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Stop the Frustration! Ten Tips for Communicating with Someone who has Dementia

As caregivers, we often use intuition to help us decide what to do. No one ever gave us lessons on how to relate to someone with memory loss. Unfortunately, dealing with Alzheimer's disease and other dementias is counter-intuitive—that is, often the right thing to do is exactly opposite of what seems like the right thing to do. Here is some practical advice:

  • Being Reasonable, Rational and Logical May Just Get You into Trouble. When someone is acting in ways that don't make sense, we tend to carefully explain the situation, calling on her rational side to get compliance. However, a person with dementia lacks the capacity to reason properly, so she does not respond to our arguments, no matter how logical. Straightforward, simple sentences about what is going to happen are usually best.
  • People With Dementia Do Not Need to Be Grounded in Reality. When someone has memory loss, he often forgets important things (for example, that some family members are deceased). When we remind him of this loss, we remind him of the pain of that loss also. Redirecting and asking someone to tell you about the person or thing he has asked about is a better way to calm a person with dementia.
  • You Cannot Be a Perfect Caregiver. You can't be perfect—you have the right to the full range of human emotions, and sometimes you are going to be impatient or frustrated. Learning to forgive your loved one as well as yourself is essential in the caregiving journey.
  • Therapeutic Lying Reduces Stress. We tend to be meticulously honest with people. However, when someone has dementia, rigorous honesty can lead to distress both for us and the one we are caring for. It's okay to tell your loved one that the two of you are going out to lunch and then "coincidentally" stop by the doctor's office on the way home to pick something up as a way to get her to the doctor.
  • Making Agreements Doesn't Work. If you ask your loved one not to do something ever again, or to remember to do something, it will soon be forgotten. It's often better to adapt the environment to the care receiver rather than the other way around. For example, getting a tea kettle with an automatic "off" switch is better than warning someone of the dangers of leaving the stove on.
  • Doctors Often Need to Be Educated by You. A doctor cannot tell during an examination that your loved one has been up all night pacing. And remember that doctors sometimes, too, need to use therapeutic lying; for example., telling the patient that an antidepressant is for memory rather than depression.
  • You Can't Do It All. When people offer to help, the answer should always be "YES." Have a list of things people can do to help you, whether it is bringing a meal, picking up a prescription, or staying with your loved one while you run an errand. It is harder to ask for help than to accept it when it is offered, so don't wait until you "really need it" to get support.
  • It Is Easy to Both Overestimate and Underestimate What Your Loved One Can Do. It is often easier to do something for our loved ones than to let them do it for themselves. However, if we do it for them, they will lose the ability to be independent in that skill. On the other hand, if we insist individuals do something for themselves and they are unable, we just increase frustration on both sides. It's a constant juggle to find the balance, which may shift from day to day.
  • Tell, Don't Ask. Asking "What would you like for dinner?" may be asking our loved one to come up with an answer when he might not have the words for what he wants, might not be hungry, and even if he answers, might not want the food when it is served after all. Saying instead, "We are going to eat now," encourages the person to eat and doesn't put him in the dilemma of having failed to respond.
  • It Is Perfectly Normal to Question the Diagnosis When Someone Has Moments of Lucidity. One of the hardest things to do is to remember that we are responding to a disease, not the person who once was. Everyone with dementia has times when they make perfect sense and can respond appropriately. We often feel like that person has been faking or that we have been exaggerating the problem when these moments occur. We are not imagining things; our loved one is just having one of those moments, to be treasured when they occur.

See the fact sheet from Family Caregiver Alliance, Caregiver's Guide to Understanding Dementia Behaviors, for more information.

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