I’ve been accused of being a little too direct in my communication. I often respond to this with, “I’m from New York,” as if cutting to the chase is an obvious regionalism. So here I go posing a question that gets right to the heart of the matter for those facing Alzheimer’s.
At the risk of leaning into my roots, let’s take this question seriously. Allow me to share what I have learned that best answers,“How do I talk to a person with dementia?”
I tried to put them in logical order, but bear in mind, logic often does not apply in these circumstances. Just all good tools. They’re screaming for an acronym but it’s too many consonants!
1. Make Eye Contact - Seems obvious but you’d be surprised how challenging this can be. For some people that’s uncomfortable in the best of circumstances. But you must screw your courage to the sticking post when talking to someone with dementia and look them directly in the eyes. Grounding communication this way is proven to reduce agitation and even positively affect memory. Looking someone in the eyes immediately says, I see you. Because you do. Often there is shame associated with Alzheimer’s so sitting with a person and taking them in fully is a gift.
2. Along these lines, don’t talk about a person, or over a person’s head with them present. Again, it seems like human contact 101, and yet, particularly as language becomes more difficult for the person, it’s tempting to speak for them without including them. Pretty soon you’re stage whispering over their head, “She doesn’t look good in that sweater,” to your sister, or a neighbor or a caregiver. Let’s all agree not to do this.
3. One of the most helpful ways to support steps one and two: put down your phone. Early on with my mother a brave friend came to visit with us. We chatted briefly and then the woman, who owned a business, pulled out her phone to check e-mail. My mother looked at me and said loudly, “She doesn’t want to be here anymore. She’s done with me!” This actually still makes me laugh, my mother’s lack of editor. I mean, she wasn’t wrong. Isn’t that how it feels when someone picks up their phone in a conversation? When people with dementia are freed from a high functioning pre-frontal cortex, they can start to express emotion with abandon. This can be jarring, and sometimes difficult, particularly when that feeling is rage, but according to experts, resist the impulse to shut them down. This article from the National Institute on Aging has great ideas.
4. Yes…and! No comedy tool is more valuable for maintaining connection with a person with dementia at all stages. It’s important to keep in mind that as the disease progresses, the reality the person is living in is not always the one you’re in. It is best to surrender to them because you won’t win by correcting them. I absolutely love this story that Maria Shriver tells about a conversation she had with her father when he was in the throes of the disease. It’s such a crystal clear of example of getting to “yes…and” which allowed them both to enjoy a moment together.
5. Alzheimer's disease is categorized by stages. You may not know what stage of the person you are speaking with is in. In the course of a conversation you may be inclined to ask a question. They may or may not be able to answer you. Staying fully present, you will be able to feel pretty quickly if trying to respond is causing them distress. As soon as you feel this, the kindest thing you can do is a) acknowledge their frustration b) give them time to answer, don’t interrupt them c) throw out a few choices for the possible answer to help them focus. Here’s another great article for navigating conversation.
These are my top five suggestions, specifically for verbal communication. There are a lot more ways to support and engage people you care about - even beyond language. If you have questions about this please feel free to reach out to me directly. If I don’t know the answer myself, I definitely know someone who will.
And let me also just say, I love you for asking.
