Rudolph C. Hatfield, PhD., edited by Kathryn Patricelli, MA
Displaying problems with the ability to understand language and to express oneself with language are common among people who have any of the different types of dementia. In some cases, these problems appear early in the disease and in others they appear later. However, at some point communication will become a problem and there are some adjustments that caregivers can make that may help. Some of these include
Adjust how you speak to the person:
Speak slowly and use an even tone.
Use short and simple words.
Make your point clear.
Sometimes emphasizing the point you want to make is helpful. For example, "I need you to brush your teeth."
Only make one request or ask one thing at a time. Telling someone to "go brush your teeth, comb your hair, and wash your face" might be too much. Take one thing at a time. When asking for someone to do a task that requires numerous steps, only request one step at a time:
"Brush your teeth" (give person toothbrush; person completes task).
"Comb your hair" (take toothbrush from person, give person comb).
(The person completes second task)
"Wash your face" (take comb, give person soap, washcloth, etc.).
Don't rush the person.
Make positive requests as opposed to negative commands. For example, instead of saying "Don't use the comb, use the brush" eliminate the word don't and the negative part of the command and simply give the person a brush and just say "Use the brush."
Stay calm. People with dementia sense frustration and irritation in often will respond in a like manner.
Use repetition if necessary.
Tone and volume can often be very important factors in communication. Talking to someone with dementia in a tone that suggests frustration or anger may only frustrate them. Talking too loud may result in them thinking that you are angry at them and this may confuse them or frustrate them even more. Control yourself. Keep your tone even, make yourself audible but don't shout, and speak slowly. Have the person repeat what you say.
Try and keep things in the present tense. Using the future tense or past tense can often be confusing to people with problems with memory issues.
If you're going to ask a question the best way form the question is to try and get a yes or no response as opposed to asking questions that require a lot of thought or reflection. Remember that people with dementia have trouble organizing their thoughts, thinking about the past, anticipating events, etc.
Don't argue with people who have dementia. Redirect them.
The use of distraction and redirection can be very helpful. This is especially helpful when the person is frustrated or upset. You can simply move to a different topic. For instance, a person that is suffering from severe dementia and wishes to go home may be very insistent. One approach might be to get them involved in an activity that they like and tell them they can go home later. Admittedly, this situation can often get very frustrating and requires many different attempts to redirect the person, but stick with it. Trying to change the subject with having them express things that make them feel more positive can often be helpful.
Sometimes simply changing the environment can be very important. For a person with dementia that is upset, cannot get off a particular topic, or is becoming disruptive, simply removing them from the environment, lowering stimulation, and spending time with them involved in some other activity can often resolve the situation (redirection).
Eliminate distractions in the environment when you are trying to communicate with the person. For example, turn off music, turn off the television, get the person into an area where people are not talking, etc.
Always attempt to directly communicate with the person. Face them, look at them, speak slowly, and have them repeat what you say. Engage as many of the person's senses as possible when communicating with them.
People with dementia respond to consistency. Keeping things consistent, trying to keep the environment as familiar as possible, and avoiding distractions and overstimulation can facilitate communication.