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Chapter 13: Communication Techniques

Introduction

Communication is the foundation of human connection. For people living with dementia, communication abilities gradually decline as the disease progresses, but the need and desire to connect with others remains. Effective communication techniques can reduce frustration, preserve dignity, maintain relationships, and improve quality of life for both the person with dementia and their caregivers.

This chapter explores ten essential communication concepts that will help you maintain meaningful connections throughout the dementia journey. You'll learn not just what to say, but how to say it—and when words alone aren't enough, how to communicate through actions, expressions, and presence.

The Importance of Communication in Dementia Care

Why Communication Matters:

  • Preserves personhood: Effective communication acknowledges the person behind the disease
  • Reduces behavioral challenges: Many challenging behaviors stem from communication frustration
  • Maintains relationships: Good communication helps preserve connections with loved ones
  • Supports autonomy: Enables the person to express preferences and maintain some control
  • Enhances quality of life: Feeling heard and understood contributes to wellbeing
  • Reduces caregiver stress: Successful communication makes caregiving less frustrating

The Progressive Nature of Communication Changes:

Dementia affects different aspects of communication at different stages:

  • Early stage: Word-finding difficulties, repetition, losing train of thought
  • Middle stage: Difficulty understanding complex sentences, mixing up words, reduced vocabulary
  • Late stage: Very limited verbal communication, reliance on non-verbal communication

Despite these changes, the person's emotional awareness often remains intact longer than verbal abilities. A warm tone and gentle touch may communicate more than words.

1. Verbal Communication

Verbal communication—the words we use and how we say them—is often the first thing we think about in conversation. With dementia, how you speak becomes as important as what you say.

Elements of Effective Verbal Communication

Tone of Voice: - Use a warm, friendly, respectful tone - Speak as you would to any adult (not as to a child) - Keep your voice calm and reassuring, especially during stressful moments - Avoid speaking in a loud or harsh tone unless hearing is impaired

Volume and Pace: - Speak clearly and at a moderate volume (louder only if hearing-impaired) - Slow down your pace slightly, but don't talk unnaturally slowly - Pause between sentences to allow processing time - Don't rush through what you're saying

Word Choice: - Use familiar, everyday words - Be specific and concrete rather than abstract - Say "Would you like to eat now?" instead of "Are you hungry?" - Use names instead of pronouns ("Let's go to the bathroom" not "Let's go there")

Verbal Communication Strategies by Stage

Early Stage: - Mostly normal conversation is possible - Give the person extra time to find words - Provide the word if they're struggling (gently) - Don't finish every sentence for them

Middle Stage: - Simplify language (see Simple Language section) - Break information into smaller pieces - Repeat key information as needed - Focus on one topic at a time

Late Stage: - Use short, simple sentences or phrases - Focus on key words ("Time for lunch") - Use repetition and routine phrases - Don't assume they can't understand—assume they can

Common Verbal Communication Mistakes

DON'T: - Use baby talk or elderspeak ("Let's go potty!") - Talk about the person as if they're not there - Argue, correct, or contradict - Ask them to remember something they've forgotten - Use sarcasm or humor they might not understand - Give multiple choices or complex instructions

DO: - Speak in a normal adult tone - Include the person in conversations - Agree and validate their reality - Offer information without demanding recall - Use gentle, obvious humor - Provide one simple option at a time

2. Non-Verbal Communication

Research shows that up to 93% of communication is non-verbal—through facial expressions, gestures, posture, and tone. For people with dementia, non-verbal communication becomes increasingly important as verbal skills decline.

Your Non-Verbal Communication

Facial Expressions: - Maintain a pleasant, relaxed expression - Smile warmly and naturally - Show interest and attention - Avoid frowning, rolling eyes, or looking frustrated - Your face should match your words (don't smile while delivering bad news)

Eye Contact: - Make gentle, warm eye contact - Get to their eye level (sit or kneel if they're seated) - Don't stare intensely or avoid eye contact - For some individuals, less eye contact may be more comfortable

Gestures: - Use natural hand gestures to support your words - Point to objects you're talking about - Demonstrate actions (show them how to use a spoon) - Keep gestures calm and not overly dramatic

Posture and Positioning: - Approach from the front, not from behind - Face the person directly - Maintain a relaxed, open posture - Keep your body language calm and unhurried - Sit or stand at their level

Physical Proximity: - Stand or sit at a comfortable distance (about arm's length) - Respect personal space, but don't be distant - In late stages, closer proximity may be comforting - Watch for signs they want more or less space

Reading Their Non-Verbal Communication

Facial Expressions: - Look for signs of pain, fear, confusion, or pleasure - A furrowed brow may indicate pain or worry - Smiles and relaxed features suggest comfort - Blank expressions may indicate lack of understanding

Body Language: - Crossed arms may indicate resistance or discomfort - Leaning forward suggests interest - Pulling away may mean they need space - Restlessness may signal discomfort or need

Vocalizations: - Tone of voice (even if words don't make sense) - Sighs, groans, or sounds of distress - Humming or singing may indicate contentment

3. Active Listening

Active listening means fully focusing on the person, understanding their message, and showing that you're listening. It's about being present, not just waiting for your turn to talk.

Components of Active Listening

Give Full Attention: - Put away distractions (phone, TV remote) - Stop other activities and focus on the person - Turn your body toward them - Make eye contact

Show You're Listening: - Nod occasionally - Use brief verbal acknowledgments ("I see," "Mm-hmm," "Yes") - Lean forward slightly - Maintain an interested facial expression

Provide Feedback: - Reflect back what you heard: "It sounds like you're worried about..." - Ask clarifying questions: "Tell me more about that" - Summarize: "So you're saying..." - Don't interrupt or finish sentences (unless they clearly want help)

Respond Appropriately: - Acknowledge their feelings - Offer reassurance - Provide information they're seeking - Take action if needed

Active Listening Techniques for Dementia Care

When Language Is Difficult to Understand: - Focus on the emotion behind the words, not just the words - Look for the feeling they're expressing (fear, joy, frustration) - Respond to the emotion: "You seem worried. I'm here with you." - Don't pretend to understand if you don't

When They Repeat: - Listen to each repetition as if it's the first time - Respond each time with patience - Look for what might be driving the repetition (anxiety, unmet need) - Provide reassurance

When Stories Don't Make Sense: - Don't correct facts or point out inconsistencies - Follow the emotional thread - Ask questions about feelings, not facts - Enjoy the story for what it reveals about what matters to them

The Power of Presence

Sometimes the most powerful form of active listening is simply being present: - Sit quietly together - Hold their hand - Make eye contact and smile - Your calm presence communicates "You matter, and I'm here"

4. Simple Language

As dementia progresses, the ability to process complex language declines. Simple language makes communication clearer and reduces frustration.

Principles of Simple Language

One Idea at a Time: - ❌ "After we eat breakfast, we'll get you dressed and then the doctor is coming at 10." - ✅ "Let's eat breakfast now."

Short Sentences: - Keep sentences under 10 words when possible - Use simple subject-verb-object structure - "Mom is here" instead of "Your daughter arrived earlier to visit"

Concrete, Specific Words: - ❌ "Take your medication" - ✅ "Swallow this pill with water"

  • ❌ "We need to go"
  • ✅ "We're going to the doctor"

Familiar Vocabulary: - Use words from the person's life and era - Consider regional terms (soda vs. pop, dinner vs. supper) - Use their preferred terms (bathroom vs. toilet, couch vs. sofa)

Avoid Abstract Concepts: - ❌ "Try to be more cooperative" - ✅ "Please sit down"

Simplifying Questions

Closed Questions (Yes/No): - "Are you cold?" - "Do you want to eat?" - "Is this your sweater?"

Limited Choice Questions (2 options maximum): - "Would you like tea or coffee?" - "Do you want the red shirt or the blue shirt?"

Avoid Open-Ended Questions: - ❌ "What would you like to do today?" - ✅ "Would you like to go for a walk?"

Giving Instructions with Simple Language

Single-Step Instructions: - ❌ "Go to the bathroom, wash your hands, and come back for dinner" - ✅ "Let's go to the bathroom" (then give the next instruction after completing this one)

Breaking Down Activities: Instead of "Get dressed," try: 1. "Here's your shirt" 2. "Put your arm in" (demonstrate) 3. "Now the other arm" 4. "Let's pull it down"

When to Simplify

  • Early stage: Mostly normal conversation, simplify only when confusion is evident
  • Middle stage: Regularly use simple language, one idea at a time
  • Late stage: Very simple sentences, key words only

5. Visual Cues

Visual cues are objects, pictures, or demonstrations that support verbal communication. They're especially helpful as verbal comprehension declines.

Types of Visual Cues

Objects: - Show the person the object you're talking about - Hold up their coat while saying "Let's put on your coat" - Point to food while asking "Would you like more?" - Show them the toothbrush before saying "Time to brush teeth"

Demonstrations: - Model the action you want them to do - Pick up a spoon and bring it to your mouth to demonstrate eating - Brush your own hair while asking them to brush theirs - Sit down to show them where to sit

Pictures and Photos: - Use photos of family members with names labeled - Picture schedules showing daily activities - Photos of meals to help choose food - Pictures on doors to identify rooms (bathroom, bedroom)

Labels and Signs: - Word labels on doors ("Bathroom," "Kitchen") - Pictures on drawers (socks, shirts) - Signs with arrows pointing to important rooms - Contrast colors to make text stand out

Written Reminders: - Simple notes: "Lunch at noon" - Memory books with photos and captions - Calendar with large print - Lists of daily activities with checkboxes

Using Visual Cues Effectively

Timing: - Present visual cues at the same time as verbal instructions - Allow time to look at and process the visual - Don't rush or overwhelm with too many visuals at once

Simplicity: - Use clear, uncluttered images - One image or object at a time - High contrast for easier viewing - Large, simple pictures work better than complex scenes

Consistency: - Use the same visual cues regularly - Keep pictures and labels in the same places - Use familiar objects rather than abstract symbols

Examples in Daily Life

Mealtime: - Show them the plate of food - Point to items on the plate - Demonstrate eating by taking a bite yourself

Getting Dressed: - Lay out clothes in the order they'll be put on - Show each piece of clothing - Demonstrate how to put it on

Bathing: - Show them the washcloth - Demonstrate washing your own face - Point to body parts to be washed

6. Patience

Patience is perhaps the most important communication technique in dementia care. Processing time increases, responses slow, and patience creates space for connection.

Why Patience Matters

Processing Delays: - The brain takes longer to understand words - Formulating a response requires more time - Multiple steps can't be processed quickly - Rushing creates anxiety and confusion

Preserved Emotional Awareness: - People with dementia can sense when others are impatient - Your frustration increases their anxiety - Feeling rushed leads to shutdown or resistance - Patience communicates respect and care

Practicing Patience

Allow Response Time: - Ask a question and wait - Count to 10 (or 20) silently before speaking again - Resist the urge to fill silence - Watch for non-verbal signs they're processing

Slow Down: - Move at their pace, not yours - Build extra time into daily activities - Expect tasks to take longer than they used to - Don't schedule back-to-back activities

Repeat Without Frustration: - Expect to repeat information - Each repetition should be as patient as the first - Use the same words each time for consistency - Consider that they might need to hear it several times

Stay Calm During Delays: - Take deep breaths - Remind yourself this isn't intentional - Focus on the person, not the task - Getting frustrated doesn't speed things up

When Patience Is Challenged

High-Stress Moments: - Getting ready for an appointment - Medication time - Meals that are getting cold - When you're tired or stressed

Strategies: - Build in buffer time - Lower your expectations - Take turns with another caregiver if possible - Remember: The relationship matters more than the schedule

Self-Care for Patience: - Take regular breaks - Practice stress-reduction techniques - Get adequate sleep - Seek support from other caregivers - Remember that impatience is human—forgive yourself

What Patience Looks Like

Physical Signs: - Relaxed body posture - Gentle facial expressions - Unhurried movements - Comfortable silence

Verbal Signs: - Speaking slowly and calmly - Not interrupting - Repeating without irritation - Using a consistent, kind tone

Behavioral Signs: - Waiting for responses - Not rushing tasks - Allowing time for decision-making - Adapting to their pace

7. Validation Techniques

Validation technique means accepting and validating the person's reality rather than correcting, arguing, or trying to reorient them to your reality. It's based on the principle that the emotions are real, even if the facts aren't accurate.

The Validation Approach

Developed by Naomi Feil, validation therapy recognizes that: - The person's feelings are always valid - Their reality is real to them - Arguing causes distress without changing their beliefs - Meeting them in their reality maintains dignity and connection

Principles of Validation

Accept Their Reality: - If they think they're 30 years old, don't argue - If they're looking for their mother (who passed away), don't bluntly state she's dead - If they think they need to go to work, acknowledge the feeling

Validate Emotions: - "You really miss your mother" - "Work was important to you" - "You sound worried about that"

Don't Lie, But Don't Argue: - You don't have to agree with false beliefs - But you don't have to correct them either - Focus on feelings, not facts

Respond to the Underlying Need: - Looking for mother = need for comfort and security - Wanting to go to work = need for purpose - Asking to go home = need for familiarity and safety

Validation in Practice

Example 1: "I need to pick up my children from school"

❌ Don't say: "Your children are adults now. You're not picking anyone up."

✅ Do say: - "Tell me about your children" - "You were always there for them" - "Being a parent was important to you" - Then redirect: "Let's have some tea while we look at photos"

Example 2: "I need to go home" (when they are home)

❌ Don't say: "You ARE home. This is your house."

✅ Do say: - "Tell me about home. What do you miss?" - "Home is a special place" - "You're safe here with me" - Then redirect: "Let's sit in your favorite chair"

Example 3: "My mother is coming to visit" (mother deceased)

❌ Don't say: "Your mother died 20 years ago. She's not coming."

✅ Do say: - "Your mother is special to you" - "Tell me about your mother" - "What was she like?" - You might say: "She can't visit today, but let's look at her picture"

Example 4: Accusations ("You stole my purse!")

❌ Don't say: "I did NOT steal your purse! How dare you accuse me!"

✅ Do say: - "Your purse is important to you" - "Let's look for it together" - "What does your purse look like?" - Then help find it without blaming

When Not to Validate

Safety Issues: - If they believe they can drive safely when they can't - If they think they don't need supervision - In these cases, validation of feeling + gentle redirection: "I know you want to drive. That must be frustrating. I'll drive us today."

Legal/Financial Decisions: - Major decisions require capacity assessment - Validation doesn't mean agreeing to everything

Benefits of Validation

  • Reduces anxiety and agitation
  • Preserves dignity
  • Maintains connection
  • Reduces caregiver-care recipient conflict
  • Honors the person's emotional experience
  • Prevents catastrophic reactions

8. Redirection

Redirection is a technique for gently shifting attention away from a distressing or problematic topic or behavior to something more positive or appropriate.

When to Use Redirection

Common Situations: - Repetitive questions or stories - Distressing topics (wanting deceased loved ones, wanting to go home) - Unsafe requests (wanting to drive, wanting to leave) - Fixation on something unattainable - Agitation or anxiety - Resistance to necessary care

Not Redirection, but Distraction: Redirection isn't about tricking or distracting like you would a toddler. It's about honoring their feelings, then offering an alternative focus.

Effective Redirection Techniques

Validate, Then Redirect: 1. Acknowledge the feeling or concern 2. Briefly validate 3. Suggest an alternative

Example: - Person: "I want to go home" - You: "I know you miss home. Let's have some tea in the living room"

Use Their Interests: - Redirect to topics or activities they enjoy - "Speaking of that, would you like to look at photos?" - "I know you love music. Let's listen to your favorite song"

Introduce a New Topic: - Change subject to something pleasant - "Look, it's snowing outside!" - "Did I tell you about the birds I saw this morning?"

Offer an Activity: - "Would you like to help me fold towels?" - "Let's go for a walk" - "Want to have a snack?"

Use Humor (when appropriate): - Light, gentle humor can shift mood - Must be appropriate and not mocking - Laugh with them, not at them

Redirection Strategies by Situation

Repetitive Questions ("When is lunch?"): - Answer the first few times - Then: "Lunch is coming soon. Would you like to help me set the table?" - Write down the information: "See, it says right here: lunch at noon"

Wanting to Leave/Go Home: - "I know you want to go home. It's not time yet. Let's [activity]" - Walk with them (the movement may satisfy the urge) - Show them a comfortable, familiar spot

Looking for Deceased Loved Ones: - "Mom isn't here right now. She loves you very much." - "Tell me about Mom" - Redirect to photos or memories

Repetitive Stories: - Listen actively the first several times - Then: "I love that story. Would you like to look at photos from that time?"

What Redirection Is NOT

NOT lying: You're not making false promises NOT invalidating: You acknowledge feelings first NOT dismissing: You don't ignore their concern NOT controlling: You're offering alternatives, not demanding compliance

Making Redirection Successful

Timing: - Redirect early before agitation escalates - Watch for signs of fixation - Don't wait until they're highly upset

Body Language: - Stay calm and relaxed - Gentle touch (if they're receptive) - Lead them physically to new location or activity

Flexibility: - If first redirection doesn't work, try another - Some days certain topics work better - Follow their lead

Environment: - Have redirection tools ready (photo albums, music, snacks) - Keep favorite activities accessible - Create pleasant spaces to redirect to

9. Communication Boards

Communication boards are visual tools that help people with limited verbal skills express needs, feelings, and preferences. They become increasingly important in middle and late-stage dementia.

What Are Communication Boards?

Communication boards display pictures, symbols, words, or photos that the person can point to in order to communicate. They can be: - Physical boards (poster, binder) - Digital (tablet) - Books or flip charts - Individual cards

Types of Communication Boards

Basic Needs Board: Pictures representing: - Thirsty (glass of water) - Hungry (plate of food) - Bathroom (toilet) - Cold/hot (thermometer) - Pain (body outline) - Tired (bed)

Feelings/Emotions Board: Faces showing: - Happy - Sad - Angry - Scared - Worried - Tired - Content

Activities Board: Pictures of: - Music (headphones) - TV (television) - Walk (shoes or outdoor scene) - Read (book) - Nap (bed) - Visit (people)

Pain Assessment Board: - Body diagram where they can point to pain location - Pain scale with faces (smiling to crying) - Words describing pain (sharp, dull, aching)

Food Preferences Board: - Pictures of common meals - Drinks - Snacks - Desserts

Creating a Communication Board

Design Principles: - Large, clear images (4-6 inches) - High contrast backgrounds - Uncluttered layout (6-12 items per board) - Relevant to the individual's needs and preferences - Use photos of actual items when possible

Personalization: - Include their specific preferences - Use photos from their life - Include family member photos with names - Consider their cultural background - Use their vocabulary (pop vs. soda)

Materials: - Laminated poster board - Photo album or binder with page protectors - Dry-erase board for reusable options - Tablet with communication app - Individual cards on a ring

Using Communication Boards Effectively

Introduce Gradually: - Start when verbal communication begins to decline - Practice using it when they're calm - Point to pictures as you say the words - Demonstrate how it works

Make It Accessible: - Keep it where they can see and reach it - Have multiple boards in different rooms - Keep it in a consistent location - Take it with you to appointments

Teach Caregivers: - All caregivers should know how to use it - Explain the system to new helpers - Include instructions on the board itself

Combine with Other Communication: - Point to pictures as you speak - Use pictures to confirm understanding ("You want water? This one?") - Watch for body language confirming the choice

Technology Options

Communication Apps: - TouchChat - Proloquo2Go - MyTalkTools Mobile - CoughDrop - LetMeTalk (free)

Tablet Considerations: - Large screen (10+ inches) - Simple interface - Locked to communication app - Protective case - Accessible location

Beyond Basic Boards

Photo Albums as Communication Tools: - Family members with names - Important life events - Favorite places - Beloved pets - Can prompt memories and conversation

Daily Schedule Board: - Visual timeline of the day - Pictures for each activity - Move a marker to show current time - Reduces anxiety about what's coming next

Choice Boards: - Morning routine (bath or shower?) - Clothing options - Meal choices - Activity options

When Communication Boards Help Most

  • Middle to late-stage dementia
  • After stroke affecting speech
  • When frustration over communication is high
  • When basic needs aren't being met
  • In healthcare settings (ER, hospital)
  • With multiple caregivers who need consistency

10. Body Language

Body language includes posture, gestures, facial expressions, and physical distance. In dementia care, you must both "read" their body language and be aware of your own.

Reading Their Body Language

Signs of Comfort: - Relaxed facial muscles - Soft eyes, maybe smiling - Open posture - Sitting back comfortably - Leaning toward you - Gentle reaching out - Calm breathing

Signs of Discomfort: - Furrowed brow - Tense jaw or lips - Crossed arms - Pulling away - Fidgeting - Pacing - Rapid breathing

Signs of Pain: - Grimacing - Guarding a body part - Hitting or pushing away when touched in specific area - Crying or moaning - Restlessness - Drawn facial features

Signs of Fear or Anxiety: - Wide eyes - Startled reactions - Withdrawal - Defensive postures - Attempting to leave - Gripping furniture or people

Signs of Anger or Agitation: - Red face - Clenched fists - Aggressive gestures - Rigid posture - Invading others' space - Rapid movements

Signs of Sadness: - Downcast eyes - Slumped posture - Slow movements - Tears - Lack of expression - Withdrawal

Using Your Body Language

Approaching: - Approach slowly from the front - Come to their eye level - Maintain comfortable distance (arm's length) - Have an open, relaxed posture - Smile gently

During Interaction: - Face them directly - Maintain gentle eye contact - Keep your body language calm - Use natural gestures - Nod to show understanding - Mirror their energy level (if they're calm, you're calm)

Physical Touch: - Always ask or signal before touching - Approach from front where they can see your hand coming - Start with neutral areas (hand, shoulder) - Avoid sudden or rough touch - Use gentle, slow movements - Stop if they pull away

What to Avoid: - Standing over them (intimidating) - Approaching from behind (startling) - Crossing your arms (defensive) - Pointing accusingly - Moving too quickly - Showing impatience through body language (eye-rolling, sighing, checking watch)

Body Language as Communication

When Words Fail: In late-stage dementia, body language may be the primary communication method: - A smile says "You're safe" - A gentle touch says "I'm here" - Eye contact says "I see you" - Sitting quietly together says "Your presence matters"

Responsive Behaviors: What we call "behaviors" are often body language communicating: - Pacing = anxiety, need for movement, searching - Pushing away = fear, pain, overstimulation - Hitting during care = fear, pain, feeling violated - Wandering toward door = need to go somewhere, need for purpose

Body Language Through the Stages

Early Stage: - Body language mostly typical - May see some uncertainty or confusion in expressions - Posture may show anxiety about cognitive changes

Middle Stage: - Body language becomes more important as words fail - May have more exaggerated expressions - Posture and gestures compensate for lost words

Late Stage: - Body language is primary communication - Facial expressions show feelings - Posture indicates comfort or distress - Reaching, pulling away, or hitting are communication

Teaching Others About Body Language

For Family Members: - Point out what their body language is telling you - Model calm body language - Explain that the person can sense tension

For Professional Caregivers: - Train in reading non-verbal cues - Practice maintaining open, calm body language - Debrief after difficult interactions about what body language said

Cultural Considerations

Remember that body language varies by culture: - Eye contact expectations differ - Personal space norms vary - Touch may be more or less acceptable - Certain gestures have different meanings - Honor the person's cultural background

Communication Through the Stages

Communication strategies must adapt as dementia progresses.

Early Stage Communication

What's Happening: - Word-finding difficulties - Repetition - Losing train of thought - Mostly intact conversation ability

Communication Strategies: - Mostly normal conversation - Allow extra time for word-finding - Gently provide words if they're struggling - Don't correct minor mistakes - Active listening - Patience with repetition - Include them in decisions and conversations

Support Tools: - Memory aids (calendar, notes) - Lists and reminders - Photos with labels

Middle Stage Communication

What's Happening: - Significant word-finding difficulty - Mixing up words - Difficulty with complex language - Reduced vocabulary - Repetitive questions/stories - May confuse people or time

Communication Strategies: - Simple language (short sentences, one idea at a time) - Closed or limited-choice questions - Visual cues and demonstrations - Validation techniques - Redirection - More non-verbal communication - Focus on feelings, not facts

Support Tools: - Communication boards for basic needs - Picture schedules - Labels on items and rooms - Photo albums for conversation starters

Late Stage Communication

What's Happening: - Very limited or no verbal communication - May not respond to questions - Grunting, humming, or nonsensical words - Body language is primary communication - Emotional awareness often remains

Communication Strategies: - Use body language and touch - Speak in short, simple phrases - Provide running commentary on care ("I'm washing your face now") - Use tone of voice to convey care - Read their body language for needs - Don't assume they can't hear or understand - Presence is communication

Support Tools: - Communication boards (point to their needs) - Pain assessment tools - Comfort objects - Familiar music

Special Communication Situations

Declining an Activity

When they don't want to do something (bathe, take medication, eat):

  1. Don't force (unless it's urgent safety issue)
  2. Validate: "I know you don't want to right now"
  3. Wait: Try again in 15-30 minutes
  4. Reframe: "Let's get cleaned up so you feel fresh" instead of "Bath time"
  5. Offer choice: "Bath or shower?"

Responding to Repetitive Questions

Strategy: - Answer patiently the first several times - Look for anxiety beneath the question - Address the underlying concern - Write down the answer - Redirect to activity

Communicating Bad News

Sometimes you must communicate difficult information (death, illness, move):

Guidelines: - Consider whether they need to know - If they won't remember, weigh the benefit vs. distress - Be honest but gentle - Keep it simple - Allow them to feel their feelings - Provide comfort and reassurance - May need to tell them multiple times as they forget and re-grieve

When They Don't Recognize You

This is emotionally painful, but: - Don't take it personally (it's the disease) - Don't quiz them ("Don't you know who I am?") - Introduce yourself: "Hi Mom, it's Sarah" - Focus on connection, not recognition - They may not know your name but feel your love

Communicating with Healthcare Providers

Preparation: - Bring list of medications - Write down questions - Bring communication board if used - Brief provider on communication needs - Speak for person if needed, but include them

End-of-Life Communication

Even in final days: - Continue talking to them - Assume they can hear - Say what needs to be said - Provide reassurance - Use touch - Play familiar music - Read favorite passages

Communication Tips for Caregivers

For Professional Caregivers

Consistency: - Use the same approaches across all caregivers - Document what works - Share communication strategies during shift changes

Cultural Competence: - Learn about the person's cultural background - Respect communication norms - Use interpreters when needed - Honor preferences

Training: - Regular communication skills training - Role-playing difficult scenarios - Feedback and coaching - Self-reflection

For Family Caregivers

Self-Compassion: - You won't always get it right - Patience is hard when you're stressed - Forgive yourself for moments of frustration - Seek support

Maintaining the Relationship: - Remember you're not just a caregiver - Find moments of genuine connection - Share activities you both enjoy - Focus on emotional connection more than facts

When to Step Away: - If you're too frustrated, take a break - Tag out with another caregiver - Breathe and reset - Return when you're calmer

Technology and Communication

Helpful Technology: - Tablets for video calls with family - Music streaming for familiar songs - Communication apps - Photo slideshows - Audiobooks

Technology Challenges: - Keep it simple - Set up in advance - Lock to specific apps - Have backup plans - Not everyone will benefit

Common Communication Challenges and Solutions

Challenge: They talk constantly and you can't get tasks done

Solutions: - Active listening during non-task times - Brief acknowledgments during tasks ("Mm-hmm") - Redirect with activity: "Tell me about this while I help you get dressed" - Accept that some tasks will take longer

Challenge: They won't answer questions or participate in conversation

Solutions: - Don't require verbal responses - Use yes/no questions - Make statements instead of asking - Sit in comfortable silence - Narrate what you're doing - Don't take silence personally

Challenge: They speak in language that doesn't make sense

Solutions: - Listen for emotional content - Respond to feelings, not words - "That sounds important to you" - Don't point out that it doesn't make sense - Look for patterns (certain words/themes)

Challenge: They're hostile or accusatory in communication

Solutions: - Don't argue or defend - Stay calm - Validate feelings - Look for unmet need (pain, fear) - Change environment or caregiver - Document patterns

Challenge: You need to give complex information (new medication, upcoming move)

Solutions: - Break into smallest pieces - One piece at a time over days - Use visual aids - Written information they can refer to - Involve them in whatever way possible - Be prepared to repeat many times

Key Takeaways

  1. Communication is about connection, not just information exchange. The goal is to maintain the relationship and preserve dignity.

  2. How you communicate is as important as what you say. Tone, body language, and facial expressions carry more weight than words.

  3. Their reality is real to them. Validation techniques work better than correction or reorientation.

  4. Patience is the foundation of all effective communication in dementia care. Processing takes time.

  5. Simple language reduces frustration. One idea, short sentences, concrete words.

  6. Visual cues bridge the gap when words fail. Show, don't just tell.

  7. Body language speaks louder than words, especially in later stages. Yours and theirs.

  8. Active listening shows respect and helps you understand the person behind the words.

  9. Redirection maintains dignity while addressing problematic behaviors or topics.

  10. Communication boards provide voice when verbal skills are lost.

  11. Non-verbal communication remains powerful throughout the disease. A touch, smile, or calm presence communicates care.

  12. Adapt your strategies as dementia progresses. What works in early stages won't work in late stages.

  13. Focus on emotions, not facts. Getting the facts right matters less than addressing feelings.

  14. You are the communication expert. The person with dementia can't adapt to you—you must adapt to them.

  15. Effective communication reduces behaviors. Many challenging behaviors stem from communication frustration.

Review Questions

  1. Why does validation technique work better than correction when someone with dementia says something that isn't true?

  2. Describe three non-verbal ways to communicate care and support to someone in late-stage dementia.

  3. What is the difference between simple language and "baby talk"? Why is this distinction important?

  4. Give an example of how you would use validation followed by redirection when someone says "I need to go pick up my children from school" (when their children are now adults).

  5. What are three types of information you might include on a basic needs communication board?

  6. Describe how you would use visual cues to help someone get dressed.

  7. What are three body language signs that might indicate a person is in pain?

  8. How can active listening help reduce repetitive questions?

  9. What should you do if someone doesn't recognize you?

  10. Why is patience considered the foundation of all dementia communication techniques?

  11. How should communication strategies change between early, middle, and late-stage dementia?

  12. What are three things to avoid in verbal communication with someone who has dementia?

Additional Resources

Books

  • "The Validation Breakthrough" by Naomi Feil - The definitive guide to validation techniques from the approach's creator

  • "Contented Dementia: 24-hour Wrap-around Care for Lifelong Well-being" by Oliver James - Includes the SPECAL method of communication

  • "Learning to Speak Alzheimer's" by Joanne Koenig Coste - Practical communication strategies written by an expert caregiver

  • "Creating Moments of Joy" by Jolene Brackey - Focuses on meaningful communication and connection

Online Resources

Communication Tools and Apps

Training Programs

  • Validation Training Institute (vfvalidation.org) - Certification in validation techniques

  • Positive Approach to Care (teepasnow.com) - In-person and online training

  • Best Friends Approach to Dementia Care - Communication-focused training program

Organizations

  • Alzheimer's Association (alz.org) - Local chapters offer communication workshops

  • Family Caregiver Alliance (caregiver.org) - Communication fact sheets and webinars

  • AGS CoCare: HELP - Healthcare professional resources for communicating with patients with dementia

Next Chapter: Chapter 14: Safety and Home Modifications explores how to create a safe environment through home adaptations, fall prevention, and wandering management.

Related Chapters: - Chapter 10: Therapeutic Interventions - Validation therapy and reality orientation - Chapter 12: Daily Living and Caregiving Skills - Applying communication during care activities - Chapter 7: Managing Challenging Behaviors - Communication's role in behavior management