The Right Communication When Working with People with Dementia
by Monica Heltemes, Occupational Therapist and MindStart OwnerRemember the telephone game we would play as kids? One person would think of a sentence and whisper it to the person next to him. Then, he would whisper it to the person next to him, and so on, until the message had made it all the way around the circle. The last person to hear the message would say it out loud. The outcome was usually a hilarious, erroneous version of the original message.
This is what I imagine is the case for the person with Alzheimer’s. Their hearing is fine. However, even though they interpret some words they hear accurately, other words might be forgotten instantly and still other words might be twisted into other words.
The result might be a garbled message like happens in the telephone game. The result might cause the person increased confusion, uncertainty, frustration, and even anger. On your end, you might not have realized this has happened, and you continue on talking. But you notice the person with dementia is quiet or maybe only nods her head at you.
Or, the outcome that you dread: the person becomes angry at you, defensive, as they seem to have twisted your words into a meaning you did not intend. I witnessed an example of this outcome recently. I overheard a conversation where a caregiver was trying to apologize for a misunderstanding to the person with memory loss. But that person would not hear of it, and he only became more angered.
What was the mistake the caregiver made? She did not start with the apology, but instead started with an explanation of the misunderstanding. The end receiver heard a garbled version of the explanation, became defensive and then upset. He never heard the apology piece. So what can be done to minimize this “telephone game” miscommunication, when working with people with dementia?
- Avoid explanations and rationales. The person with dementia has diminished reasoning abilities, so their reality is different than yours.
- Say it simply and to the point. Less is more, so speak 1 or 2 sentences at a time. Face the person and speak at a slower rate.
- Give them time to process what you have just said before talking again
- Affirm the person’s message to you and do not argue. It is best to validate what the person is saying, regardless of the truth of the statement. So in the example above, the caregiver would have done best to first validate the other person’s point of view (“yes, that would have made me upset, too”) then the apology (“I am sorry for the misunderstanding”).