Communication can be complicated between any two people – and when one has memory loss, it can be even more challenging. After a lifetime of communicating with someone in a certain way, finding that it no longer works can be demoralizing or frustrating for both people. However, it is possible to learn how to communicate in new ways that can be both effective and satisfying.
Memory problems affect everyone differently, and there aren’t any one-size-fits-all solutions to the challenges it can bring to communication. Choose the tips below that apply to your situation.
Cognitive conditions can affect memory differently at different points in time, so it’s common for people with memory loss to find that some approaches may work better one day over another. It may help to review these tips periodically, and try out new strategies every so often.
Set Up for Successful Communication: If you set up a conversation for the best chance of success, you can make a big difference in how well it goes.
1. Find the right time – for both of you
- It’s more difficult for people to express themself, and to understand what is said, when they are tired, stressed, or not feeling well.
- When possible, arrange important conversations for a time of day that your loved one is at their best.
- A good night’s rest, a full stomach and an empty bladder can go a long way in helping someone feel relaxed and comfortable.
- Many people with memory loss pick up on others’ emotional energy and start sharing their feelings.
- Do your best to keep a positive perspective and realistic expectations.
- If you’re feeling stressed, rushed or irritated, it’s probably not the best time to engage in conversation. Take a moment to relax before you begin, or briefly excuse yourself as needed to calm down. Take some deep breaths and consider what’s really important in this interaction.
2. Reduce distractions
- It’s much harder to concentrate on a conversation when there is a lot of activity in the room.
- Find a quiet corner, turn off the television and background music, close doors to busy hallways, or do what you can to create a comfortable, distraction-free area to converse.
3. Make sure you have their full attention, and give them yours
- Maintain eye contact and listen attentively. Take in their words as well as their facial expressions, body language and other non-verbal communication to best understand their message.
- Stay at or below their eye level by sitting or kneeling. Standing over them can feel intimidating.
- If they wear hearing aids, be sure they are charged and in use. If your voice is higher-pitched, try to speak in a lower tone if your loved one has hearing loss.
Be Present with Them – Wherever (and Whenever) they Believe They Are
People with dementia or memory loss may sometimes become confused about what’s real or where they are in time.
1. Join them where they are
- Some types of memory loss lead people to believe they’re younger than they really are, or that a family member who has passed away is still alive. In most cases it’s best to simply join them where they are without correcting them.
- If they’re asking if someone has died, it shows that they remember it on some level. Tell them yes, and give them the emotional support they need to process their loss.
- If they don’t remember someone has died, it’s a clue that their brain can’t handle the loss right now. Tell them something like “We’ll see them later” or “They’re not here right now”, and then focus on addressing the underlying feelings.
- Are they feeling uncomfortable or insecure and seeking the comfort and security they feel in the presence of that person?
- Reminisce about the person to stir up comforting feelings.
- Address the underlying cause of discomfort, such as pain or fatigue.
2. Speak about what can be seen
- When talking to someone with long-term memory loss it helps to speak only about what can currently be seen, rather than referring to people or things that aren’t here right now.
- Look at pictures to spark new memories or conversation.
- Create a life story album or photo memory box with notes or captions listing names or details about each picture.
- Create a communication board with images of daily activities and essentials, such as a toilet, food or drink. Point to an image to communicate when words fail. (Walking to the bathroom itself, or show them the food or a drink may work best of all.)
3. Repetitive questions
- If they are asking the same question repeatedly, they are seeking reassurance for something that is concerning them. Answer each question as if it's the first time it was asked.
- Writing a note may help, but sometimes it creates more anxiety.
- If the person becomes distressed about upcoming appointments or events, avoid telling them about it too far ahead of time.
Look and Listen for Feelings
It’s often helpful to listen and respond to the emotional message beneath the literal words themselves.
1. If you don’t understand what they’re saying
- Ask yourself what they need from the interaction. Are they just trying to connect, or are they expressing a need or concern?
- If they are trying to connect, non-committal responses can help them feel heard.
- “Tell me more about that.”
- “Oh, yeah?”
- Echo back a few of their words
- If they are trying to express something they feel is important show them you take their concerns seriously.
- Mirror their facial expression, make eye contact and listen attentively.
- Show them that what they’re saying is important because they are important. Help them feel you’re taking care of the problem. Be careful not to make them feel you’re dismissing their concerns, even if you know it’s not based in reality.
- Distractions often don’t work when people are really concerned about something. First, help them feel their concern is being addressed, and then they’ll usually be more open to redirection.
- Validating and naming their feelings can help them feel understood.
- “This is really hard, isn’t it?”
- “I would be upset too if that happened to me.”
- “It looks like you’re feeling really frustrated. I can understand why.”
2. Memory loss often makes people feel frightened, vulnerable and insecure
- Offer plenty of sincere praise and compliments. They can tell whether or not you’re being sincere.
- Allow them to express their negative feelings in a healthy manner.
- If they seem to be stuck in negative thoughts about the past (rumination) or about the future (worry) it’s probably not healthy. Distraction, exercise or a change of scenery may be a better option.
- Sharing humor and singing are ways to communicate that can reduce stress.
- Protect their trust in you.
3. Treat them with respect
- Don’t talk about them to others as though they aren’t in the room. Speak directly to them.
- Allow them time to find their own words. Don’t interrupt or be too quick to fill in their words when they struggle to find them. If they are getting frustrated or want help it’s fine to suggest a word.
Use Fewer Words
The brain needs extra time to process thoughts and information with most memory impairing conditions. Minimize the amount it needs to process – and allow ample time for it to do so. It can make all the difference between understanding or getting overwhelmed and frustrated.
1. Use fewer words and simpler sentences
- Speak a little slower, and enunciate clearly.
- Use a natural rhythm and a respectful tone.
- Keep explanations brief.
2. Avoid “trigger” words
- For many people, the words “No”, “Don’t” and “Can’t” will trigger resistance. For others, words like “shower” can do so.
- Find alternate ways of saying things to avoid triggering resistance, or simply don’t speak of them at all. (Many tasks can be accomplished without ever speaking about them.)
3. Become comfortable with silence
- It can feel awkward to sit together without filling every moment with chatter, but processing all these words takes a lot of energy for many people with dementia or memory loss.
Take the Pressure Off
Having memory loss is often exhausting, difficult, embarrassing or frustrating. The more pressure you can relieve from your interactions, the better they will function, and feel.
1. Don’t rush
- Allow plenty of time for them to process their thoughts and respond.
2. Don’t test their memory or highlight forgetfulness. Give them hints and clues instead
- Avoid questions, which can trigger feelings of stress, embarrassment or failure if they don’t know the answer.
- Questions can cause the brain to confabulate – to unconsciously make up information that may not be true in order to fill in gaps in memory.
- Instead of asking a question, try sharing a thought or memory of your own to stimulate conversation without putting them on the spot.
- Avoid pronouns such as “it”, “he” and “she” when possible. Instead use the name or specific noun to make it easier for them to follow what you’re saying.
- Don’t ask if they remember you. Instead, give them clues such as, “Hi, Mom, it’s me, Nancy!” This type of additional information can be helpful.
3. Avoid correcting them
- Don't correct their word choices if you know what they mean. If you need clarification, ask them to tell you more about it, or ask, “Do you mean….?”
- Avoid correcting mistakes that don’t matter in the big scheme of things. If you feel correcting them is important in a certain circumstance, be careful to preserve their dignity. How would you correct your boss in front of a room full of people?
- Never argue.
4. Avoid overwhelming them
- Offer limited choices. Too many choices can be overwhelming, but asking which of two options they’d prefer can give them valuable choice and control to choose the right word.
- “Yes / No” or “Either / Or” questions are easier to answer than open-ended questions.
- Remember that people with memory loss can’t always answer yes or no reliably. If they say “yes” with their words, but their actions or body language says “no”, that’s the answer.
- Break questions or tasks into small parts, and address only one at a time.
Master Non-Verbal Communication
A huge part of communication is nonverbal, and this becomes all the more important when talking with someone with memory loss.
1. Tone of voice
- Your tone of voice conveys a lot about how you are feeling and how you regard the person.
- Avoid speaking harshly or interacting when annoyed or irritated. It’s hard to hide these feelings from someone with memory loss. Do your best to let these feelings go and connect with sincerity, patience and respect.
- Take care of your own needs and well-being to avoid building up negative feelings like resentment or irritation.
- Avoid talking down, speaking in a condescending tone, or treating them like children.
- Always convey respect and treat the person like an adult.
2. Visual cues and gestures
- Give them clues in the form of visual cues and gestures.
- Sit down and pat an empty seat where you want them to sit.
- Look for clues about what’s on their mind. What are they looking at? What is happening (or has recently happened) around them?
3. Facial expressions and body language
- Pay attention to their facial expressions and body language to gain valuable information about how they are feeling.
- Pay attention to your own facial expressions and body language to notice what messages you are sending about your own feelings or intentions.
- Smiling, open arms and hands indicate trust and a willingness to connect.
- Crossed arms, rolling eyes and sighing heavily can indicate irritation.
- A rapidly tapping foot, or rushed movements can indicate impatience and can create anxiety.
4. Behavioral communication
- Behavior is often the only way they have to communicate their needs and emotions.
- Ask yourself: what are they trying to communicate with this behavior? Which needs may be unmet? Are they hungry, uncomfortable, bored, depressed or ill?
- If they are saying “no” or pushing away care it’s important to stop and respect their wishes. Try again with a different approach in a bit, if needed.
- Touch can be an effective way for caregivers to convey affection, comfort and reassurance.
- A gentle touch on the arm or squeeze of the hand can refocus their attention when you need it.
Remember: There are a number of medical conditions that can cause your loved one to experience memory loss. Whether they are in the early stages of Alzheimer's Disease or have another type of health condition that has led to Cognitive impairment or cognitive decline, such as Parkinson's Disease or other Types of Dementia, memory loss is difficult for all caregivers.
It is always important to keep up with your own personal care and mental health while you care for your older adult. Living a healthy lifestyle and incorporating self care and. support groups into your daily life are key.
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