in the dining room.
Summary
Good communication is the building block of a caring and trusting relationship between a person
suffering from dementia and the caregiver, but as you know, communicating with someone
suffering from Alzheimer’s can be very challenging. As a caregiver, it is important for you to
help the person stay protected, comforted and connected to the world, as well as perform the
activities of daily living and improve quality of life. To do this you must start with a positive
attitude and some key strategies that include showing respect, being flexible and patient,
avoiding topics that trigger agitation or point out memory problems, and being sensitive to non-
verbal behavior. In addition, you should approach caregiving as a collaborative team effort in
which the person can make valued contributions.

It is important not to assume that the person with dementia remembers things, or understands
what you are saying, as memory can fluctuate from day to day. Because of this, you may need to
modify activities and instructions on a daily basis. Some strategies to help ensure your successful
communication include making sure that the person is paying attention to you focusing on one
idea at a time; speaking clearly, making sure to use simple, direct instructions and the important
words last; using body language that matches your words, including facial expressions and
gestures; using cues, prompts, and questioning techniques such as unfolding and limiting the
number of options available; creating a pleasant environment that promotes communication by
reducing distractions and sources of stress; and trying not to point out errors, argue, criticize,
scold, or embarrass the person. These strategies will help establish a caring and trusting
relationship. By using these strategies and having an open-mind, you can prevent problems and
difficult behaviors before they arise.

Communication in the Early Stages of Alzheimer's

An individual in the early stages of Alzheimer's is still able to participate in meaningful
conversation and engage in social activities. However, they may repeat stories, feel overwhelmed
by excessive stimulation, and have difficulty finding the right words.
Tips for successful communication:
● Don't make assumptions about a person's ability to communicate based on their
diagnosis, the disease affects each person differently
● Don't exclude the person from the conversations
● Speak directly to the person rather then to the other caregivers
● Take time to listen to the person express their thoughts, feelings, and needs

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 ● Give the person time to respond. Dont interrupt
● Ask what the person is still comfortable doing and what he or she may need help with
● It's ok to laugh
● Dont pull away, your honesty, friendship, and support are important to that person
Communication in the Middle Stages of Alzheimer's
This is the longest stage of Alzheimer's, sometimes lasting many years. As the disease
progresses, the person will have greater difficulty communicating and require more direct care.
Tips for successful communication:
● Engage the person in one- on-one conversation in a quiet space with minimal distractions.
● Speak slowly and clearly.
● Maintain eye contact, this shows you care about what they are saying.
● Give the person plenty of time to respond
● Be patient and offer reassurance. It may encourage the person to explain his or her
thoughts.
● Ask one question at a time.
● Ask yes/no questions such as "would you like some coffee?", as opposed to "what would
you like to drink?"
● Avoid criticizing or correcting. Instead, listen and try to find meaning in what the person
says. Repeat what was said to clarify.
● Avoid argueing. If the person says something you don't agree with, let it be.
● Offer clear, step-by-step instructions for tasks. Lenghthy requesta may be overwheming.
● Give visual cues. Demonstrate a task to encourage participation.
● Written notes can be helpful when spoken words seem confusing.
Communication in the Late Stage of Alzheimer'sThis stage can last from several weeks to
several years. As the disease progresses, the person with Alzheimer's may rely on non-verbal
communication, such as facial expression or vocal sounds. Around the clock care is usuu lly
required in this stage.
Tips for successful communication:
● Approach the person from the front and identify youself.
● Encourage non-verbal communication. If you dont understand what the person is saying,
ask him or her to gesture or point to.
● Use touch, sights, sounds, smell, and taste as a form of communication.
● Consider the feelings behind words or sounds. Sometimes the emotions being epxessed
are far more impertant than whats being said
● Treat the person with dignity and respect. Avoid talking down to them as if he or she isnt
there.
● It's ok if you don't know what to say, your presence and friendship are most important.
Tips for Communicating Successfully with Persons with Dementia. Effective
communication can significantly improve the quality of life in persons living with dementia

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1. Talk to them! And Often
2. Be a good listener. Listening is one of the most important tools in communication skills.
Listening to older adults makes them feel important, and that your interested in them. A
good caregiver listener can pick up on clues about their health and well-being.
3. Be observant. Be attentative.
4. Be aware of your own appearence
5. Get down to their eye level
6. Dont talk to them like they are babies, and speak in a natural voice.
7. Stay calm. Take a break when neccessary, Dont let your frustrations show
8. Be friendly and cheery. Never walk past them without acknowledging them or saying
hello.
9. Reduce background noise
10. Keep things simple
11. Be prepared to repeat yourself.
12. Be positive
13. Be patient
14. Be kind and understanding
15. Don't argue or criticize
16. Give them time to think and respond.
17. Plan ahead- determine if there are certain times of the day, where they respond better to
communications.