How to Communicate with a Loved One Who Has Dementia: A Helpful Resource for Families in Pittsburgh

For caregivers, communicating with a person that struggles with dementia can be a frustrating and painful experience.

A person with whom you could once have very deep conversations may now be someone that can’t form sentences, that may ask you the same question multiple times, forget names, respond to and/or give simple commands, and who will become very irritated when the conversations that he/she/they now engage in are overly simplified.

For families, the changes your loved one is experiencing may be all of the above and more, for example, very overwhelming. It may be very difficult to know how to respond to your loved one now that all the strategies you previously relied on to communicate with them are not effective anymore.

Although it may be perceived as difficult to talk to your loved one now that he/she/they has dementia, never-the-less, it can be done.

You need to keep in mind that dementia has a major impact on the ability of the person who has it to receive, comprehend, and respond to stimuli. Your messages to your loved one need to be very simple, give him/her/them the message that you are there for him/her/them and respond to his/her/them needs in a comforting and safe manner.

While in Pittsburgh, you will relax more and your loved one will experience a greater degree of calm. You will also help your loved one maintain their dignity and keep them feeling valued and appreciated.

Our wonderfully talented, nurse led staff at Confiable Health devote all of their energy and creativity to making dementia care better. Since our staff delivers dementia care with our clients’ needs in mind, we are completely comfortable in creative solutions as long as we are respectful.

Because dementia creates significant barriers to communication and daily activities, it can create more and more frustrating and difficult situations for the loved ones of a dementia patient. This problems in communication, and behavior characterized by confusion and the repetition of actions, will be dealt with and we will also outline what is necessary to have outside professional support. Families exploring different care options can also review our home care guide in Pittsburgh to understand available services and support options.

Change in Communication

While the communication of most dementia patients changes with the progression of their illness, some communication changes that occur suddenly are cause to be concerned. These can be the first signs of a new illness.

If you observe recent sudden alterations to the cognitive function and behavior of your loved one alongside sleep disturbance and a decline in physical ability, along with the emergence of new symptoms like a fever or difficulty breathing, you should contact the doctor of your loved one as soon as possible. There could be many different explanations of the symptoms your loved one is experiencing, including an infection, dehydration, pain, a new medication, a stroke, and many other things.

Dementia Care In Pittsburgh

At Confiable Health, we provide customized home care for the elderly in Pittsburgh and the nearby communities in Allegheny County. Our employees help the loved ones of dementia patients understand the patients’ needs and develop caring and supportive safe plans.
Learn more about different levels of support in our complete guide to home care in Pittsburgh.

Call: 412-530-3192

Email: Leads@confiablehealth.com

Schedule a Free In-Home Care Assessment

Dementia and Communication

Dementia is a broad term that describes the many different cognitive function and memory illnesses that interfere with daily living and behavior.

Dementia is primarily known as a form of Alzheimer’s, but many other diseases also present dementia and can influence communication in many different ways, including many of the other diseases of the nervous system, such as the vascular dementias, the Lewy body dementias, the frontotemporal dementias, cortico-basal dementia, and the dementia of Parkinson’s.

The type and level of communication impairment varies in individual dementia patients and can depend on the type of dementia, the particular brain damage, the patient’s overall health, the stage of dementia, and the environment.

Some issues with communication that dementia patients may present include the following:

• (a) inability to find words;
• (b) inability to follow long conversations;
• (c) inability to process complicated questions;
• (d) inability to remember things that were said moments before;
• (e) inability to think and remember things in a linear and logical way;
• (f) inability to process and recognize humor and sarcasm;
• (g) inability to interpret facial expressions;
• (h) inability to describe and explain physical sensations and feelings;
• (i) inability to separate memories of the past from the present;
• (j) inability to recognize familiar people; and
• (k) inability to process multiple commands and respond in a timely manner.

These issues with communication are a result of dementia and not of the person or patient being difficult or uncooperative. Knowing the effects of dementia and communicating more appropriately can help families avoid being upset and try to avoid confrontation. Being more supportive can help as well.

An example of this is:

“You have always made sure to prioritize your children’s safety. You’ve succeeded, because they are all safe now and well taken care of. Please, next to me.”

Because the original statement is centered around the stress caused by having to defend themselves. The goal of the statement is not to win the debate that is being caused by your original statement, but to ensure that the person feels safe. Repeating the false statement does not accomplish anything.

You will not need to repeat their false statement to maintain focus, or redirect the statement to ensure they feel safe. You will be able to reassure, and redirect, while addressing the statement.

Start Every Conversation In A Calm Manner

Before you start losing your cool, take a moment to assess your tone and posture, your facial expressions, and your stress level.

People with dementia may not understand your words, but they will be able to feel the emotions that are behind your words.

When you get the chance, approach the dementia patient to the front, because if you approach from the rear, you may be alarming them.

Make contact, and use their preferred name.

Stand with your face relaxed, and in a more open posture.

Because of this, your initial statement will be the most important part of the interaction.

Based on the previous examples, it’s helpful to communicate that we are running late, and your task is to go and get ready with the use of the following. “Good morning Mom, it’s Matthew. I’m helping you get ready. We have lots of time.”

Eliminate Disturbances

The listening and separation of sounds may contribute to the strain of communicating with your loved one. You may be accidentally adding to the burden by having the radio or TV on, a phone that’s not on silent and various other noises. To ensure your communication is not adding to the strain, please take the following steps, if you have not already considered doing the following:

1. Lower or turn off the TV.
2. Change to a quieter room.
3. Close the distracting door.
4. Relocate or quiet the various other people.
5. Make sure the hearing aids work.
6. Adjust the glasses.
7. Sit at the same eye level.
8. Recognize and adjust for any other signs of your loved one being tired, hungry, in a state of discomfort or in any other form of pain.

Environmental distractions could make communication with a loved one who has dementia, that much more difficult. Fortunately, having a quieter room has been proven to make that communication a little better.

 

Use Simple, Short Sentences

Instead of long, complex sentences or explanations, use short and simple sentences.

Instead of giving the long direction below,

“After you finish your breakfast, go upstairs, brush your teeth, find your blue sweater, and get your coat because we have to leave for your appointment.”

You can say the shorter variation below.

“Finish your breakfast.”

Once they do, say the next short instruction.

“Now let’s brush your teeth.”

You can give each instruction in the same fashion, waiting in between, until you get to the last two instructions.

“Here’s your blue sweater.”

“Now we’ll put on your coat.”

The last two instructions can also be said with the same fashion.

This approach gives people with dementia the opportunity to complete each instruction, respects their independence, and allows them to complete each part at their own pace without the feeling of having to complete the task quickly. Remember simplification does not equate to allowing yourself to speak to them in baby talk. You still have to be respectful.

This also means simplifying your questions. Simplifying in this case means only giving one option when asking the question. Instead of giving the answer to the question, simplify your question and restrict it to just one option.

“Are you hungry, do you want lunch, and should I make soup or a sandwich?” is a good example of a question to avoid.

Instead, ask the first of the set of simplified questions. The one you should ask first is, “Are you hungry?”

Once they answer the first question, then you can ask your second question which is the option between soup and a sandwich.

Being specific also helps simplify because specificity, in this case, helps to limit the amount of options. Instead of asking a broad question and making the person think to answer, ask a specific question.

You should also aim to not overstimulate the brain. In this situation, oversimplifying is the way to go, which should be your end goal, to minimize the amount of work needed to answer the question.

Yes or No Questions are quicker to answer, and require less cognitive energy. These types of questions can be used in overwhelmed situations. For example, instead of asking, “What would you like to drink?” you can ask, “Would you like tea?”

You can also say, “Would you like the blue shirt?” instead of asking, “What do you want to wear today?”

Using simpler types of questions, and in particular these types of questions, can help you avoid overwhelming these individuals with an interrogation type question.

Make sure the questions you ask are for the particular support and do not jeopardize your loved one’s memory or ability to answer questions.

You need to wait a while for your loved one to answer the type of question you asked.

This is one example of the various strategies you can use in order to communicate effectively with a loved one suffering from dementia.

You need to ask the question just once, and wait with your answer to the question.

In the case of individuals that simply have a hearing problem, do not answer the question for these individuals, and just restate the question.

Even if you feel that the silence is too long, a wait is necessary for your loved one to process and respond. Jumping the gun to answer a question will only create anxiety, but your patience will help these individuals recognize that they are being supported.

Memory Testing

Examples of memory testing questions include:

• Do you know who I am?
• Do you remember our conversation?
• What did you have for breakfast?
• Who visited you yesterday?

While these questions may seem ‘innocent’ or meaningless, frequent or constant memory testing will likely make almost anyone feel defensive or anxious.

Memory testing.

Do you know who I am?

Should be said as:

Hi mom, it’s Sarah. I’m so happy to see you.

Memory testing.

Do you remember where we went yesterday?

Should be said as:

We went to the park yesterday. The flowers were beautiful.

This invites the person to make a conversational contribution without feeling like they’re being burdened with a memory test.

The purpose of a conversation is to create a connection, not a memory test.

Do not correct their memory

Most often, memory correction is unhelpful and makes the situation worse.

If a family member has a memory of a specific event that is incorrect, ask yourself the following questions:

Will I be helping them with this memory correction, even if it’s distressful?

Will this correction impact an important medical or financial decision for them?

Will I be helping them by this correction, or will I just cause them distress?

If there is no concern for their safety, let them remember the event incorrectly.

Instead of saying, ‘your purse didn’t get stolen, you always misplace your stuff,’ you could say, ‘you’re upset about your missing purse, we’ll help you find it.’

You could distract them from thinking the purse was stolen, and the family member will feel sorry for them and think it was a good response.

Recognizing the Emotional Needs of Dementia Patients

People with dementia can’t always communicate verbally, and some may have a hard time communicating at all, but the people around them can express and explain their emotions.

Take the following sentence, for example, if someone needed to say the following sentence emotionally, they could say:

“I want to go home.”

Perhaps the person feels threatened. Maybe the person feels lonely. Perhaps the person just knows they are not where they’re supposed to be. Maybe the person just wishes they could go to a place of happy memories.

Instead of just saying, ‘you are home’ over and over, you could try:

“You want to feel comfortable and safe.”

“I’m here with you.”

“Tell me about your home.”

“Let’s look at these family photographs.”

When is my appointment?

Where is dinner?

Where is my husband?

Where is my husband? may be an effort to deal with some form of anxiety, and may be an effort to receive some form of reassurance.

One thing to keep in mind when a repeated question is answered or a statement is responded to is, you need to remain as calm as possible, you must keep in mind that the repeated statement may also be the first that was answered. Some of the following may help with reducing anxiety or interruption of repeated statements:

Write your answer, and show it to the individual. You may also restate the question and show your answer with some replacement props. As you answer, offer the individual a preferred activity.

Some example responses where the repeated statement is where is my husband may be, “You’re going to see your husband after we have dinner.”

Confiable Health provides individual care to families in the following communities

Pittsburgh, Penn Hills, Monroeville, Bethel Park, Mt. Lebanon, Robinson Township, Moon Township, North Hills, South Hills, Allegheny County.

Our care provides safety and dignity to our clients while placing comfort as the top priority.

To schedule a Free In-Home Care Assessment, call us at 412-530-3192.
You can also reach us at Leads@confiablehealth.com.

What Not to Say to Someone with Dementia

There are times when we tend to elect more damaging words to say to someone when we hear the following:

You already asked me.

You should know who I am.

That did not happen.

You can’t remember.

You are the difficult one.

You are being difficult on purpose.

This may represent a loss of control. While we understand the reasons for this, it does not relieve the stress caused by the loss of control.

You should try to say the following:

Let me explain for the umpteenth time that you are mistaken.

Try saying you are mistaken instead of that simply never happened.

If the undesired behavior is identified, a polite request for cooperation to exhibit the desired behavior may help return the individual to a more positive and cooperative state. This technique is referred to as Positive Directions.

For example, rather than saying:

“Don’t go outside.”

You can say:

“Let’s sit together in the living room.”

Rather than saying:

“Stop touching that.”

You can say:

“Please hold this towel for me.”

Rather than saying:

“Don’t get up.”

You can say:

“Please stay seated while I bring your walker.”

Positive Directions are clearer and more constructive than the techniques to which they are substituted. Positive Directions shift the focus away from the undesired actions that your loved one is performing and toward the actions that they are likely to willingly engage in.

When You Give Directions, Focus on Actions

When verbal instructions become difficult, you can still communicate information through actions. This is the best means of communication in this situation.

For example, rather than verbally instructing the person to brush their teeth, you can hold a toothbrush up for them as a visual cue to demonstrate the action to be done.

When offering choices, you can hold the choice in your hand for them to select, or simply demonstrate the options to be selected.

Pointing to a chair is one way to offer the choice of sitting, as is demonstrating the action of washing hands.

And, the cup can be kept out as a visual for the action to demonstrate.

Displaying where the cup belongs may be more effective than verbalizing where it belongs.

Sending and receiving instructions can be difficult for you as well as the person you are communicating to.

Your family member may indicate particular needs in many different ways. For example:

• Making a Face or a Drawing
• Walking or Running in a Straight Path
• Hand Sign or Gesture
• Touching a Private or Protected Area of the Body
• Showing or Giving a Food or an Item
• Walking or Moving to a Different Location
• Reaching a Hand Toward an Item
• Freezing in a Position to be Quiet
• Moving in a Queasy Way from One Location to Another
• Making Quick and Jerky Movements
• Making a Soft, Gentle Movement or a Change

All of the above behaviors may indicate a need for food or a drink, a need for stimulation, a need to take a break, a need to use the restroom, a need for air, a need to change one’s position, etc.

Instead of labeling a behavior “difficult,” think about the following:

• What are they trying to tell us or what do they want to express?
• What may be or could be the cause for this?
• What could be the cause of their discomfort?
• Is too much time or too much noise the cause?
• Do they not comprehend the request?

Do not dismiss “difficult behavior.” Instead, interpret it as a means of communication.

 

Difficult Behaviors During Bathing and Self-Care

Difficult behaviors can be understood partly as a response to the loss of privacy and exposure, feelings of vulnerability, and changes in sensory stimuli (e.g., temperature and touch) during different phases of bathing, dressing, and grooming.

Think about the following before starting any of these activities:

• Always explain what you plan to do.
• Ask for permission the best you can.
• Have all the required equipment within reach.
• Provide a temperature that is comfortable.
• Keep the person’s private areas, private.
• Give short simple directions.
• Break the activity into small parts.
• Don’t hurry, take your time.

An example that could be said is “It’s time to freshen up. Would you like to wash your hands or your face first?” instead of “We have to go shower now”.

Difficult behaviors means that the activity has to be stopped. Safely stop the activity when you must.

For additional assistance, your family members can contact Personal Care Services 
Personal Care Services helps in a respectful way related to bathing, dressing, grooming, and other personal care activities.

Issues with Medication

With medication, the more the individual has to do other tasks that they believe is different from the act of taking the medication (e.g., believing that they already took it, etc.), the more difficult it becomes.

The individual can benefit from the addition of a new, simple, and easy to follow routine.

Remain calm and collected. A high stress environment does not allow for a lengthy explanation of complex systems.

Routine can be fundamental. Try your best to implement simple routines.

Medications should not be hidden in food.

If food is the only way to get the medication into that person, the best option would be to contact the person’s doctor and see if that is an acceptable way to get them to take their medication.

Medications also should not be altered, like crushing them, or any other way, without contacting the healthcare provider. Some medications need to be taken intact.

If the person start refusing a medication, or refusing a medication for an extended period of time, then the best option is to contact a different provider.

There could be many reasons why the medication is being refused, including side effects and other struggles. It may also be difficulties in trusting the system. Considering Medication Management Services in Pittsburgh  which are available in Pittsburgh, may be a good option for families.

Anger and Accusatory Behavior

It is very common that patients suffering from Dementia will get angry and accusatory with caregivers when they cannot seem to understand why their request to stop theft is being denied. It is also common for them to get angry when they realize they are being cared for by a stranger, instead of a family member.

In these kinds of instances caregivers should do the following:

• Lower their voice and remove excess stimuli from the environment to promote a calmer atmosphere.
• Always keep a safe distance. Do not engage in verbal combat.
• Acknowledge the feelings they are expressing and accept them.

Redirecting people with the use of calming activities while providing support and reassurance can prove beneficial.

“I understand that you are upset, and I’m here to support you while keeping you safe. Let’s go to a calmer space.”

Controlling people using tactics that contain, or worsen, the situation like shaming, threatening, and providing them with an isolated space is inappropriate and makes everything worse.

When their behavior is also concerning and volatile along with the sudden mental state of being more irrational, it is definitely time to call for help. It is also time to seek help when they are showing new concerning symptoms like a fever.

Common Issue Mistreatment and How to Respond to Hallucinations

It is somewhat normal for dementia patients to behave in a way where they think they see, hear, or even believe things that are not there or real.

When someone behaves in a way that you think is irrational or even inappropriate, ridicule of any form is never justified.

When a person is not experiencing reality, it is not critical to make them aware of the true situation.

What the person is feeling is most important.

For a person experiencing, poor lighting, shadows, and even what can be seen as misplaced, and is likely irrational, behavior, provide the following.

“This sounds scary, you are not alone, and I will help you.”

When someone is behaving in an unusual, sudden, and irrational way, especially if they are experiencing hallucinations, they are a cause for concern and medical help must be sought urgently.

What is Sundowning?

For people who are experiencing dementia, the early evening hours are typically the most confusing and the most enervating.

If you’re interacting with someone that is sundowning, it’s best to speak in a quiet voice.

A quiet voice can help reduce background noise since a quiet voice invites silence. During the day, and sometimes during the early evening, background noise can be even more distracting.

If it’s the late evening, it’s best to have all the lights in the house on to avoid the relaxing presence the darkness can bring.

The person sundowning likely has some unmet need.

To meet that need, it is best to not spend too much time explaining the situation to the person to provide comfort.

Common things to say when someone is sundowning is, “I am staying with you,” or “Everything is taken care of.”

Some families may need even more evening support, which may be a reason to consider Overnight Home Care in Pittsburgh  or  24 Hour Live-In Care 

Dementia Care: Issues with Dining

There are many things to consider when dealing with someone that has dementia when it is time to eat.

Dementia can make a person’s cognitive ability to focus and make decisions extremely limited, which can be very frustrating when trying to eat.

The best option may be to remove distractions and bring silence while you bring a simple food item and speak less to give simple instructions to a greater extent.

Be prepared to answer lots of questions. Give the person time, and be ready to determine if they are having any issues swallowing.

Food should not be a subject for pressure or debate.

See a doctor for persistent symptoms of coughing, choking, trouble swallowing, and for unexplained weight loss.

For other available options for Pittsburgh Speech Therapy and Home Health Care , see the following resources.

Final Thoughts

Communicating with a loved one who has dementia requires patience, understanding, and compassion.

Although dementia can change the way a person communicates, your loved one still needs to feel respected, valued, and supported. By using simple words, allowing extra time, reducing distractions, and focusing on their emotions, you can create calmer and more meaningful interactions.

At Confiable Health, we understand the challenges families face while caring for someone with dementia. Our nurse-led team provides compassionate dementia care in Pittsburgh that focuses on safety, comfort, and dignity.

If you need support creating a care plan for your loved one, contact Confiable Health today.

Call: 412-530-3192

Email: Leads@confiablehealth.com

Schedule a Free In-Home Care Assessment

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