Talking with Someone Who Has Dementia
Here are a few tips for success when talking with someone who is living with dementia:
Don’t talk down to the person or treat them like an infant (often called “elderspeak”). Regardless of how much the person with dementia can or cannot understand, treat them with honor and use a respectful tone of voice.
Use their names and preferred titles. Learn what the person’s preferred name is and use it. Be careful with using “honey,” “sweetheart,” or similar terms. You may mean it genuinely in affection, but it can also come across as demeaning or patronizing.
Don’t just talk loudly. Not every person with dementia has a hearing impairment, and using a loud tone can make them feel like you’re yelling at them. You can increase your volume if the person doesn’t respond, or if you become aware that they have a hearing problem.
Avoid interrogating. Limit your questions to just a few. Your goal is to encourage and provide encouragement during your visit, not to fire endless question at them that may be difficult to answer.
Don’t ignore the person. If you have question, ask the individual FIRST to give him a chance to respond before turning to someone else for an answer. Also, don’t talk about the person as if they’re not there. They might understand more than you give them credit for, so convey your respect by addressing them directly.
Smile and make eye contact. In dementia, a genuine smile can reduce the chance of challenging behaviors. Your warm smile and eye contact convey that you are glad to be with them and are two of the most important factors in communicating with anyone.
[much of this article was paraphrased from an article on verywellhealth.com]
Preserved Implicit Memory (PIM) in Persons with Dementia
Despite major changes to memory and skills, people with Alzheimer’s disease are often able to keep some skills even as symptoms get worse. These are known as preserved implicit memories. They may include reading or listening to books, telling stories, sharing memories, singing, listening to music, dancing, drawing, or doing crafts. Preserved skills may last longer because they're managed by parts of the brain affected in the later stages of the disease.
Have you ever driven home from somewhere and then realized you don’t remember anything about the drive? (That used to happen to me sometimes while driving home from work!) This is a form of implicit memory (IM). The memory is not recalled or “declared” consciously, but is instead demonstrated in completion of a task.
Research demonstrates that practice can sustain some motor skills for dementia patients in the later stage. When skills are practiced under constant conditions (the same steps each time), the skill is often preserved even though it may be done more slowly.
For example, if your loved one always used a natural toothbrush, preferred mint flavored toothpaste, and often listened to the morning news on the radio while brushing her teeth, it could strengthen the motor skill memory by setting up her bathroom with many of her unique PIM features (natural toothbrush, radio, mint toothpaste) and having her complete the steps needed to brush her teeth in the same order each day.
[much of this was paraphrased from an article on our.oakland.edu]
Dehydration
Even people who can walk and appear to be able to care for themselves may become dehydrated. Someone with dementia may not recognize that they are thirsty, or they may forget to drink. They might also struggle to get themselves a drink or to tell you when they are thirsty. This can lead to them becoming dehydrated, which can cause headaches, increased confusion, constipation, and urinary tract infection (UTIs).
Tips to help a person stay hydrated:
*Encourage him to drink throughout the day. Offer different types of drinks, such as water, tea, coffee, fruit juice, soup, and smoothies.
*Give her a drink whenever she is eating.
*Use a clear glass so he can see what’s inside, or try a brightly colored cup to draw attention.
*Make sure the cup or glass is not too heavy or a difficult shape to hold.
*Encourage him to eat foods that have a high liquid content, such as popsicles, soups & broths, and yogurt. Many fruits & vegetables also have high water content.
*Try using sweets called Jelly Drops, which can help people with dementia to take in more water.
The amount of fluid a person needs varies with the individual and with the season. People need more fluids during the summer months. If you are uncertain whether the person is getting enough fluid, ask her doctor how much she should be drinking.
Have you had the experience of an elderly loved one telling the same story over and over?
My heart goes out to the many family caregivers who must listen to the same statement, question, or story 20 times in an hour because a parent or spouse has some form of dementia. (I’ve been there; I get it.) Short-term memory loss makes it impossible for dementia patients to remember what they just said, so they say it again and again and again.
When it comes to dementia, repetitive speech is very common and can result in same-story syndrome or dementia looping. This can be exhausting to those around them, but it is always best to practice empathy. Some reasons why they repeat themselves include:
*short-term memory impairment
*anxiety, discomfort, fear, frustration, stress
*wanting to communicate & not finding anything else to say
*being bored or under-occupied
*being stuck on a particular word, phrase, or action
Some ways you can respond to those who repeat themselves:
*Validation. If he says he wants to go home (and he is at home), what does it hurt to say “OK, we’ll leave soon.” (Just remember to respond the same way each time, so as not to confuse him further.)
*Distraction. After the second or third repetition, try changing the topic of conversation. Use anything you can think of to pique her interest and change the subject.
*Redirection. Sometimes changing the subject isn’t effective, and you will need to place his attention on a different activity. This can include chores, crafts, snacks, watching TV, listening to music, etc.
Keeping a loved one engaged will improve their quality of life and keep your efforts from becoming too tedious.
For your own sanity: practice self-care. Keeping your cool can be hard if you’ve heard the same story over and over. Get some fresh air, take a warm bath, or just step into another room for a few minutes, take a few deep breaths, and then try again.
Did your loved one once enjoy reading, but can no longer concentrate?
Anyone with an illness that causes progressive dementia will eventually be unable to read or will not be able to make sense of what she reads. People with dementia can have trouble understanding written information even when they can still read the letters or words.
When my Mom was living with Alzheimer’s and no longer able to read (previously a favorite pastime), I would often read aloud to her. If she was having a bad day (her bad days often involved cussing and yelling), I would gently take her hands and say “Mom, let’s get comfy and read a story.” I wouldn’t ASK . . . because she rarely knew how to respond to questions; they just made her confused or more irritable. I would begin to read aloud. If she were still vocalizing irritably, I would just ignore that and keep reading at normal volume, often with my hand on hers. Eventually she would start listening. At that point, I would start the story over, and continue to the end, or until she fell asleep. LOL
Would your loved one enjoy being read aloud to?
Caron Garliepp
February 2025