How to speak to someone living with Alzheimer’s Disease

How to help someone with dementia - support someone with dementia

Alzheimer’s Disease is one of the most common dementias, contributing to about 60% of dementia cases worldwide. Word finding and language difficulties are some of the first changes seen in early Alzheimer’s Disease. As a result, many people living with Alzheimer’s-type dementia struggle to feel understood or communicate their needs. Caregivers also commonly struggle to speak with people living with Alzheimer’s Disease. This can produce strong emotions, such as frustration and anxiety.

You may be looking to help your loved one feel understood or even find yourself struggling to communicate with them. That is why we’ve developed this article.

Shutting down and pushing away: the default stance

Many people assume that people ‘should’ be welcoming and pleasant when interacting with strangers, and these values extend to people living with Alzheimer’s Disease. However, for many people living with memory loss or cognitive limitations, social interactions are some of their most stressful and distressing experiences. People living with Alzheimer’s Disease have come to learn that the safest social interactions involve some distance from others. For example, they might prefer ‘small talk’ where no meaningful questions are asked of them in a very time-limited interactions.

A person living with dementia is likely to ‘seek safety’ in communication as a default stance for speaking with others, producing both benefits and consequences for the person living with dementia:

BenefitsConsequences
Feels in control of social engagement.Experiences stress from trying to control other people’s actions.
Creates a ‘safe distance’ for communication.Feels they must ‘push people away’ from them.
Limits the number of social interactions.More negative emotions from arguing with and distancing from other people.
Avoids difficult or invasive questions which they may not understand.Other people do not come to understand their needs.
Some benefits and consequences of rejecting others when living with Alzheimer’s Disease.

6 strategies for speaking to someone with Alzheimer’s Disease

Use a ‘Grand Invitation’ to shift emotions and attention to you.

STEP 1

It takes time to shift attention to new people and tasks. In the context of Alzheimer’s Disease, it can take even longer to shift attention. People living with dementia often require grand gestures —like a large and sweeping wave — to notice new people in their environment.

Furthermore, most people living with Alzheimer’s Disease are constantly searching for clues that they might ‘know’ the person. Unfamiliar faces are often treated with suspicion. A distant wave ‘hello’ is good. But, a large and sweeping wave as you enthusiastically call out the other person’s name will immediately suggest some level of familiarity.

Speak on their level… literally.

STEP 2

Speaking at ‘eye level’ with persons living with dementia is essential. For example, consider also sitting down in a chair if they are sitting. Perhaps you might kneel or crouch down if the other person is much shorter than you or sitting in a wheelchair. These actions help the person with Alzheimer’s Disease maintain a safe distance while also feeling respected and heard.

You should, however, avoid standing in front of the person’s path of travel. It is suggested to instead use a ‘side-by-side’ approach instead to help the person living with Alzheimer’s Disease feel like they are speaking to a friend in casual conversation. Standing in front of someone may feel like you are arguing with them, or even blocking their path of movement. This can make the conversation feel distressing for a person living with dementia.

Accept (and anticipate) rejection.

STEP 3

Whatever you do, don’t take rejection personally. Everyone seeks safety in social interactions. Unfamiliar faces are especially likely to raise suspicion and cause stress for people living with dementia. You should anticipate that the most logical response to your ‘grand invitation’ will be rejection, no matter how great it is.

Someone coping with a constant state of confusion works hard to protect their personal space and possessions from strangers. Consider giving more space than usual to provide them with a sense of safety. In light of hostility or rejection, your best response is to be accepting of the other person’s right to reject your presence. You can openly acknowledge some of the stress introduced through your interactions, and apologize for the experience. Many people choose to exit early, and re-approach later.

Ask them to make choices.

STEP 4

When living with Alzheimer’s Disease, one’s loss of independence is one of the most difficult life challenges to accept. Most people have difficulty being told what to do, how to eat, and where to walk. Perhaps the biggest secret is that we can provide meaningful yet safe choices for people living with dementia. For example:

  • “Do you mind if I sit next to you?”
  • “Which chair do you want me to grab? This one or that one?”

Be sure to offer safe choices for the client. These are often fixed choices for inconsequential things, like picking a chair or a table to sit at. It may also include choosing which direction to walk in a hallway.

One question at a time, building up over time.

STEP 5

It is best to assume all questions are ‘invasive’. That is, questions can cause quite a lot of suspicion and confusion for a person living with Alzheimer’s Disease. Test the waters carefully when asking questions by first asking a single, open-ended question. It is recommended to limit yourself to asking only 1 or 2 open ended questions. Otherwise, this can produce more stress than necessary, and prevent further communication.

There is an opportunity to ask a few close ended questions in response to the topic of conversation. However, avoid asking multiple questions in rapid-fire sequence.

Speak in a clear and rhythmical tone.

STEP 6

Many people try to use short sentences and speak clearly. However, you may not realize the power of rhythm and intonation in your normal speech. Many language centres are closely connected to working memory processes. As a result, language is one of the first functions to degrade in Alzheimer’s Disease. The pattern and intonation of our speech can help overcome language barriers by suggesting meaning, independent of the words we use. For example, speaking in a jovial tone will suggest the topic of communication is about something positive and optimistic.

Other communication strategies include:

  • Acknowledge what they said before asking another question. Paraphrasing is a very useful skill to demonstrate you heard what they said, and are listening to them wholeheartedly.
  • Give extra time for people living with Alzheimer’s Disease to respond to your questions. It takes longer to retrieve information and conceptualize the response to your questions.
  • Go with the flow by letting the them guide your next question. Instead of jumping to new topics, ask related questions as a way to gradually shape the focus on the conversation.
  • Invite them to participate in group conversations or have others join in the conversation, where possible. This helps remove the pressure of a ‘one-on-one’ interview for some people living with dementia. (For others, it may introduce unnecessary distractions.)
  • Speak using an adult tone of voice, avoiding use of a ‘juvenile’ or patronizing tone wherever possible. A pleasant and friendly tone of voice is often the most effective, providing it does not annoy or ‘irk’ the person living with Alzheimer’s Disease.

Published by Adam Henley

Adam is a Registered Nurse with experience in chronic disease management, symptom measurement, hematology/oncology, primary care behavioural health and geriatrics. He combines counselling, nutrition & exercise with traditional home nursing care. Adam cares to live health together with clients in a manner consistent with Parse’s Theory of Human Becoming. At the heart of his care, Adam offers evidence-based strategies to transform health together.

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