Communicating with the person with dementia

Introduction

Communication is a very complex process and it is not surprising that many communication skills are lost when someone has dementia. Expression and understanding are both affected. Some skills of expression are well preserved whilst other aspects are considerably impaired. Although individual people who have dementia will differ in how their language and communication skills are affected, there are often similarities in their losses.

How communication is affected

The ability to think of the right word may be noticeably worse in the early stages. Later, only everyday words may be used and other words lost completely.

Pronouncing letters and words is not affected until the very late stages.

Putting sentences together is not much affected in the early and middle stages, but may get worse later.

Knowing when to reply is not affected at first, but the person will tend to say things which relate to him or herself rather than respond to what has been said. This makes the person appear uninterested in what others are saying. He or she may fail to pick up humour or sarcasm or subtle messages. What the person has to say is most affected. In the early stage topics are fewer and the person does not try to explain original thoughts or insights. He or she may speak less and conversation is dull. Later he or she cannot keep to the topic and becomes vague and rambling. He or she may speak more but begins to make less sense. Messages are repeated. Less and less is communicated.

In the late stages the person may say almost nothing, or keep repeating only one or two phrases or sounds which make no sense.

Generally it is the automatic language skills, for example responses such as ‘hello’, which are said without thinking which are retained for the longest time. Aspects of communication which require careful thought are soon lost.

How you can help

When we speak to someone with dementia we must try to send messages which he or she will understand. This can be difficult because problems with understanding are harder to spot than problems with expression. The response of the person to what you say can indicate if he or she have understood. The person’s ability to communicate should give you a good idea of the level at which to pitch a conversation. It can help if you are guided by a few rules.

1. Make sure that the person is paying attention to you. Eye contact is important. Gently touching and calling the person’s name can draw his or her attention.
2. Keep sentences short and simple. Make one point at a time. Stick to simple, familiar ideas rather than complicated new concepts. Make statements and not logical arguments.
3. Say exactly what you mean. Avoid suggested or implied messages. Don’t say (with a sigh) "Monday, and its raining again!". Say, "It’s raining, I can’t put the washing out to dry."
4. Use real names, not pronouns (he, she). This reminds the person of who you are talking about.
5. Do not ask questions which need a complicated answer. Questions which can be answered with a word or two are best.
6. Information is not easily taken in. It helps to repeat the important parts of a message.
7. Gestures, body language (how we use our hands, eyes and posture), touch and tone of voice are often understood right through to the late stages of the illness. Sit in a position where the person can easily see you.
8. Conversation is enjoyable, but the topic needs to be one which both parties can grasp. For people with dementia this tends to be the old and familiar things in life.

It is possible, of course, that a problem with communication is caused by a hearing problem. If you suspect this, arrange for the person to see their GP. A speech therapist can give professional help with communication. Ask your GP or hospital consultant about this.

Sometimes people think that if the person with dementia does not understand then it is all right to talk about him or her in his or her presence, or believe that even if the person does grasp something of what is being said, he or she will forget about it in five minutes. Both ideas are wrong. Body language and gesture is likely to be understood and so the person with dementia will be aware of being talked about even if he or she cannot grasp the meaning. This can be upsetting. It is also possible that he or she will continue to feel angry or upset long after forgetting the original reason.

In company, conversation becomes much more difficult to follow. People talk quickly or talk at the same time, and the person with dementia is soon lost and feeling isolated. Generally, it is best to avoid large groups but encourage visits from old friends and members of the family.

Contact the 24 hour Dementia Helpline if there is a communication problem you want to talk about. Our trained volunteers may be able to help, or if the problem is complex, can get advice from our speech therapy advisor.

Communicating (pdf, 135kb, 6 pages)

Caring for a person with dementia

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