Patient and Family Education

The Great Eight Communication Tips
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Communication between people is basic and instinctive to human nature. Unfortunately communication through language is challenging when caring for or talking with people who have dementia. Below we describe the "Eight Great" tips for effective communication for dementia. If you practice them, your listening and caring skills will improve.

1 Avoiding speaking slowly. “Working memory” is a system for temporarily storing and managing information required to carry out complex cognitive tasks. For most people who have dementia, working memory holds information for just seconds. If you speak too slowly, the words can get lost before they are comprehended.

2 Start with the main point. Sometimes called “right-branching” sentences, the main clause should come before a subordinate one. Here is an example: “Sit here and eat dinner.” The first directive is to “sit here.” Avoid “left-branching” sentences that place the subordinate clause first or in the middle. When you use left-branching sentences, the listener has to wait to hear the main point. Here is an example: “If you want to eat, you should sit here.” Right-branching sentences place less demands on working memory.

3 Minimize background noise. It is estimated that significant hearing loss among older people is common. For those who are ages 65-75, approximately 30-35% suffer from meaningful hearing loss. Prevalence rates increase for those who are older than 75. In this age category, hearing loss is approximately 40-45%. Ambient noise just makes hearing more challenging. Try to have conversations in quiet places. To sensitive yourself, assume that the listener hears less well than you do. If you are having trouble hearing, find another place for the conversation.

4 Nonverbal behavior should match verbal behavior. We provide cues to our thoughts and feelings through nonverbal behavior. If our behavior doesn’t synch with what we are saying, listeners with dementia can become confused. Therefore, pay attention to both verbal and nonverbal communication. Avoid “disconnects” such as walking away from the listener while you are talking. If you want to have a meaningful conversation, don’t watch the television and talk with the listener at the same time.

5 Eyes to eyes, lips to lips. Both to improve hearing and to communicate that you want to understand, mirror your position with that of the listener. If she is sitting, you sit. If she is standing, you stand. Make sure you are face-to-face. If you are talking to someone in a wheelchair, find your own chair and sit directly in front of the listener.

6 Keep it concrete. When talking with an older adult who has dementia, use short, concrete, and direct statements. For those with dementia, abstraction abilities have typically eroded. Metaphors, vague statements, and circular reasoning are confusing. Better to say: “Take your pill at night” than: “So you don’t wake up during the night, take your pill before you go to bed.”

7 Am I making sense? Decoding language and responding in kind is a complex process. It requires many functioning parts of our brains; parts that are often disabled by dementia. We recommend that you periodically check and make sure that the listener understands you. Think about this analogy—Understanding a conversation for a demented person is like you starting a novel on page 100. You have to work very hard to understand the plot.

8 Repetition is good. If you spend time with an older adult who has dementia, you will frequently hear the same questions and statements often repeated. This can be frustrating and hard to deal with. We recommend that you think about repetition more positively. Rather than feeling annoyed, interpret repeated statements and questions as the demented person’s attempt to communicate with you and remember. Try to answer repeated questions using variations in your answers. Repetition is good.

There are many other important communication strategies. We have listed only eight that have been particularly useful. Language is complex, and there are many important considerations to effective communication with persons who have dementia. Be on your guard for ageist statements, cultural insensitivities, and negative stereotypes, as they certainly can interfere with meaningful communication. We hope you find the “great eight” useful. Let us know what communication tips you use and prefer.

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