The Alzheimer’s Society have published some useful tips on communicating with people with dementia, which may be useful to staff in adult social care services.
Before you speak
Make sure you’re in a good place to talk – quiet, with good lighting and without too many distractions (e.g. no radio or TV on in the background).
Get the person’s full attention before you start.
Position yourself where the person can see you as clearly as possible (eg with your face well-lit) and try to be on the same level as the person, rather than standing over them.
Sit close to the person (although not so close you are in their personal space) and make eye contact.
Make sure your body language is open and relaxed.
Have enough time to spend with the person. If you feel rushed or stressed, take some time to calm down.
Think about what you are going to talk about. It may be useful to have an idea for a particular topic ready. You can also use the person’s environment to stimulate topics.
If there is a time of day where the person will be more able to communicate (eg in the morning) 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 ‘bad’ ones.
Make sure any of the person’s other needs are met before you start (eg they’re not hungry or in pain).
How to speak
Speak clearly and calmly.
Speak at a slightly slower pace, and allow time between sentences for the person to process the information and respond. This might seem like an uncomfortable pause to you, but it is important for helping the person to communicate.
Avoid speaking sharply or raising your voice.
Use short, simple sentences.
Try to communicate with the person in a conversational way, not question after question (it can feel like an interrogation).
Don’t talk about the person as if they are not there or talk to them as you would to a young child – be patient and have respect for them.
Try to laugh together about misunderstandings and mistakes – it can help. Humour can help to bring you closer together, and may relieve the pressure. However, be sensitive to the person and don’t laugh at them.
Include the person in conversations with others. This may be easier if you adapt what you say slightly. Being included can help a person with dementia to keep their sense of identity and feel they are valued. It can also help to reduce feelings of exclusion and isolation.
What to say
Try to avoid asking too many questions, or complicated questions. People with dementia can 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.
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.
Ask questions one at a time, and phrase them in a way that allows for a ‘yes’ or ‘no’ answer (eg rather than asking someone what they would like to do, ask if they would like to go for a walk) or in a way that gives the person a choice (eg ‘would you like tea or coffee?’).
Rephrase rather than repeat, if the person doesn’t understand what you’re saying. Use non-verbal communication to help (eg pointing at a picture of someone you are talking about).
If the person becomes tired easily, it may be better to opt for short, regular conversations. As dementia progresses, the person may become confused about what is true and not true. If the person says something you know is not true, try to find ways of steering the conversation around the subject and look for the meaning behind what they are saying, rather than contradicting them directly. For example, if they are saying they need to go to work is it because they want to feel useful, or find a way of being involved and contributing? Could it be that they are not stimulated enough?
Listen carefully to what the person is saying, and offer encouragement.
If you haven’t understood fully, rephrase what you have understood and check to see if you are right. The person’s reaction and body language can be a good indicator of what they’ve understood and how they feel.
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 out for clues. Also pay attention to their body language. The expression on their face and the way they hold themselves can give you clear signals about how they are feeling.
Allow the person plenty of time to respond – it may take them longer to process the information and work out their response. Don’t interrupt the person as it can break the pattern of communication.
If a person is feeling sad, let them express their feelings. Do not dismiss a person’s worries – sometimes the best thing to do is just listen, and show that you are there.
Body language and physical contact
Non-verbal communication is very important for people with dementia, and as their condition progresses it will become one of the main ways the person communicates. You should learn to recognise what a person is communicating through their body language and support them to remain engaged and contribute to their quality of life.
A person with dementia will be able to read your body language. Sudden movements or a tense facial expression may cause upset or distress, and can make communication more difficult.
Make sure that your body language and facial expression match what you are saying.
Never stand too close to someone or stand over them to communicate – it can feel intimidating. Instead, respect the person’s personal space and drop to or below their eye level. This will help the person to feel more in control of the situation.
Use physical contact to communicate your interest and to provide reassurance – don’t underestimate the reassurance you can give by holding the person’s hand or putting your arm around them, if it feels appropriate.
Adult social care services are always looking to improve their ability to communicate with people with dementia. Managers of adult social care services are well advised to bring to the attention of their staff and carers the tips on communicating with people with dementia produced by the Alzheimer’s Society.
Albert Cook BA, MA & Fellow Charted Quality Institute Managing Director Bettal Quality Consultancy