Effective Communication Strategies Through the Stages of Dementia
Springwell has remained open and providing services during the COVID19 pandemic, and that includes our regular program of staff development and education. Josh Obeiter, Dementia Ambassador and volunteer trainer recently led an annual remote web-based training for Springwell staff on behalf of the Alzheimer’s Association. The focus was how to communicate effectively with those living with Alzheimer’s or another dementia. For all types of dementia, communication changes take place throughout the course of the disease. Communication is more than the words we say. It is multifaceted and includes body language, tone, and emotion in how we express ourselves. Josh emphasized that the emotional part of the brain is intact until the very end of the disease so while an individual might not understand words, they can feel the emotion we are conveying.
In the early stages, the individual may have difficulty finding words. They may take longer to speak or respond. They may withdraw from conversation and struggle with decision making or problem solving. At this stage, the person can still communicate through language. It is often best to ask directly how to help with communication. Some prefer help when struggling to find a word, while others prefer to be given time to come up with it on their own. Allow plenty of time for conversations and always include the person in conversations that affect them, including planning for their future. Do not have a conversation about them where they can hear it without including them. Be honest, laugh together and stay connected with each other. Remember that body language conveys a lot; don’t let your anxiety about their condition come through in your words.
In middle stages of dementia, individuals often use familiar words or phrases repeatedly. They may easily lose train of thought and will speak less frequently. Some individuals who speak multiple languages may revert to their first language. Communication may occur through behavior more than words. As an example, pacing may indicate boredom.
Some helpful communication strategies at this point include: Always approach them from the front and say who you are and call the person by name. Maintain eye contact and get at eye level if seated or reclining. Avoid criticizing, correcting, and arguing. Pay attention to your tone. Try to join the person’s reality by letting them know you hear their concerns whether they are expressed through words, behavior, or both. “Avoid quizzing the person to generate conversation. Keep conversations basic and positive.” Josh also advised that “this stage has lots of ups and downs; it is helpful for caregivers, family and friends to ‘ride the wave.’” Respond to their emotions with respect and empathy.
If a person with dementia says, “I can’t find my husband,” it is important to acknowledge and address the comment. It may be as simple as “your husband is at work right now.” But if the husband is deceased, the person may be feeling lonely and it is helpful to recognize that emotion and offer support. Visual images are helpful in the middle stages. “Which sweater would you like to wear today?” Show them the sweaters to make the choice easier. Often writing things down is useful because written words may be better understood than verbal. A whiteboard can be a great tool for this.
In the late stages of dementia, the person may only make sounds or speak a few words. They can still hear you and understand what is going on. Help them to feel safe and happy. Be respectful and keep talking to them. It is important to listen for any expressions of pain and try to alleviate it.
All five senses become important for maintaining connection at this stage of the disease. Use sight to connect with art by looking at pictures or photos. Perhaps the person would enjoy painting or drawing with colored pencils. Connect to them with sound by playing familiar music. Often memories from the age 15-25 stay intact so music from that time may make them happy. The gentle tone of your voice reading to them is another way to use the sense of hearing. Aromas they like may bring them comfort. The scent of herbs, spices, flowers or comfort food like chicken soup or apple pie may please them. At this stage, the person may be losing weight and their appetite, so Josh recommends giving them food that brings them joy rather than a strict healthy regimen. Favorite foods, popsicles, flavored drinks, ice cream and pudding may appeal. Touch gives comfort. Examples include holding their hand or brushing their hair.
Josh concluded the training by emphasizing the importance of caregivers taking care of themselves while taking care of someone with dementia. “If you don’t get enough rest, it will be harder for you to be a good caregiver.”
Springwell’s Information and Resources team and The Alzheimer’s Association can help caregivers and their loved ones through this journey. More information is available here.