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How to Communicate Better With a Loved One With Dementia

If you’re talking with a loved one who has dementia, providing context is the key to a successful interaction, according to Brent Forester MD and Tom Harrison, authors of The Complete Family Guide to Dementia, published by Guilford Press. Here’s some advice from the authors

Tom Harrison & Brent Forester MD
How to Communicate Better With a Loved One With Dementia

This article was written by Brent Forester MD and Tom Harrison, authors of  The Complete Family Guide to Dementia: Everything You Need to Know to Help Your Parent and Yourself.

When you’re talking with a loved one with dementia, it’s very helpful to understand what their experience is like. Here’s an exercise that can help: If you own a novel that you haven’t read, open it to a random page in the middle and read just that page. 

What do you find? You can probably get a vague understanding of the action, a sense of the mood, and perhaps some idea about a character or two. You can probably tell if you’re meant to experience drama, suspense, humor, or some other emotion. But you don’t really know what’s going on. You can’t understand why things are happening the way they are because you haven’t read the previous chapters. You have no memory. And because you have no memory, you have no ability to put things into context.

People with dementia experience something very similar. They might have a general sense of who people are and what they’re doing in the present moment. But what they lack is the ability to put these things into context, and therefore to make sense of what’s happening.

Therefore, one of the keys to effective communication with a person with dementia is to continually supply context. 

It’s Something You Do Already

This is actually something that people do naturally in certain other situations. For instance, imagine that you have a group of close friends who have known each other for a long time and have a lot of history, stories, and “in-jokes.” Then a new person joins your group. A certain amount of your time will be spent explaining background information and relationships and obscure references. You have a sense that the new person has opened your novel in the middle and that you need to explain your backstory so that he or she isn’t mystified.

Another example would be doctors and dentists who explain each thing they’re about to do during a procedure so that the patient doesn’t feel confused, surprised, or upset.

It’s hard to realize that you need to do this sort of thing with a loved one, because we assume that our loved ones know the backstory. But dementia takes this ability away.

How to Provide Context

It’s possible to provide context in a subtle way, simply by including information. For instance, you might say, “This is Helen. She’s your aide and she’s here to help you take a bath.” This is far easier and less confusing than having someone your loved one might not recognize simply arrive and suddenly begin trying to take his or her clothes off.

Or you might say, “This is Barbara, who’s married to your son Bill.” This helps provide context and also spares your loved one the embarrassment of asking who the other person is. 

It’s good to get into the habit of explaining anything you do or any change you make to the environment. “I’m turning the television off so that it will be easier for us to talk.” “I’m getting you a sweater because it’s cold today.” “I’m going to the kitchen to get a drink of water and I’ll be right back.” “We’re going to the eye doctor today to see if you need new glasses.” Continually supplying context in this way will help the person with dementia to stay calm and oriented. 

Be Careful With Pronouns

Another good idea is to avoid the use of pronouns as much as possible. Pronouns are words such as he, she, his, her, it, and so on. They’re short words that substitute for longer words because it’s assumed that the person we’re talking with knows what they refer to. But with dementia, that’s a dangerous assumption. “He’ll put it in his car” can be very confusing. “Your son-in-law Jim will put your purse in the car so you’ll have it while we’re riding” supplies far more context.

When people use a lot of pronouns, individuals with dementia sometimes feel as though everyone around them is speaking in code. They may become paranoid, and think that people are talking behind their back or otherwise trying to keep them from knowing what’s going on. Avoiding pronouns is a good way to keep this from happening.

Of course, it can sound stilted to talk without pronouns. (And eliminating them altogether is impossible.) Nevertheless, being aware of your use of pronouns and minimizing them as much as you can is often very helpful.

Don’t Become Defensive

Occasionally a loved one might snap at you for using these context-providing techniques. “I know who Barbara is!” they might say angrily. “You don’t have to talk down to me like that!” 

Of course, the truth is that your loved one might or might not have known who Barbara was if you didn’t explain. It’s easy to become defensive when you’re snapped at like this, but it’s important to remember that the comment is not about you. Your loved one is simply frustrated with themselves because they need to have the context explained, and expressing that frustration in the only way that they can think of at the moment. You can simply ignore the comment and continue subtly providing context.

Purchase The Complete Family Guide to Dementia here.

Date posted: Dec 15, 2023
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Tom Harrison & Brent Forester MD

Harrison, a writer and former editor, and Forester, an award-winning researcher, specialize in dementia and mood disorder care. Coauthors of The Complete Family Guide to Dementia.

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