Conversations with a Loved One with Dementia

This week is National Better Conversations Week.  It’s celebrated every year on Thanksgiving week, as friends and family come together around their tables and enjoy each other’s company.  It’s a time expected to be warm and uplifting.  But when someone at the table is affected by cognitive decline brought on by dementia, that warmth may be stifled by feelings of awkwardness or frustration.Loved ones with dementia still need communication and social interaction.  But the changes in their brains make communication more challenging, and their ways of communicating may change.  The friends and family surrounding that person need to find new strategies for connecting with that person and interpreting the messages they are trying to get across.  Here are some recommendations based on an article from the Social Care Institute for Excellence:

1. Minimize background noise. Distractions from the television, noisy cooking and cleaning devices, or traffic can make it difficult for the person with dementia to focus.  Ask the family around the table to take turns talking, and consider environmental adjustments to reduce background noises.
2. Take it slow and easy. Take deep breaths and relax your body.  Remind yourself to slow the conversation down.  You are likely used to communicating at a much faster pace than the person with dementia can manage.  Adjust to their pace, and don’t be in a hurry.
3. Focus on the person’s feelings. Watch their tone and body language.  Is your loved one relaxed, happy, anxious, frightened, angry?  Do they remember previous interactions with you, or are they responding as if they’ve seen you for the first time that day?  Remember that they have no control over the changes in their brain.  Introduce yourself and patiently explain why you are there each time.  Make sure to moderate your voice so you don’t show any signs of frustration – they will pick up on your feelings as well.
4. Open with warmth and friendliness. Consider your verbal and physical approach before you enter the conversation.  Keep your tone friendly.  If needed, remind the person of your name.  Consider the person’s physical as well as cognitive needs:  do they have visual or hearing impairment that could also impede communication?  Make sure you can be seen and heard clearly.  Try to meet the person at their eye level if they are seated.  Sit nearby and let them grow accustomed to you before striking up conversation if they seem reluctant or withdrawn.
5. Cultivate touch awareness. Many people with dementia are deprived of social contact and are hungry for more.  Others are very sensitive to touch and prefer to avoid it.  Test the waters with a light touch to their shoulder or hand.  If they move away, take your cues from them and use touch sparingly.  If they grasp your hand, reciprocate with touch:  they may find more physical contact reassuring.
6. Identify and name the person’s emotional state. Use your eyes and ears to evaluate your loved one’s emotions.  Listen to their words, but also pay attention to other factors:  tone of voice, facial expressions, body language, respiration rate, or signs of physical discomfort.  Once you have a sense of what they are feeling, go ahead and name it: “You sound sad today,” or “You seem like you’re in a really good mood.”  The person with dementia may not have a very good memory for past events, but they can engage in talking about their present feelings.
7. Come to the table with an open mind. Try to dismiss your preconceived ideas of how the conversation will take shape; instead, take your lead from the person with dementia.  Let them talk about what’s on their mind, and avoid dominating the conversation or rapidly switching topics.
8. Be prepared to engage in creative interpretation. The words that come out of your loved one’s mouth may not make literal sense but may symbolically represent their thoughts or feelings.  For example, if they express a need for their mother or deceased spouse, they might be seeking the comfort, closeness, and stability those people provided in the past.  Interpreting the conversation may be a little like assembling a puzzle of the person’s life.  They may mix the past and present together.  Learn as much as you can about the person’s life story to help piece together what they mean.
9. Keep the conversation going. Stick to slow and simple conversation.  Use visual aids if appropriate – for example, if you are talking about medication, have the medicine bottle on the table.  Repeat the person’s name frequently to help maintain the connection and concentration.  Confirm that you understand what they are telling you.  If you must correct a mistake, take a gentle approach and avoid an overly-assertive tone.
10. Know when and how to wrap it up. Watch for signs that the person is becoming fatigued, and take a break when they need it.  It’s better to have short, frequent conversations rather than long, infrequent ones.  Don’t leave the room or the person’s home suddenly; make sure you have their attention, tell them how much you’ve enjoyed your time together, and make it clear that you are departing so they are not confused.  Make sure you end the conversation on a positive note so that they will feel good afterward.  The feelings from your interaction are likely to outlast their memory of what was discussed.

It’s normal to feel awkward or to be unsure of what to discuss with your loved one with dementia, but the patterns become more familiar with practice.  If you are unsure of what to talk about, consider some of these conversation starters.  Your interactions with your loved one are meaningful to them and will help prevent them from feeling lonely and isolated.  Even if your first conversation doesn’t feel successful, keep trying different strategies until you find your rhythm.