How to handle communication challenges

Communication can be frustrating for the person with dementia, and for their family, friends, and carer team who do not always know the best way to respond. We are often asked how to handle communication challenges and we say think – body language, facial expression, and tone of voice. Whenever you are talking to the person with dementia keep your body language open, your facial expression warm and cheerful, and your tone of voice light, positive, and confident. This will bring a sense of hope and reassurance to the conversation.

The communication challenges we’re asked about also tend to have some common themes so we’ve provided some answers and recommendations to questions carers ask us. We hope these are of help!

Why do they keep asking for their mum or dad?

For many people, parents mean comfort, security, and love. The person might be trying to experience these feelings again. If you think the person may be feeling insecure, comfort them and offer them reassurance.

Why do they keep talking about needing to go to work when they are no longer working?

The person may need to feel a sense of purpose; that they are useful and needed. Help preserve independence by encouraging the person to take part in household activities, such as dusting or drying up, even if it’s not done the way that you would like it.

When they’re feeling sad or angry they can’t explain why – how can I help?

It could be a sign of unidentified pain or an irritant about the environment the person is in. Check the temperature of the room and environment. Check for signs of bruising, redness, unusual swellings, or other conditions like arthritis, toothache or headache. Seek advice from a GP about pain relief. You could also validate the person’s feelings by saying, “You look sad about something”.

Why do they keep asking to go home when they are at home?

The person might be missing a sense of safety, security or familiarity. Having a look at some familiar things could help, e.g. old photos or videos, or items around the home. Talk to them about their ‘home’ and give some reassurance.

Why are they having difficulty finding the right words?

Having difficulty finding words maybe a direct result of changes to the brain, specifically the temporal lobe. It could also be due to tiredness, distress or a noisy environment. Give the person plenty of time to reply and use pictures and notes if you can. Listen very carefully to the person, watch their body language, and reduce external distractions.

When I speak they look confused and don’t understand me – why is this?

This could be due to a lower level of understanding, difficulty with concentrating, or too many distractions. Be reassuring and gentle. Try saying or asking in a different way. Give the person time. If appropriate, use touch.

Why are they withdrawn and unresponsive?

This could be due to difficulty with understanding or an inability to express themselves due to language problems, temporal lobe damage, or possible depression. Face the person, gain eye contact, and pace the conversation. Don’t give too much information or ask too many questions. Investigate whether depression could be an issue for the person through a visit to the GP.

They keep asking me who I am and why I’m in their house – why?

People with dementia lose recognition of familiar people, faces and their environment; this can be due to fear or memory changes. Try to understand the person’s reality. Remove yourself to another room for a few minutes and re-enter calmly and say something like, “Hello, I’m back now, lovely to see you.”

If the confusion occurs suddenly it could be indicative of an infection or physical ill health causing some confusion, which may need medical intervention.