Many patients with advanced dementia can no longer speak or understand language. Researchers found that patients with nonverbal dementia often receive substandard care because their caregivers do not know how to communicate with them.
A non-verbal patient, for example, may refuse food because they do not recognize the texture of the food. Or the patient may become belligerent during bathing because they do not understand what is happening. Over time, skipping meals leads to malnutrition, and cutting back on bath time leads to poor hygiene.
In recent years, researchers have increasingly focused on how to communicate with a person who has dementia. Their findings may be useful for someone working with dementia patients in a clinical setting or someone caring for a loved one at home.
Communicating with patients with dementia
More than 50 million people worldwide living with dementia, a progressive neurological disease. There are more than 100 types of dementiaand the most common, such as Alzheimer’s disease, affect memory and bodily function.
In the early stages of the disease, a person with dementia may forget words. As the disease progresses, they may lose the ability to construct complex sentences. They may also have trouble remembering what is said.
People with
will no longer understand figures of speech such as metaphors or idioms. Phrases like “It’s raining cats or dogs” or “I was rolling on the floor laughing” can be confusing. Non-verbal communication also loses meaning and a person may no longer understand a shrug or a thumbs up.
In a focus group of 22 caregivers, all participants with family members who had severe dementia said that day-to-day communication was a major challenge. Eighty percent of caregivers with loved ones with mild to moderate dementia said the same.
Read more: The various diseases behind language impairments
How to talk to someone with dementia
Although caregivers say communication is a big struggle, researchers have long neglected the topic. A literature review from 2017, for example, focused on nurses’ communication with dementia patients. The research team found only six articles that met their search criteria.
The volume of research is growing and 2021 literature review in International Journal of Nursing Research found 31 qualifying articles. Researchers are beginning to understand more about how dementia affects communication and how caregivers can make sense of their messages.
Avoid Elderspeak
Caregivers of dementia patients are advised first not to use “elder”..” People using the “language of the elders” usually have high singing tones, as if they are speaking to a small child. Expressions of endearment such as “dear” or “dear” are often used.
Elderspeak can lower a patient’s self-esteem, especially if they may feel infantilized. It can also make them more resistant to the caregiver or to the task, such as dressing or bathing.
Instead of using the language of elders, the researchers recommend speaking in a confident, friendly tone that keeps pace in mind. The caregiver should ask simple yes or no questions. They should paraphrase when necessary. Repeating phrases such as “We’ll put your coat on” can calm the patient.
Avoid downward communication
Whenever possible, caregivers should stand so that they are not looking down at the patient. Standing over the patient can feel like a form of downward communication, which gives the feeling that the caregiver is in charge and talking to the patient. Some patients may resist in response.
Patients with mild to moderate dementia may still be able have a discussion or follow step-by-step instructions. They can still make a choice when presented with several options. Caregivers are encouraged to be comfortable with the silence that comes between a question and an answer.
Eliminate distractions
Patients with different levels of dementia will benefit if their environment is free of distractions. Caregivers should turn off televisions or radios, close hallway doors, and limit the amount of information the patient is trying to process.
Patients who are still talking may need time to process what is being said before responding. Listening and responding can be difficult, and such a challenge can lead to frustration.
Read more: The 4 main types of dementia
Understanding communicative behavior in dementia
Dementia patients who are no longer able to communicate may sometimes appear agitated and angry. Screaming, resisting the bathroom, or pushing away the dinner plate is part of what researchers call behavioral communication.
Behavioral communication can sometimes seem like rude behavior, but researchers urge caregivers to focus on the underlying message. If a dementia patient, for example, is in physical therapy and suddenly takes off her shirt, the caregiver should know that she is overheated. She can’t articulate that she’s too hot, so she removes the source of her discomfort.
Caregivers may also feel frustrated by the patient’s inability to communicate. Being yelled at while trying to button the patient’s shirt can make a person want to walk away from the task at hand. Researchers have expressed concern that there is a lack of understanding of behavioral communication. Patients who rely on behavioral communication are at greater risk of substandard care, leading some scientists to call for more research and awareness.
Read more: How to diagnose dementia