When someone you love begins showing signs of dementia, it’s important to help that person feel safe and calm.
Good communication is an effective tool in curbing agitation and other behavioral problems that go along with memory impairment, says Morgen Hartford, a social worker who works with families as a programs manager at the Tucson-based Desert Southwest chapter of the national Alzheimer’s Association.
Keep reminding yourself to exercise compassion, empathy and patience, Hartford says. If you become frustrated, take a time out for yourself.
“Know that they may not remember going to the grocery store and you will have to tell them again and again,” he says.
Here are some tips for interacting with someone who has dementia:
Someone with dementia has distorted thinking and often has delusions that leave them convinced things are a certain way. That could mean thinking that someone who is dead is alive, or that it’s a different year, and that they are a different age.
“Arguing with the person will often make the situation worse,” Hartford says.
Also, exercise patience with outbursts — that is the illness talking, not the person, officials with the National Institute on Aging advise.
Step into their world.
A person with dementia might say something that is not true — perhaps that they are leaving on a trip or that someone is on their way to pick them up.
Hartford advises trying to validate the feeling behind the statement.
“You could say, ‘I understand you are expecting a ride. Why don’t you come with me and wait until your ride gets here?’” Hartford says. “Step into their world and go along with them. The way their brain is changing, trying to explain why something is a certain way or not is not very fruitful.”
If your grandmother thinks you are her long dead cousin, for example, sometimes it’s better to go along with it. People with dementia can forget their relationships with their spouses and other family members.
“It can be emotionally challenging and really hard,” Hartford says. “But often it is not hard for the person with dementia.”
Avoid the phrase, ‘Don’t you remember?’
“Even if we’ve met 30 times, I always introduce myself: ‘My name is Morgen and we met last week and had a chance to visit’, ” Hartford says. “Saying, ‘don’t you remember?’ is not a good phrase. They get put on the spot and can get stressed. Getting stressed can make their memory worse.”
As for reminding someone that they have dementia, in some cases that is not a problem. But other people don’t know anything is wrong with them and telling them could upset them and make things worse, Hartford says.
Try not to change your tone of voice when talking to someone with dementia. Avoid baby voices and baby talk.
Age is the primary risk factor for Alzheimer’s and people over age 65 have led accomplished, rich lives. “To infantilize them disregards all their life accomplishments up until that time,” Hartford says.
“Especially in the early stages, often there is an awareness that changes are happening and honoring their dignity and personhood can be really so important. They are still people with feelings, and are sometimes more sensitive because their reasoning and judgment can be impaired.”
Keep thoughts and directions short and simple. It’s OK to repeat yourself several times. If you do repeat yourself, do it in the exact same way — don’t change the words or tone.
“They don’t always get the whole picture. You may say a sentence and they may only process part of it. Say it a second time and they may catch the second part of it,” Hartford says.
If someone is repeating that they are about to do something that might be harmful to themselves like taking a bus trip alone, move the conversation in a different direction.
You could say that you also love to travel by bus and talk about the most recent place you visited. Then act as a guide for the conversation.
Offer concrete examples.
Non-verbal communication with gestures is very important. Often asking someone if they want a drink just might not compute.
When someone has dementia, their abstract thinking is often impaired. Asking, “Are you thirsty?” might be too abstract. Instead, if you have a water bottle, hold it up and say, “Here, have a drink,” or “Do you want a drink?” Hartford says.
Ask permission to help the person communicate.
If someone is mixing up words or forgetting them, ask if it’s OK for you to help.
“Ask them, ‘If you forget, is it OK if I fill in with you, or if I guess?’ ” Hartford says. “Some people will be OK with it, some won’t.”
Communicate at eye level with limited distractions.
Looking down at someone can make them feel suspicious or anxious and can change the power dynamic, Hartford says. The aim is to level the playing field.
“We’re dealing typically with older adults who have changes in hearing,” Hartford says. “They may really rely on reading lips, talking face-to-face.”
Also, limit distractions that people with dementia can have a hard time tuning out. A television, radio or air conditioning unit can be distracting. Get into a quiet space when you want to communicate.
Tell your loved one that it’s OK they forgot and it’s not their fault.
“Reassure the person that it’s going to be OK,” Hartford says. “They want to know they are safe and they are going to be well cared for. Just like anyone wants to be reassured. It goes back to validating — ‘I know you are scared and I am here to help.’”
The National Institute on Aging suggests showing a warm, loving matter-of-fact manner and to hold the person’s hand while you talk.