How to interact with someone who has dementia

Family members and caregivers often have a very difficult time communicating with someone with dementia. Many times, miscommunication actually creates negative behaviors. It is important to remember that people who have dementia are not being deliberately difficult. They can be reacting to stress or a frustrated attempt to communicate with you. If you don’t know how to connect and communicate with them, frustration will affect you as a caregiver and in them. It is our job to provide comfort and to learn how to connect with each person we meet who has any type of cognitive decline.

Dementia robs the person of speech, dignity and so much more. We will add more to their list of losses if we do not know how to communicate and connect.

As caregivers, we must step into their world of dementia. Pulling them into our reality will only create mistrust and potential behaviors. One common mistake is in handling a resident who continuously asks for his mother. If we tell him his mother is dead, we make him angry, depressed, upset and mistrustful. However, if we step into the dementia world instead and say, “Your mother called, and she will be here at 6:00 this evening,” this proves to cause less stress and makes them more comfortable.

I have had many people tell me that they could not possibly “lie” to the person. My response is, “This is not about you. It’s about the resident.” When that response is finally absorbed, staff and even family members become more connected and at ease. The resident may continue to ask this question 20 times a day, but when everyone provides the same answer, the resident can move on and have a better day, participating in activities and interacting with others.

Tips to improve communication

• Create a calm environment. Take things slowly and smile whenever possible. If the resident seems upset, show care and concern.
• The tone of your voice and your facial expression are very important, since residents pick up on nonverbal cues easily. Try not to over-react to a situation.
• Always assume residents can understand what you are saying. Never talk about the person as though he/she is not present. If you do, a behavior could occur and then you have more issues to deal with.
• Avoid quizzing the person on names and dates. Not knowing the answer can be very embarrassing for them. This quizzing also can increase distrust and the belief that you are “testing” them. Often when we give a cue, the confused person can answer.
• Draw their attention by providing a gentle, reassuring touch on an arm or shoulder, or by holding hands. When you provide touch, you demonstrate security, a caring nature and your compassion.
• Get down on their level—sit next to them, bend down or kneel down so you are not hovering over them.
• Try lowering the pitch of your voice. Do not shout but deepen your voice as it appears easier for them to understand.
• Make eye contact and slow down. Do not talk too fast and do not rush them. This in itself will create a behavior.
• Observe the resident’s body language and imagine what he/she might be feeling or trying to express. Is she hungry, tired or in pain?

Using interactions to preserve dignity

• Be reassuring but never be condescending. Praise their actions but do not patronize. Appeal to their sense of humor—but never laugh “at” them.
• Do not argue or correct their “facts.”
• Do not speak for them. So often, this occurs due to time constraints or with family present. However, if we always speak for them, they will eventually cease speaking altogether.
• Give them adequate time to respond. Dementia can slow down response time and being rushed through a response or choice just causes additional frustration.
• Do not do everything for them. If they need assistance with activities of daily living, find a way to keep them involved in the process. For example, if they can no longer dress themselves, let them point to the clothes they want to wear. I do not recommend showing an entire closet, but perhaps two articles of clothing that they can even point to. This offers them choices and provides the feeling of having some control over their lives.
• Tell the resident it is time for her shower instead of asking if she wants to take one. Many times, you will get a negative answer if you ask a yes/no question. Be sure to have everything ready for the shower or bath though ahead of time.
• Do not treat them like children or as if they are stupid. Giving them respect is crucial to a successful connection.
• If they become angry, do not respond with anger. Be calm and try to get them involved in something they enjoy, like music, a change of environment or a snack.
• Take the time to listen to them even if you cannot understand them. They still have something to say, and they still want to express themselves and be heard. As dementia progresses, speech becomes more and more difficult to understand.

We often chastise the negative behaviors from those with dementia. In all actuality, we are the ones instigating many of their frustrations and behaviors. If we learn to step into the world of dementia and remember that our residents only live “in the moment,” quality of life and care will increase for them every day. Those days of frustration for you as a caregiver will be minimal.

Diane Mockbee, BS, AC-BC, is director of operations for the National Association of Activities Professionals Credentialing Center (NAAPCC) and is the director of activities at Paseo Assisted Living in Peoria, Arizona. She can be reached at dmockbee@paseovillageaz.com.

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