Conversations with Dementia

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Last week I discussed ways that language could be affected by Alzheimer’s disease. This week, let’s look into six best practices when you are conversing with someone living with dementia.

1. Patience is probably the key skill that you can bring to these conversations. It’s crucial to wait, giving the person time to retrieve a word or a thought. Prompting might help, but do so gently, suggesting the possible word with a question. As the disease progresses, normal exchange in conversation is increasingly difficult. Your loved one may lose their train of thought, halting the dialogue, or they may abruptly change topics as they cannot hold onto a sustained thought.

2. Don’t presume to speak for them, even though it is often the easiest approach. You might ask their permission to do so, saying, “May I answer that question for you?” They might be relieved to allow this small kindness. At a lacrosse game in which one of our daughters was playing, a male parent of one of her teammates approached Harvey and began talking to him. This was about one year into his Alzheimer’s. Harvey tried to reply, but I could tell that he was having trouble. I tried to be seamless and gentle as I took over the conversation from our side. After the parent left, Harvey turned to me with relief in his eyes and said, “Thank you!” Further in the disease, you will need to shoulder ever more of the burden of conversations.

3. Physically prepare the space for the conversation if possible. This is best done by minimizing distractions so that their full attention is on your conversation. A blaring TV will only derail interaction. It is best if you can approach the person with dementia one-on-one, face to face, and at eye level. If you begin speaking while you are out of their direct line of vision, your loved one will likely be confused as to who is speaking. They may not even realize that they are being spoken to if they can’t see you. And it’s uncanny how helpful reading lips can be, even when we don’t realize that’s what we’re doing.

4. Address them by name, and introduce yourself, even if you are a close family member. You may need to start addressing them by their name rather than their pet name as they may not know themselves as “Mom” for instance. You may need to call yourself by name, followed by your relationship. For example, “Hello, William. It’s good to see you. I’m Laura, your daughter.” They may reply, indignantly, “I know who you are!” That might be true, but it may be a bluster to cover up confusion. And please don’t ask them to remember who you are!

5. Speak simply and slowly with short sentences and simple words. Your loved one may not be able to follow a string of sentences with multi-syllable words. Pause often to allow the meaning of your words to sink in. If they ask you to repeat something, try to use the exact same words. I use to try rephrasing something that I had said, thinking that a new way of saying it might click for Harvey. However, rephrasing can be confusing because they might be trying to comprehend what you just said, but now you’re throwing new words at them.

6. Remember that your body language conveys a message too. They may not understand your words, but they can understand crossed arms and a scowl. Better still, they will understand a comforting hand on their shoulder, a smile on your face, and a gentle look in your eyes far better than a sincerely spoken sentiment. And be mindful of THEIR body language. If they seem tired, sad, or angry, take a break from the interaction.

Later in the disease, a two-way conversation is not so important. Your loved one will gain comfort from just being near you, and from hearing your voice, even if you just rattle on.

Most importantly, be patient, reassuring, and supportive.