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Communication in Dementia
Individuals with dementia may have difficulty concentrating and processing complex, abstract information. These challenges extend to organizing their thoughts and the words they wish to convey.[1] This can result in difficulties expressing themselves, frequent repetition, and difficulty maintaining a coherent conversation.
As their condition progresses, individuals with dementia often engage in fewer verbal interactions. Instead, they might increasingly rely on nonverbal cues, such as sounds and gestures, to bridge the gap in communication.[2]Gradual cognitive decline may also cause individuals with dementia to revert to their native language and forget other languages they have learned.
Given these difficulties, caregivers may need to make adjustments to how they communicate with individuals with dementia. Here are some communication tips for caregivers:[3], [4], [5], [6]
1. Get the individual’s attention
- Begin by addressing the individual and introducing yourself (e.g., “Mom, I am your daughter, [Name]“).
- Communicate face-to-face, maintain eye contact and address them by their name.
- Consider using gentle physical touch, such as holding the individual’s hand.
- Accommodate any hearing or vision needs that the individual may have.
- Maintain a moderate volume, speak at a slower pace, and use a calm and unhurried tone.
- Be patient as individuals with dementia may need more time to process the conversation and formulate responses.
2. Minimize distractions
- Keep the environment quiet. If the individual is watching TV, lower the volume or, with the individual’s consent, turn it off.
- Ensure adequate lighting in the environment.
3. Be direct and specific to avoid confusion
- Use short and simple sentences to facilitate comprehension.
- Avoid abstract concepts. Focus on easily understandable language (e.g., “Is it time to eat now?” instead of “Are you hungry?“).
- Focus on a single concept at a time to prevent overwhelming the individual.
- Repeat and paraphrase when necessary to enhance understanding.
- Use body language to supplement verbal communication.
- When giving directions or instructions, provide step-by-step guidance.
- When individuals with dementia struggle to answer questions, ask yes or no questions or multiple-choice questions instead of open-ended ones (e.g., “Would you like to eat an apple?” instead of “What fruit do you want?“).
- Avoid having a long conversation. If a longer conversation is needed, let the individual take a break, for example, by having a sip of water.
- Shift the focus during conversations and redirect attention away from topics that may cause anxiety.
4. Form connections
- Form connections by focusing on the interests, skills, and talents that the individual possesses.
- Avoid criticizing and correcting mistakes. Instead, provide encouragement and praise to boost their confidence.
- Maintain focused listening by providing appropriate responses, such as nodding and encouraging the individual to express themselves.
Useful Resources
- Alzheimer Society of Canada: Communicating with people living with dementia
- Alzheimer’s Association: Effective communication strategies
- National Institute on Aging: Alzheimer’s Caregiving: Changes in Communication Skills
- Hong Kong Jockey Club Centre for Positive Ageing: Communication
- The Hong Kong Alzheimer’s Disease Association: Communication (Chinese)
- Alzheimer Society of Canada: Communication tips for dementia (Chinese)
- Elderly Health Service, Department of Health, Hong Kong SAR Government: Dementia – communication skills
- Hong Kong Jockey Club Cadenza e-Tools for Elderly Care: “Vision, Hearing & Speech” v12 – Skills for communicating with older adults with dementia (Cantonese video with English and Chinese subtitles)
Communication in Dementia
Individuals with dementia may have difficulty concentrating and processing complex, abstract information. These challenges extend to organizing their thoughts and the words they wish to convey.[1] This can result in difficulties expressing themselves, frequent repetition, and difficulty maintaining a coherent conversation.
As their condition progresses, individuals with dementia often engage in fewer verbal interactions. Instead, they might increasingly rely on nonverbal cues, such as sounds and gestures, to bridge the gap in communication.[2]Gradual cognitive decline may also cause individuals with dementia to revert to their native language and forget other languages they have learned.
Given these difficulties, caregivers may need to make adjustments to how they communicate with individuals with dementia. Here are some communication tips for caregivers:[3], [4], [5], [6]
1. Get the individual’s attention
- Begin by addressing the individual and introducing yourself (e.g., “Mom, I am your daughter, [Name]“).
- Communicate face-to-face, maintain eye contact and address them by their name.
- Consider using gentle physical touch, such as holding the individual’s hand.
- Accommodate any hearing or vision needs that the individual may have.
- Maintain a moderate volume, speak at a slower pace, and use a calm and unhurried tone.
- Be patient as individuals with dementia may need more time to process the conversation and formulate responses.
2. Minimize distractions
- Keep the environment quiet. If the individual is watching TV, lower the volume or, with the individual’s consent, turn it off.
- Ensure adequate lighting in the environment.
3. Be direct and specific to avoid confusion
- Use short and simple sentences to facilitate comprehension.
- Avoid abstract concepts. Focus on easily understandable language (e.g., “Is it time to eat now?” instead of “Are you hungry?“).
- Focus on a single concept at a time to prevent overwhelming the individual.
- Repeat and paraphrase when necessary to enhance understanding.
- Use body language to supplement verbal communication.
- When giving directions or instructions, provide step-by-step guidance.
- When individuals with dementia struggle to answer questions, ask yes or no questions or multiple-choice questions instead of open-ended ones (e.g., “Would you like to eat an apple?” instead of “What fruit do you want?“).
- Avoid having a long conversation. If a longer conversation is needed, let the individual take a break, for example, by having a sip of water.
- Shift the focus during conversations and redirect attention away from topics that may cause anxiety.
4. Form connections
- Form connections by focusing on the interests, skills, and talents that the individual possesses.
- Avoid criticizing and correcting mistakes. Instead, provide encouragement and praise to boost their confidence.
- Maintain focused listening by providing appropriate responses, such as nodding and encouraging the individual to express themselves.
Useful Resources
- Alzheimer Society of Canada: Communicating with people living with dementia
- Alzheimer’s Association: Effective communication strategies
- National Institute on Aging: Alzheimer’s Caregiving: Changes in Communication Skills
- Hong Kong Jockey Club Centre for Positive Ageing: Communication
- The Hong Kong Alzheimer’s Disease Association: Communication (Chinese)
- Alzheimer Society of Canada: Communication tips for dementia (Chinese)
- Elderly Health Service, Department of Health, Hong Kong SAR Government: Dementia – communication skills
- Hong Kong Jockey Club Cadenza e-Tools for Elderly Care: “Vision, Hearing & Speech” v12 – Skills for communicating with older adults with dementia (Cantonese video with English and Chinese subtitles)
Responsive Behaviours in Dementia
Individuals with dementia may face challenges expressing themselves due to cognitive decline. Difficulties in expressing needs can lead to responsive behaviours.
Examples of responsive behaviours include aggression, repeated behaviours, hallucinations, and agitation.[7], [8], [9], [10] These responsive behaviours may be a way for individuals to express loneliness, hunger, or insecurity about environmental changes.
Responsive behaviours can also result from an individual’s dementia symptoms. Delusions or paranoia are symptoms that cause individuals to misunderstand their real-world experiences. For instance, they may believe that someone has stolen their belongings or drugged them, even though it is not true. Individuals with dementia may exhibit responsive behaviours in reaction to these misinterpretations.
Responsive behaviours are challenging because they can interfere with an individual’s daily activities, causing distress for caregivers and increasing caregiver burden. Over time, this may impact relationship quality and the well-being of both the caregiver and the individual with dementia.
Therefore, caregivers should try to understand the underlying causes for their loved one’s responsive behaviours, minimize triggers, and offer appropriate responses to reduce the risk of misunderstandings escalating to confrontations. Proper strategies can help enhance the quality of life for both individuals with dementia and their caregivers.
Responsive Behaviours in Dementia
Individuals with dementia may face challenges expressing themselves due to cognitive decline. Difficulties in expressing needs can lead to responsive behaviours.
Examples of responsive behaviours include aggression, repeated behaviours, hallucinations, and agitation.[7], [8], [9], [10] These responsive behaviours may be a way for individuals to express loneliness, hunger, or insecurity about environmental changes.
Responsive behaviours can also result from an individual’s dementia symptoms. Delusions or paranoia are symptoms that cause individuals to misunderstand their real-world experiences. For instance, they may believe that someone has stolen their belongings or drugged them, even though it is not true. Individuals with dementia may exhibit responsive behaviours in reaction to these misinterpretations.
Responsive behaviours are challenging because they can interfere with an individual’s daily activities, causing distress for caregivers and increasing caregiver burden. Over time, this may impact relationship quality and the well-being of both the caregiver and the individual with dementia.
Therefore, caregivers should try to understand the underlying causes for their loved one’s responsive behaviours, minimize triggers, and offer appropriate responses to reduce the risk of misunderstandings escalating to confrontations. Proper strategies can help enhance the quality of life for both individuals with dementia and their caregivers.
Tips for Caregivers in Managing
Responsive Behaviours
Immediate actions:
- Listen patiently: Be patient and try to understand the emotions and feelings behind their words and behaviours.
- Validate feelings: Demonstrate acceptance and respect for their emotions and feelings. Try to alleviate their distress by addressing their concerns. Show that their feelings are valid and respected. For example, say, “I’m sorry you are feeling upset”, or “I’m here with you”.
- Stay calm and avoid arguing: Avoid confrontation or disagreement with their feelings. For example, if individuals believe someone has stolen their wallet, avoid arguing with them or telling them that it is not real, as this can escalate negative
- Provide distractions: Alleviate strong emotions by offering distractions to shift their focus. Examples may include listening to their favourite music, eating their favorite food, or having a walk together.
- Identify the problem: Look beyond the words or behaviours displayed and try to identify the underlying feelings they may be trying to express.
- Remove or minimize triggers: Reduce noise, light, shadows, or even objects that may trigger strong emotions and result in responsive behaviours.
- Address unmet needs: Strong emotions may arise due to unmet needs such as hunger, pain, or loneliness. Addressing these needs can help manage responsive behaviours.
Long-term actions:
- Record the details: Caregivers can document information, such as the time, frequency, duration, and location when responsivebehaviours take place. Caregivers may be able to identify patterns and triggers by analyzing these records and details. Discussing this information with healthcare professionals can also help identify strategies to manage these behaviours.
- Establish a regular routine: Maintaining regular daily routines can reduce theanxiety and insecurity that individuals with dementia experience when faced with changes.
- Avoid over-stimulation: Create a dementia-friendly home environment by reducing loud noise and dark shadows that can trigger responsive
- Participate in non-pharmacological interventions: Assist individuals with dementia to engage in activities such as music therapy and art therapy to improve their responsive behaviours. Learn more about Interventions for Dementia.
- Review medications with medical professionals: Consult with healthcare professionals, such as the individual’s family doctor, to review medications, understand side effects, and see if other medications can help manage responsive behaviours.
Useful Resources
- Alzheimer Society Ontario: Shifting Focus – a guide to understanding dementia behaviour
- Elderly Health Service, Department of Health, Hong Kong SAR Government: Dementia – Managing behavioural problems
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong: Behavioural and psychological symptoms of dementia (BPSD) (Chinese)
- Caritas Elderly Centre – Ngau Tau Kok: Dementia – Behavioural and psychological symptoms of dementia (BPSD) (Cantonese video with Chinese subtitles)
Learn more about repetitive behaviours in dementia:
- Alzheimer Society of Canada: Repetitive behaviours
- Alzheimer’s Association: Repetition
- UCLA Health: Caregiver Training: Repetitive Behaviors | UCLA Alzheimer’s and Dementia Care Program
- Social Services, Yan Oi Tong, Hong Kong: “Disease or not”: Effective communication with older adults living with dementia series– EP7 “Repetitive behaviours” (Cantonese video with Chinese subtitles)
Learn more about anxiety and agitation in dementia:
- Alzheimer’s Association: Anxiety and Agitation
- National Institutes of Health: Coping with Agitation and Aggression in Alzheimer’s Disease
- UCLA Health: Caregiver Training: Agitation and Anxiety – UCLA Alzheimer’s and Dementia Care Program
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong: Coping with agitation and aggressive behaviour (Cantonese video with Chinese subtitles)
Learn more about hallucinations or delusions in dementia:
- Island Health: Dementia Caregiving: Hallucinations or Delusions (video)
- Social Services, Yan Oi Tong, Hong Kong: “Disease or not”: Effective communication with older adults living with dementia series – EP3 “Hallucination, auditory hallucination 1” (Cantonese video with Chinese subtitles)
- Social Services, Yan Oi Tong, Hong Kong: “Disease or not”: Effective communication with older adults living with dementia series – EP4 “Hallucination, auditory hallucination 2” (Cantonese video with Chinese subtitles)
Learn more about sundowning (a state of confusion occurring in the late afternoon and lasting into the night[1]):
Tips for Caregivers in Managing Responsive Behaviours
Immediate actions:
- Listen patiently: Be patient and try to understand the emotions and feelings behind their words and behaviours.
- Validate feelings: Demonstrate acceptance and respect for their emotions and feelings. Try to alleviate their distress by addressing their concerns. Show that their feelings are valid and respected. For example, say, “I’m sorry you are feeling upset”, or “I’m here with you”.
- Stay calm and avoid arguing: Avoid confrontation or disagreement with their feelings. For example, if individuals believe someone has stolen their wallet, avoid arguing with them or telling them that it is not real, as this can escalate negative
- Provide distractions: Alleviate strong emotions by offering distractions to shift their focus. Examples may include listening to their favourite music, eating their favorite food, or having a walk together.
- Identify the problem: Look beyond the words or behaviours displayed and try to identify the underlying feelings they may be trying to express.
- Remove or minimize triggers: Reduce noise, light, shadows, or even objects that may trigger strong emotions and result in responsive behaviours.
- Address unmet needs: Strong emotions may arise due to unmet needs such as hunger, pain, or loneliness. Addressing these needs can help manage responsive behaviours.
Long-term actions:
- Record the details: Caregivers can document information, such as the time, frequency, duration, and location when responsivebehaviours take place. Caregivers may be able to identify patterns and triggers by analyzing these records and details. Discussing this information with healthcare professionals can also help identify strategies to manage these behaviours.
- Establish a regular routine: Maintaining regular daily routines can reduce theanxiety and insecurity that individuals with dementia experience when faced with changes.
- Avoid over-stimulation: Create a dementia-friendly home environment by reducing loud noise and dark shadows that can trigger responsive
- Participate in non-pharmacological interventions: Assist individuals with dementia to engage in activities such as music therapy and art therapy to improve their responsive behaviours. Learn more about Interventions for Dementia.
- Review medications with medical professionals: Consult with healthcare professionals, such as the individual’s family doctor, to review medications, understand side effects, and see if other medications can help manage responsive behaviours.
Useful Resources
- Alzheimer Society Ontario: Shifting Focus – a guide to understanding dementia behaviour
- Elderly Health Service, Department of Health, Hong Kong SAR Government: Dementia – Managing behavioural problems
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong: Behavioural and psychological symptoms of dementia (BPSD) (Chinese)
- Caritas Elderly Centre – Ngau Tau Kok: Dementia – Behavioural and psychological symptoms of dementia (BPSD) (Cantonese video with Chinese subtitles)
Learn more about repetitive behaviours in dementia:
- Alzheimer Society of Canada: Repetitive behaviours
- Alzheimer’s Association: Repetition
- UCLA Health: Caregiver Training: Repetitive Behaviors | UCLA Alzheimer’s and Dementia Care Program
- Social Services, Yan Oi Tong, Hong Kong: “Disease or not”: Effective communication with older adults living with dementia series– EP7 “Repetitive behaviours” (Cantonese video with Chinese subtitles)
Learn more about anxiety and agitation in dementia:
- Alzheimer’s Association: Anxiety and Agitation
- National Institutes of Health: Coping with Agitation and Aggression in Alzheimer’s Disease
- UCLA Health: Caregiver Training: Agitation and Anxiety – UCLA Alzheimer’s and Dementia Care Program
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong: Coping with agitation and aggressive behaviour (Cantonese video with Chinese subtitles)
Learn more about hallucinations or delusions in dementia:
- Island Health: Dementia Caregiving: Hallucinations or Delusions (video)
- Social Services, Yan Oi Tong, Hong Kong: “Disease or not”: Effective communication with older adults living with dementia series – EP3 “Hallucination, auditory hallucination 1” (Cantonese video with Chinese subtitles)
- Social Services, Yan Oi Tong, Hong Kong: “Disease or not”: Effective communication with older adults living with dementia series – EP4 “Hallucination, auditory hallucination 2” (Cantonese video with Chinese subtitles)
Learn more about sundowning (a state of confusion occurring in the late afternoon and lasting into the night[1]):
References
[1] Wray, A. (2021). Why dementia makes communication difficult: a guide to better outcomes. Jessica Kingsley Publishers. (English)
[2] Wray, A. (2020). The Dynamics of Dementia Communication. Oxford University Press. https://doi.org/10.1093/oso/9780190917807.001.0001 (English)
[3] National Institute on Aging. (2017). Alzheimer’s Caregiving: Changes in Communication Skills. https://www.nia.nih.gov/health/alzheimers-caregiving-changes-communication-skills
[4] Alzheimer’s Society. (2022). Understanding and supporting a person with dementia. https://www.alzheimers.org.uk/sites/default/files/2022-05/524LP-understanding-and-supporting-a-person-with-dementia.pdf
[5] Alzheimer’s Society. (2020). Communicating.
https://www.alzheimers.org.uk/sites/default/files/2019-09/500lp-communicating-190521.pdf
[6] Alzheimer Society. (2023). Communicating with people living with dementia. https://alzheimer.ca/en/help-support/i-have-friend-or-family-member-who-lives-dementia/communicating-people-living-dementia
[7] Alzheimer’s Society. (2019). “Dementia and Responsive Behaviours”.
[8] Better Health Channel (2014). Dementia – behaviour changes. Retrieved on 15 Aug 2023 from https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/dementia-behaviour-changes
[9] Andrews, G. J. (2006). Managing challenging behaviour in dementia. BMJ, 332(7544), 741–741. https://doi.org/10.1136/bmj.332.7544.741
[10] Alzheimer Society of Canada (2016). Shifting Focus – a guide to understanding dementia behaviour. https://brainxchange.ca/Public/Files/Behaviour/ShiftingFocusBooklet.aspx
[11] Mayo Clinic. (2022). Sundowning: Late-day Confusion. https://www.mayoclinic.org/diseases-conditions/alzheimers-disease/expert-answers/sundowning/faq-20058511
