Today we have a guest Post from Christina Padilla, a speech-language pathologist and Certified Dementia Practitioner living and working in Evanston, IL.
Let’s face it: nothing about dementia is easy. It’s as hard on the individuals with dementia as it is on the people who love and care for them. But you can still maintain a rewarding relationship with your loved one by learning some communication strategies to improve your daily interactions throughout the progression of this disease:
- Focus on the relationship. It is better to be in relationship than it is to be right. Your loved one is going to say things that hurt or upset you, possibly even accusing you of things that are not true. It’s important to understand that this is part of their disease and does not reflect reality. Arguing or correcting them with a “reality check” will only lead to anger and agitation but attempting to enter their reality and understand the true origin of their feelings will deepen your relationship.
- Identify the underlying need. Given the communication difficulties people with dementia are experiencing, the words they say often don’t reflect the real message they are trying to convey. They may not be able to adequately verbalize when they need to go to the bathroom or feel hunger, pain, cold, loneliness, or sadness. They may feel they are living in a different time of their lives, as many people with dementia regress to an earlier time over the course of their disease. With a few well-placed questions and a little detective work, we can identify the need within their message and help meet it.
Having these two as a general grounding, use these tactics as you communicate:
- Apologize sincerely. This is not admitting to wrongdoing, but rather offering an apology for the distress they are experiencing. It is important that you be sincere if you use this strategy.
- This does not mean pretending something is true when it is not, but rather entering your loved one’s experience instead of denying it. If they are having an hallucination, you can ask them about what they see without pretending you see it too. If they accuse you or someone else, you can acknowledge it by saying, “You’re thinking I…” and then try a transition phrase such as, “Let’s figure this out.”
- Ask simple questions. Yes/no questions are too narrow and will often end the conversation but offering either/or choices (Are you hot or cold? Are you hungry or is it something else?) or asking simple open-ended questions (Can you tell me more about what you see?) is a good way to get more information. Often acknowledging your loved one’s feelings/experience is all they need, and you can gently redirect them by suggesting an alternative activity or segueing into a new conversation. If they feel heard and seen, they will usually follow your lead.
Here are a couple of examples of situations and ways to respond that can help give you more information about what might really be going on:
- Situation 1: “Someone stole my purse!”
Response: “You’re thinking your purse has been stolen! Let’s figure this out. Where do you usually keep it? Do you need something inside it or did you want to go somewhere?”
In this situation, you are not only acknowledging your loved one’s feelings, but also gently helping them to find the lost item while at the same time investigating why they need it. Maybe they are looking for a tissue, want to go for a walk, or are living in a past where it’s their job to do the weekly shopping. Once you figure it out, you can follow their lead or redirect (e.g., why don’t we take a walk to the corner store).
- Situation 2: “Help, I’m covered in ants! They’re crawling all over me!”
Response: “I’m so sorry, that must be very itchy! Why don’t we move to another chair and put on some of this lotion?”
In this situation, your loved one is hallucinating based on a physical stimulus, possibly feeling itchy or even pain. By acknowledging their discomfort and then offering a possible solution, you validate their experience while at the same time calming and redirecting them, and the outcome is much more pleasant than if you had tried to convince them there were no ants.
These are just a couple examples of how patience and your “detective skills” can improve your communication and deepen your relationship with your loved one living in dementia … remember that you are living with it and can walk away. They can’t. You won’t always get it right, and every day will present a new challenge, but the more you practice, the more easily you can flow along with your loved one’s experience, and your new understanding may just take you to some wonderful places!
Christina Padilla is a speech-language pathologist and Certified Dementia Practitioner living and working in Evanston, IL. She has spent the past 11 years working with adults with neurogenic disorders and disease and their families to improve communication, swallowing, and cognition for a better quality of life. If you wish to ask her a question or wish some help within your own orbit, please email by way of: info@creativecaremanagement.com .
Charlotte Bishop is an Aging Life Care Advisor, Geriatric Care Manager and founder of, certified professionals who are geriatric advocates, resources, counselors and friends to older adults and their families in metropolitan Chicago. She also is the co-author of How Do I Know You? A Caregiver’s Lifesaver for Dealing with Dementia.
