How to communicate with patients who has dementia.

When I first came here in the United States, I encountered a lot of dementia patients. I did not know how to handle them. They were reluctant to receive care. They refused to undergo therapy. They refused virtually anything I offered them. But with patience and persistence, I succeeded in gaining their trust. I learned that good communication skill is the key to building a relationship with dementia patients. A relationship that is founded on trust. Once you have developed it, caregiving becomes less stressful.

And when I say communication skills, it involves both the verbal and nonverbal language. Let me share with you some of the techniques that I have learned from my research and practical application in caring for dementia patients. I have proven these to be effective.

Positive attitude.

First and foremost, you need to have a positive mental and emotional attitude. Patients are very sensitive. They can detect how you feel towards them through your speech and nonverbal expressions. So, it is important that you establish a positive atmosphere around them. A soft and kind tone of voice and a sincere smile can do a lot to help them feel comfortable.

Be sensitive.

Dementia patients have difficulty expressing themselves. You need to use all your senses in observing their nonverbal expressions. Is your patient frowning? Does he maintain an eye contact with you and the other people around him? Is he staring at something? Did he smell reeked? Listen, listen, and listen well. Try to decipher what the person is trying to say or convey.

Limit external distraction.

Persons with dementia are easily disrupted by noise, light, and other glaring visual objects. So, when trying to get the patient’s full attention, make sure to limit unnecessary external distractions. Turn off the radio or TV, and close the curtains or door in his room. And if you need to move some of his belongings, you must ask for his permission first.

Gentle approach.

As dementia progresses, the patient’s vision becomes limited. Make sure that he recognizes you easily. Approach him from the front. Before speaking, position yourself at an eye level with the person. Identify yourself to help him recognize you easily. Maintain an eye contact with him throughout the conversation.

Call the person by his first name, if he so prefers it.

It helps you get his attention and as a sign of respect, address him according to the profession he was once engaged in, such as Doctor, or Sir or Ma’am if he were a serviceman. Speak slowly using simple words in short sentences. If, at first, he does not understand what you were saying, repeat it over again using the same words as when you first said it. You may use hand gestures or other body languages to reinforce your words.

But, just a word of caution, though: be careful in using nonverbal language. It might run contrary to your words. A crossed arm, for example, may send a message that you are impatient.

Typically, a dementia patient has a slow response time. It may take him up to 30-90 seconds to process any message or information he receives. It matters, then, that you exercise more patience when you don’t get a quick response. And while he is processing the information you feed him, do not distract him. Refrain from raising your voice, unless the patient is hard of hearing. It would help the patient if you could visually demonstrate your point. For example, when instructing him to raise his arm, you may show him how to do it.

Mention the proper names of people and specific places. Avoid using pronouns as these would only confuse the person with a cognitive problem. You would also make things easy for him if you use close-ended questions answerable by either Yes or No.

Use short sentences and direct to the point. When explaining an activity, keep your sentences short. Break down the information or the process by which the activity is to be carried out.

One step at a time.

There are two kinds of problems with dementia has in communication. One is having difficulty in expressing himself and the other one is difficulty in understanding what the other person is saying. He may understand more than he can say or express. Make sure to not make assumptions about what he understands.

Some patients have occasional difficulty in finding their words. They may have trouble remembering names. Most of the time they substitute words such as wall or wheel, or pie or tie. Sometimes they also change words with related meaning like book for read, or circle to ball, radio to television.

Sometimes patients are able to ramble on quite fluently and it seems like it is a lot. But if you will try to decipher them, it will not make sense.

In my experience, I don’t just tell my patient that we were going to the bathroom. Instead, I would start by instructing him to lean forward. Then, as soon as he had done so, I’d proceed to tell him to push up from the arms of his chair, before further instructing him to stand up. Once the patient starts walking, I would tell him what is going to happen next.

The most important point here is to make your patient feel safe with you. And make sure, you get his approval before you proceed with the entire activity.

Be supportive and friendly,

It’s normal for the dementia patient to become agitated. This occurs when he is anxious or confused. He gets confused over his past experiences and with reality itself. When the person in your care is agitated, let him know that he got your full attention and support. Give particular attention to his feelings. Empathize with him.

Don’t argue when he insists, for example, that the present time is the 1950s. If it helps, you may suggest that you take a walk together so that his attention may get redirected.

Dementia patients retain their Long Term Memory while practically lose their Short Term Memory. They remember the events that occurred 30 years back, but could not recall what had happened in the past 30 minutes. When your patient starts talking about his life, show your interest in knowing what had happened like 15 – 30 years ago. And as you converse, you may apply other forms of communication, such as a smile or a touch.

Maintain a sense of humor.

The comic actor, Charlie Chaplin, once said, “A day without laughter is a day wasted.” It makes sense. Apply humor when dealing with your dementia patient whenever appropriate. But, of course, humor should not be at his expense. After all, laughter is said to be the best medicine.

To sum up all these, I should say it takes both expressive and receptive communication to make caregiving stress-free. A healthy relationship between the person with dementia and the caregiver is founded on trust.

Here are some more ways to improve your communication with your dementia patients:

• Check their hearing levels. Make sure they hear you well. Majority of your patients/dementia will have hearing problems. Check their hearing aide. Talk a little bit louder, but not too loud that they think you are shouting at them.

• Talking about talking loud, make sure to talk in a nice low tone. A raise tone is a nonverbal sign that make dementia patient upset. I don’t like being shouted at either.

• Use short phrases, simple sentences. Avoid or minimize complex explanations. Instead of saying, “We will go to the doctors office tomorrow when i am not busy and probably after having my car fixed.” Say this instead, “We will go to your doctor tomorrow.”

• Last but not the least, i have learned this in a hard way, make sure to speak slowly and wait for the patient to respond. Wait. Wait. Wait.

If you are living with a patient with a dementia, you have probably learned their non-verbal signs and cues when they are happy or upset. You know what, same thing with them. They still recognize (depending on their stage) your own non-verbal signs. Here are some additional ways to improve your non-verbal communication signs with your dementia patients.

• Make sure to remain calm and pleasant. Even if you feel upset your body language, your facial expression is seen by your patient.

• Smile, smile, smile. Even if you don’t feel like it.
• Look directly at the patient, eye level. Not over, not under. But eye level. If they are in a wheelchair, kneel down and be at their eye level.

• Use other cues, in rehabilitation. We use different cues such as pointing, touching and visual cues. Make sure to point what you want and describe it in the most simplest way.

• Limit complex reasoning for the patient. Your dementia patient is no longer able to process information properly.

Even when you patients are unable to communicate, they all still need love and affection. I remember one of my end-stage patient, her daughter continues to hug and kiss her every time, all the time! I wonder how or what the patient feels inside when her daughter kisses her and hugs her.