How would you promote effective communication with a patient with dementia?

Dementia affects people in different ways and changes in communication are common. The person may find it hard to express themselves clearly or to understand what others say. As the dementia progresses, communication can become more difficult. This can be frustrating, challenging and upsetting for the person living with dementia, as well as for their families and carers.

Changes in communication

Each person with dementia is unique and difficulties in communicating thoughts and feelings are very individual. There are many causes of dementia, each affecting the brain in different ways.

Some changes you may notice include:

• difficulty in finding a word, or saying a related word instead of one they cannot remember
• speaking fluently, but not making sense
• reduced or limited ability to understand what you are saying, or only following part of it
• changes in reading and writing skills
• loss of conversational social conventions, such as interrupting or ignoring someone talking, or not responding when spoken to
• difficulty expressing emotions appropriately

Seek advice

• Book a hearing check with an audiologist. Hearing aids may be recommended, or adjustments may be made to existing hearing aids.
• Make an appointment with an optometrist to check eyesight. Glasses may be recommended for some people.
• Talk with the doctor about a referral to a speech therapist for support with personalised strategies for communication.

Communicating feelings

People communicate feelings and attitudes both verbally and non-verbally, using:

• body language, such as facial expressions, posture and gestures
• the tone and pitch of their voice
• words.

A person living with dementia may:

• communicate their feelings and attitudes in non-verbal ways, particularly when talking becomes difficult
• gauge how a person caring for them is feeling by reading their body language and the tone and pitch of their voice.

It is important for family and carers to encourage positive communication experiences, especially on ‘bad’ days. Sometimes a carer’s own stress or tiredness can make it hard to encourage positive communication and communicate effectively. It is important for carers to maintain their wellbeing, because it has a positive flow-on effect for communication.

What to try

Caring attitude

While many people with dementia may not always understand what is being said, they still have feelings and emotional responses. It is important to maintain their dignity and self-esteem.

Tips for conversation

• Be calm and talk in a gentle, clear way.
• Keep sentences short and simple, focusing on one idea at a time.
• Always allow plenty of time for what you have said to be understood.
• Be flexible and allow plenty of time for a response.
• Consider using names and relationships to help the person, such as “Jack, your son”.
• When you are trying to explain something, it can help to draw a simple picture or diagram.
• Ask questions that require a yes/no response or involve a limited number of choices, to make it easier for the person to respond.

Body language

• Use facial expressions and hand gestures such as pointing or demonstrating to make yourself understood.
• Consider touching and holding hands to help keep their attention, and show warmth and affection.
• Smile, as sharing a laugh can often communicate more than words.

Create the right environment

• Try to avoid competing noises, such as TV or radio.
• Try to keep still while you talk; if possible, stay in the person’s line of vision.
• Maintain routines to help minimise confusion and assist communication.
• To reduce confusion, encourage all family and carers to use the same communication approaches as each other and repeat messages in the same way.

Things to avoid

Arguing. It will only make the situation worse.

• Ordering the person around.
• Telling someone what they can’t do. Instead, suggest what they can do.
• Being condescending. People can tell when a tone of voice is condescending, even if the words are not understood.
• Asking direct questions that rely on a good memory for a response.
• Talking about the person in front of them as if they are not there.
• Negative body language. Sighs and raised eyebrows can easily be picked up.

*Adapted from A. Robinson, B. Spencer and L. White Understanding difficult behaviors, Eastern Michigan University, Ypsilanti, Michigan, 1989.

Tips from a person with dementia

Christine Bryden (Boden) was diagnosed with dementia at age 46 and has shared a number of her insights about ways that families and friends can help a person with dementia. Christine is also the author of a number of publications, including Who will I be when I die?, the first book written by an Australian with dementia.

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