Which of the following techniques should you use when communicating with an individual with dementia

Índice Show

Before you communicate
Making sure the person is comfortable
Preparing to communicate with a person with dementia
Things to consider about conversation topics
Tips for listening to a person with dementia
Supporting the person to express themselves
How to communicate
Ways to communicate with a person with dementia
How to pace conversations
Things to consider about body language
What to communicate
Tips for asking questions
What to do if the person has difficulty understanding
How to adapt your communication style
Three communication techniques to try
1. Reality Orientation
2. Validation Therapy
3. Reminiscence Therapy

These tips apply to however the person usually communicates, for example speaking English or signing British Sign Language.

Every person’s experience of dementia is unique, so not every tip may be helpful to the person you care for. Use the tips that you feel will improve communication between you.

Before you communicate

Making sure the person is comfortable

Make sure you’re in a good place to communicate. Ideally it will be quiet and calm, with good lighting. Busy environments can make it especially difficult for a person with dementia to concentrate on the conversation, so turn off distractions such as the radio or TV.
If there is a time of day where the person is able to communicate more clearly, try to use this time to ask any questions or talk about anything you need to.
Make the most of ‘good’ days and find ways to adapt on more difficult ones.
Make sure any of the person’s other needs are met before you start – for example, ensuring they are not in pain or hungry.

Preparing to communicate with a person with dementia

Think about how you might feel if you struggled to communicate, and what would help.
Plan enough time to spend with the person. If you feel rushed or stressed, take some time to become calmer beforehand.
Think about previous conversations you have had with the person and what helped you to communicate well then.
If the person has begun to communicate using the first language they learned, and you do not speak it, consider arranging for family members or friends who also speak the language to be there with you. If the person prefers reading, try using translated written materials. A translation or interpretation app on a smart phone or tablet can translate between you if you don’t speak the same language. If you need an interpreter, speak to your local authority, the person’s care home, or an organisation such as the Institute of Translation and Interpreting.
Get the person’s full attention before you start.

Things to consider about conversation topics

Think about what you are going to talk about. It may be useful to have an idea for a particular topic ready.
If you are not sure what to talk about, you can use the person’s environment to help – anything that they can see, hear or touch might be of interest.

Listening

Tips for listening to a person with dementia

Listen carefully to what the person is saying. Offer encouragement both verbally and non-verbally, for example by making eye contact and nodding. This ‘active listening’ can help improve communication.
The person’s body language can show a lot about their emotions. The expression on their face and the way they hold themselves can give you clear signals about how they are feeling when they communicate.
If you haven’t fully understood what the person has said, ask them to repeat it. If you are still unclear, rephrase their answer to check your understanding of what they meant.
If the person with dementia has difficulty finding the right word or finishing a sentence, ask them to explain it in a different way. Listen and look out for clues. If they cannot find the word for a particular object, ask them to describe it instead.

Supporting the person to express themselves

Allow the person plenty of time to respond – it may take them longer to process the information and work out their response.
Try not to interrupt the person – even to help them find a word – as it can break the pattern of communication.
If the person is upset, let them express their feelings. Allow them the time that they need, and try not to dismiss their worries – sometimes the best thing to do is just listen, and show that you are there.

How to communicate

Ways to communicate with a person with dementia

Communicate clearly and calmly.
Use short, simple sentences.
Don’t talk to the person as you would to a child – be patient and have respect for them.
Try to communicate with the person in a conversational way, rather than asking question after question which may feel quite tiring or intimidating.
Include the person in conversations with others. It is important not to speak as though they are not there. Being included can help them to keep their sense of identity and know they are valued. It can also help them to feel less excluded or isolated.
If the person becomes tired easily, then short, regular conversations may be better.
Avoid speaking sharply or raising your voice.

How to pace conversations

Go at a slightly slower pace than usual if the person is struggling to follow you.
Allow time between sentences for the person to process the information and respond. These pauses might feel uncomfortable if they become quite long, but it is important to give the person time to respond.
Try to let the person complete their own sentences, and try not to be too quick to assume you know what they are trying to say.

Things to consider about body language

Stand or sit where the person can see and hear you as clearly as possible – usually this will be in front of them, and with your face well-lit. Try to be at eye-level with them, rather than standing over them.
Be as close to the person as is comfortable for you both, so that you can clearly hear each other, and make eye contact as you would with anyone.
Prompts can help, for instance pointing at a photo of someone or encouraging the person to hold and interact with an object you are talking about.
Try to make sure your body language is open and relaxed.

What to communicate

Tips for asking questions

Try to avoid asking too many questions, or asking complicated questions. The person may become frustrated or withdrawn if they can’t find the answer.
Try to stick to one idea at a time. Giving someone a choice is important, but too many options can be confusing and frustrating.
Phrase questions in a way that allows for a simple answer. For example, rather than asking someone what they would like to drink, ask if they would like tea or coffee. Questions with a ‘yes’ or ‘no’ answer are easier to answer.

What to do if the person has difficulty understanding

If the person doesn’t understand what you’re saying even after you repeat it, try saying it in a slightly different way instead.
If the person is finding it hard to understand, consider breaking down what you’re saying into smaller chunks so that it is more manageable.
Try to laugh together about misunderstandings and mistakes. Humour can help to relieve tension and bring you closer together. Make sure the person doesn’t feel you are laughing at them.

Read our blog post to find out seven things not to say to somebody living with dementia.

What not to say

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Did you know that just 7% of communication is the words we use? The rest is body language and tone of voice. Even if a person with dementia cannot follow what you’re saying, they can still pick up on these non-verbal cues – and that is why calm, conscious communication is so important when you are caring for or spending time with someone who has dementia.

These techniques will help you to communicate in ways that will have a positive effect on how you interact with people with dementia.

The rewards are well worth the effort too, as good communication is an important part of maintaining your bond with a person living with dementia and upholding their quality of life.

How to adapt your communication style

It can take time to adjust the way you communicate, especially when you’re with a loved one who you have known for many years, or even your whole life.

When caring for someone with dementia, being patient, calm and clear is important for two main reasons:

Progressive memory loss impacts their ability to organise and express their thoughts
Recent memory loss causes the past to merge with the present, which creates confusion

The way you communicate can help to alleviate the feelings of stress and frustration that a person with dementia experiences in these situations.

As more research is being conducted into dementia, effective communication techniques are being validated. But before we dive into those, let’s first look at the general dos and don’ts of communicating to someone with dementia.

What not to do when communicating to someone with dementia

Speak over loud background noise such as TV or radio.
Communicate when you are out of their eyesight.
Ask multiple questions after each other.
Use negative body language or a condescending tone of voice.
Argue or raise your voice.
Talk about the person as though they aren’t there.

What you should do when communicating to someone with dementia

Remain calm and speak in a gentle, matter of fact way.
Use a respectful tone of voice.
Try to maintain eye contact.
Focus on one idea or question at a time.
When asking questions, phrase them for simple yes or no responses (e.g. ‘Would you like roast chicken for dinner?’ instead of ‘What would you like for dinner?’).
Allow plenty of time for the person to process what you have said.
Try to put places and people into context (e.g. ‘your daughter Kate’ or ‘your hometown Cairns’).
Use body language, hand gestures and facial expressions to explain something.
Demonstrate activities you would like the person to engage in.
Emphasise what the person can do, rather than what they can’t.
Use gentle touch on the person’s hand or shoulder, if appropriate.

Irregular routines and inconsistent communication styles among family and carers can also create confusion, so aim for as much consistency as possible. Dementia Australia has more insights on maintaining positive communication, including a helpful series of tips provided by a woman living with dementia.

Also remember that it’s much harder to maintain positive, calm communication if you aren’t taking care of yourself. As a carer, friend or family member, your own self-care is important too.

Three communication techniques to try

Now that you have an overarching understanding of the general rules of communication, here are three techniques you can try. You may already be doing some of these things intuitively and, if so, well done.

When trying these techniques, the general communication tips above still apply.

1. Reality Orientation

Suitable for: Alleviating disorientation and confusion

This technique works best in the early stages of dementia, when the concept of time and date is still comprehensible. It works by using a tool like a reality board (explained below) to bring a disorientated or confused person back to their present reality.

Reality Orientation in practice

A reality board is a great tool for Reality Orientation. Each day, write important information on a whiteboard or noticeboard, such as the date, day of the week, weather and upcoming activities for the day or week, such as visitors and appointments. When the person with dementia becomes disorientated or confused, use the reality board to re-orientate them to the present by gently bringing awareness to who they are, where they are, and the present time and/or date.

2. Validation Therapy

Suitable for: Building trust and a sense of security

Feeling confused is an overwhelming situation for a person with dementia, and it can be difficult to know how you can be of help when this happens. Validation Therapy is best used for someone who has substantial short-term memory loss and can no longer understand the present.

In this situation, a person with dementia goes in and out of the past and present, and it can feel wrong to allow them to ‘live’ in the past. However, when you enter into their perceived reality, you reduce conflict and this builds trust and security. You do this by acknowledging the person’s view of reality, listening and asking questions.

Validation Therapy in practice

People with dementia will often return to the past and do not always have the cognitive ability to come back to the present. For example, they may think they’re waiting for a spouse to return home from a job they held many decades ago. When this happens, simply acknowledge their thoughts about what they perceive to be happening. This approach avoids perpetuating any feelings of frustration and low self-esteem.

3. Reminiscence Therapy

Suitable for: Reducing stress and building strong emotional bonds

At every stage of dementia, positive experiences are an important part of maintaining quality of life. Reviewing the past is enjoyable for most people with dementia and is a beneficial communication therapy, as it gives them a feeling of value, belonging and peace.

Participating in this activity also builds deeper relationships, but remember to be gentle and light (something that is more difficult when you have been heavily invested in that person’s life).

Reminiscence Therapy in practice

There are many ways to apply ReminiscenceTheory and your approach should be tailored to the individual life experiences and interests of the person you are caring for. Each tactic should be performed individually to avoid confusion.

Common tactics include:

Looking through family photo albums.
Creating a scrapbook organised into different periods of life, such as childhood, marriage, family, holidays and career.
Discussing a favourite item of clothing, or the history of a sentimental ornament or trinket.
Listening to familiar songs and singing along or discussing the memories they trigger.
Planning activities the person previously enjoyed, such as painting or gardening.

It’s important for everyone to understand how to communicate with someone who has dementia, with initiatives like dementia-friendly communities showing the benefits of a community-wide approach.

For more practical information on caring for someone with dementia, see our free Dementia Care Guide, which has been created specifically for carers and families. It includes tips for managing behavioural changes, planning activities and accessing services that can assist you. Or if you require in-home assistance caring for someone with dementia in Australia, see our approach to dementia care.