To effectively communicate, we must realize that we are all different in the way we perceive the world and use this understanding as a guide to our communication with others.

Tony Robbins
Motivational Author and Speaker

Communication is a two-way street. In order for communication to be successful, the message sent must be received, understood, and processed before a response is formulated. This must also be done in a way that makes sense to the receiver. A clear understanding of the message sent is hard to achieve when the other person has dementia.

↪ Think about a time when you may have misinterpreted what someone said. Did it result in your having negative feelings such as anger or even fear?

The person with dementia suffers from increasing cognitive decline and memory loss. The message they receive during communication with a caregiver is often blocked by distractions, or seems fragmented and incomplete.

Body language (tone of voice, facial expression, the way we carry ourselves) can send a different message from what we are saying. For instance, a caregiver may be reacting to the thought of having to toilet a patient, and on some level may be angry she has to do it. If the caregiver does not monitor her facial expression or tone of voice, the emotion she feels will show. Upon seeing this, the patient may respond with mistrust, fear, anger, and other negative emotions. The result can be a defensive response to what may have been an offer of assistance. The patient’s attempt to protect the self when frightened or upset is often reported as combative behavior, when in fact it is not.

The caregiver should also recognize that as dementia progresses there are changes in the person’s ability to communicate and express needs. This affects their ability to respond appropriately.

As dementia progresses, these changes include:

• The loss of the ability to find the right word, often describing objects rather than naming them
• The inability to finish sentences or express cohesive thoughts
• The loss of train of thought
• Reverting to language of origin (memory loss beyond the time of learning English)
• The need for longer periods of time to respond

↪ Think about your own style of communication when you work with people who have dementia. What steps do you take to make sure your patient understands you?

The guidelines for good communication skills include:

• Approach the person with dementia from the front or side, Do not startle him.
• Monitor the body language of the person with dementia. Body language can broadcast anger, fear, hostility, approachability, friendliness, and a host of other emotions. If her body language is negative, re-approach at a later time.
• Monitor your own body language, facial expression, and tone of voice to avoid giving mixed messages. Don’t let your personal feelings show.
• Do use positive facial expressions to reinforce your message.
• Introduce yourself each time you approach. Don’t forget that people with dementia have short-term memory and may not recognize you.
• Make sure the light is on your face so the person with dementia can clearly see you and use visual cues to help him understand what you need from him.
• Monitor the environment for distractions that might take away attention, frighten or upset the person with dementia. Turn off the TV or music or move the person to a quiet area.
• If possible, sit next to the person at eye level. Standing above them is intimidating.
• Speak slowly and distinctly in short sentences. Make one point at a time. A sharp voice or rapid speech can also intimidating.
• Take time to explain what you are doing and why. Negative behaviors are usually a reaction to not understanding why something is being done, such as taking medication when the person does not realize they are sick.
• Avoid using pronouns such as him or her. Say the name of the person and their relationship to your patient: “Catherine, your daughter”. . .
• Allow extra time for a response.

It’s important to note that communication is not limited to a verbal exchange and evaluation of body language. All of the senses are used to interpret information about the environment and the people around us. Taste (especially sweet and salty), touch (eg, massage) or smell (eg, aromatherapy) can also be used to convey positive comforting messages, especially in the later stages of dementia.