Communicating With Dementia: Avoiding Distress and Irritation

Dementia comes with many new behaviors that may upset both you as the caregiver, as well as the person with dementia. Not all situations are preventable but having a few tricks up your sleeve to lessen irritation will calm and soothe everyone involved more quickly. Keep in mind that just because a person with dementia’s ability to clearly communicate diminishes, their needs do not. Often calling out in distress or anger are clues that some need is going unmet. As a caregiver, it is your job to put on your detective’s hat and get to the root of the unmet need. As a set of general rules, when attempting to calm a person with dementia, there are a few things you can do to prevent agitation.

• Connect: In any interaction, especially one that is task oriented like dressing, bathing, or feeding, take a brief moment to connect. Don’t just rush in front of them and get right to the task at hand. A brief 30-seconds to form a connection and allowing them to feel secure will pay big dividends. Greet them warmly by name. Ask how they are doing. Is there anything they need? Then you can suggest what task needs to be completed and have a higher likelihood they will be cooperative.
• Look level: Speak with them at their eye level. Sit, kneel, or squat to allow them not to feel intimidated by a figure towering over them.
• Hold their hand: Convey security and safety by holding their hand, preferably their dominate hand.
• Speak simply: Don’t use lots of words and speak simply.

Approach and non-verbal actions make a big difference. Here are some ways to approach daily activities of living.

• Grooming: Greet them. Again, it’s important to connect with them at their eye level. Bring them to the bathroom or in front of a mirror. Give them grooming supplies and the choice to do things for themselves. You can first guide their hand in a “hand under hand” manner with your hand around theirs and the brush, toothbrush, etc. as you complete the task together. Offer encouragement. Ask what they’d like to do next. Guide them through the movements. Cue them step-by-step and offer assistance when needed. Visual cues are easier to understand.
• Dressing: Greet them, don’t rush in, and, again, get at their level. Hold their hand. Ask if they have any needs. Suggest changing clothes and assist them up. Ask them to choose between one of two items to give a sense of independence. Explain each step of changing. Compliment them. Use few words, so you don’t confuse them.
• Meals: Greet them. Ask to dine with them. Take their hand. Describe what is there. Ask what they would like first. See if they will pick up the utensil. If this is difficult you can hold their hand in yours “hand under hand” and feed them. Tell them when another bite is coming.
• Distress: Go to them and suggest finding a solution to their problem. Take their hand. Ask them for details or to see a photo of the person if they are not there. Ask questions about the concern they are having. Begin to change the topic and redirect them gently. Remember that they are not able to fully express underlying needs. The important thing is to let them know you are there to help.

Additional techniques that can calm and soothe are the following:

• Arm pumping: Grasp their hand firmly and gently pump their arm to calm them down. From here, you can repeat saying the action you would like them to do, and the rhythm of your command will also soothe them.
• Deep exhaling: This is useful when the person with dementia is urgently upset. Get them to breath out in strong exhales to relax their ribcage. Take their hand in between both of your hands. Pump their arm and gently squeeze their hand, noting that their dominant hand will be preferred.

Remember, everyone is different. Be gentle and patient with yourself and find the tips that work best for you and your loved one.   Colleen Kavanaugh was a caregiver for a decade to both parents who lived with Breast Cancer, Alzheimer’s and Parkinson’s diseases. She’s now a Certified Dementia Practitioner and Certified Dementia Communications Specialist who advocates for and empowers family caregivers in all areas and stages of care. You can learn more about Colleen at www.thelongestdance.com.