Talking to Loved Ones With Dementia

As a death doula, I have many clients living with dementia. During every visit, I try to engage my clients in conversation. Our loved ones with dementia often feel abandoned, ignored and overlooked. Conversation is a vehicle for connection, for dignity and for compassion.

First, Go With the Flow

One way to connect with someone with dementia is to go with the flow. You may not understand what your loved one is saying. It doesn’t matter. Respond with something that seems to make sense in their world:

“There, there….a rabbit with a red hat. He’s going to the meeting.”

“Oh – the red hat looks good on him. I hope he enjoys the meeting.”

Another way to connect is to gently draw someone into the current moment in the environment they are in:

“Victor, I see you are looking at a book about hockey. Did you play hockey when you were younger?”

“Yes, yes I did.”

“Oh, wonderful! Did you enjoy playing hockey?”

What Do the Experts Say?

The NHS in the United Kingdom has published some great tips for engaging in conversation with people living with dementia:

• Speak clearly and slowly, using short sentences
• Make eye contact with the person when they are talking or asking questions
• Give them time to respond because they may feel pressured if you try to speed up their answers
• Encourage them to join in conversations with others, wherever possible
• Let them speak for themselves during discussions about their welfare or health issues
• Try not to patronize them or ridicule what they say
• Acknowledge what they have said, even if they do not answer your question or what they say seems out of context – show that you’ve heard them and encourage them to say more about their answer
• Give them simple choices – avoid creating complicated choices or options for them
• Use other ways to communicate – such as rephrasing questions because they cannot answer in the way they used to

The Alzheimer Society of Canada also has some great tips for communicating with your loved one:

• Use what you know about the person 
• Reduce Distractions
• Chat face-to-face
• Be flexible
• Stay positive 

Tips for Compassionate Conversations

In addition to the great advice posted so far, my personal advice is the following:

Do not test your loved one by asking if they remember who you are or what day it is. Instead, offer information. Can you imagine how frustrating it would be if every conversation were a test of your cognitive abilities? I like to greet someone with dementia by saying something like, “Hi, Doris! I’m Laura. I can’t believe it’s been ten days since I last saw you!” With this greeting, I gave the person my name; it was the last time we saw each other. Leave the cognitive testing to the care team, and try as often as possible to add orienting details to your conversation. 

Do not disagree. We tend to use logic to bolster our arguments when we disagree. For people who have dementia – especially at an advanced stage – logic is something that is not in the cognitive toolbox. Do not try to correct a person about what they had for dinner, what day of the week it is, or whether their mother is still alive. Unless it is something that might result in harm or danger to your loved one, let them be right. 

Talk directly to the person instead of with someone else about that person. For example, far too often, I see an elderly person or person with dementia completely ignored while their health and well-being are discussed. Whenever possible, I try to redirect that conversation back to the person being talked about:

“How did Suzy sleep last night?”
“Let’s ask Suzy! Suzy – did you sleep well?” or,
“Suzy – I think I know the answer to this question. Do you mind if I tell Deborah how your sleep was last night?”

Laughter is good for the soul. Conversations that lead to laughter or giggles make our hearts feel good. Tell a joke or reminisce about something funny that happened years ago. 

I like to say that people won’t remember your name or who you are, but they WILL remember how you made them feel. Add love and compassion to your tone when you speak. Help a person with dementia feel cherished and loved. I can guarantee that every person with dementia is desperate for more love and more connection. 

An Opportunity to Learn More

If you want to know more about communication, managing difficult behaviours or about how to provide compassionate care, please consider registering for my virtual or face-to-face Death Education Workshops. I have an entire workshop on dementia and you will come away with valuable information that you can use – immediately – to create a closer connection with your loved one.

The Power of a Good Chat

When we can laugh together, it enriches all of us. These conversations are shared with the intent of showing the value, wisdom and dignity of human beings. Through sharing the conversations, we can learn how to speak with our loved ones living with dementia in a way that is meaningful to them. This post is not meant to harm or tease any human being. 

Contemplating the Afterlife

Rich: Where are we?

Laura: We are at XXX

Rich: How long have I been here?

Laura: I am not sure, Rich, but I did hear that you have been here a couple of years. 

Rich: Oh. That’s a long time. Nothing happens here. The walls are white. I feel like I am waiting for something.

Laura: I understand.

A few minutes later…

Rich: Where am I? Am I dead?

Laura: No.

Rich: How do I know?

Laura: Well, right now, you are eating a muffin. Would you eat if you were dead? 

Rich. I’m not sure. I might. 

Laura (bringing another resident into the conversation): Steve? Do you think we eat in heaven?

Steve: No. I think we drink rum and smoke cigars.

Rich: Amen to that. But I don’t think we are in heaven yet. 

Laura: Rich, what do you think heaven looks like?

Rich: I don’t know. What do YOU think heaven looks like?

Laura: I imagine beautiful trees, lakes and flowers.

Rich: Sounds like Muskoka. 

Laura: That would be all right with me. Steve, what do you think heaven looks like?

Steve: A parade of naked women.

Laura: Fair enough.

Rich: Am I alive?

Laura: Yes.

Rich: How do I know?

Laura: Are you breathing?

Rich: (takes a deep breath). I am. I still don’t know where I am, though.

Laura: That’s OK – as long as you feel safe. 

A few minutes later…

Rich: Where is heaven?  And where is hell?

Steve: Heaven is where the naked women are.

Laura: Well, I think heaven and hell are right here on earth. 

Rich: Right here, right now?

Laura: Sure. If we have a bad attitude, and find fault in everything, and wake up miserable, that feels like hell, right? And, if we think of the glass as half full, wake up happy, and things are sunny-side up, we are in heaven.

Rich: So….heaven is an egg.

Steve: Why did the chicken cross the road?

Rich: To get out of here! (laughter ensues)

Rich: Am I dead?

Laura: No.

Rich: Is HE dead (points at Steve)

Steve: If I was, you would be a naked woman. 

Rich chortles. 

Rich (looking at Laura): So, I am not dead. And as far as I know, I’m not a woman.

Laura: Fair assessment

Rich: I was an engineer. I had to be analytical

A few moments of silence while we all contemplate life….

Rich: Hmmm. I have been here a long time. Nothing is happening. Everything is white. Rich looks at me and at Steve. He surveys the room carefully. Suddenly, his whole face brightens with a flash of realization.

Rich: I got it! I understand!

Laura: What?

Rich: I AM IN ….PURGATORY! (look of triumph for having figured it out)

Rich, pointing at Steve and I:  AND YOU ARE STUCK HERE WITH ME!

Steve: I am pretty sure that Elvis is here, too.