Better Communication in Dementia Care

Are you caring for a loved one with dementia? You don't have to figure this out all on your own. Welcome to Truth, Lies Alzheimer's, the show that helps you reimagine a new relationship with your loved one, a relationship a little more free of stress and anxiety. Join host Lisa Skinner and her 30+ years of experience as she guides you on a new path to a better relationship with those you care for. Here's Lisa.

Hello everyone, welcome to another new episode of The Truth, Lies Alzheimer's Show. I'm Lisa Skinner, your host. I'm genuinely excited today to have you all here spending part of your day with me so I can share some more insightful information with y'all that I believe can help you communicate better with your loved ones living with dementia. Today's episode is called Common Communication Challenges in Dementia Caregiving and Effective Solutions that I am going to share with you. As most of us listening today are aware, we know dementia is a progressive decline in memory, in thinking, in behavior, and the ability to perform daily activities that are severe enough to interfere with living an independent life. What happens in dementia? Well, damage to brain cells affect not just short-term memory, but language, judgment, orientation, personality and behavior, and many, many other cognitive functions. Some of the key symptoms are, and this is just a couple of examples, there are many, many, many of them. In the early stages, forgetting recent events, misplacing items, difficulty finding the right word to insert into a conversation or a sentence, and getting lost in familiar places. Towards the mid-stage of dementia, we start to see confusion about time and place. More difficulty with daily tasks, personality changes, sometimes extreme, and poor judgment. And then in the latter stages, we will see severe memory loss, loss of speech, the inability to recognize family members, and becoming fully dependent on others for our care. Now, some of the red flags that you should be aware of that are not considered part of the normal aging process is a rapid decline, extreme personality changes. You might notice somebody having a lot of difficulty managing their finances or their medications, getting lost frequently. And as a result of this continuation in cognitive decline, communication between family members, care, care partners, and the people living with dementia becomes increasingly challenging. And I know a lot of you have already experienced that. Well, I'm going to tell you about a 90-second rule in dementia care, and that is a communication strategy allowing individuals 60 to 90 seconds to process information and respond to the requests we're making of them. And this 90-second rule reduces frustration and agitation. And the reason why is because dementia impacts our brain processing speed. So caregivers should wait at least 90 seconds after asking a question or giving instructions before repeating them or acting upon them. So let me, let me share with you the key aspects of this 90-second rule. In terms of the processing time, people with dementia often experience significantly delayed cognitive processing. Therefore, allowing them at least 60 to 90 seconds to process your words can help them from feeling overwhelmed by having too many words thrown at them all at once and too quickly. So what does that do to help? Well, it reduces agitation. Allowing this pause prevents re-triggering or overwhelming the person, which can cause them to become extremely upset or even shut down. It encourages their independence by giving them time to understand and complete a task, like for example, putting on a jacket themselves. Let them try it themselves first. If you see them struggling, of course that can cause frustration and anxiety, but that is when you could step in and help, but let them try it first. Rather than having the caregiver immediately do it for them. It offers better communication abilities. If no response occurs after 90 seconds, we recommend using nonverbal cues, tactile prompts, or break down the request into smaller steps. It's really vital for caregivers to understand that dementia is a physical breakdown. Affecting their comprehension. And it's not just memory loss. So implementing this technique can and will be extremely effective for you. As people living with dementia continue to decline cognitively and as they progress through the stages of the disease, communication with them does become increasingly challenging in dementia care. You can expect that. So what I've done here is created a variety of scenarios for you to illustrate some of the situations that can and do arise in your daily dementia caregiving journey. And they follow a consistent structure that you can implement into your daily routines. Each one of these scenarios includes what the issue is at hand, a brief scenario, an effective solution, and a practical action, along with a takeaway for family members and caregivers. So in this first group, I'm going to illustrate scenarios that represent language decline and understanding. So number 1, the issue is progressive language loss makes basic needs hard to express. Here's a scenario for you. A 79-year-old with Alzheimer's increasingly struggles to name objects and express when he's thirsty, hungry, or experiencing pain. So what happened here is the caregiver misinterprets his silence as agreement and misses his cues. So an effective solution here is to use yes or no questions with clear, concrete choices. Pair the questions with nonverbal cues such as gestures and pictures. Maintain a pain symptom checklist that the person can point to. And the takeaway for you all here is when words fail, rely on simple choices and observable signals. Keep a calm, patient tone to reduce anxiety. The second scenario. The issue is this person has word-finding troubles causing her frustration, and that results in miscommunication between her and her caregiver. This person has vascular dementia, and she often pauses mid-sentence, then becomes frustrated, and her caregiver fills The situation in with assumptions leading to mismatched actions. Very common. So here's an effective solution for you. Accept these pauses as part of her processing the information. Give her extra processing time and use broad nonverbal prompts So point to an item, show her some options, validate her attempts even when her words are imperfect. And the takeaway here is patience and validation prevent misinterpretations and preserve dignity during your conversations. Third issue, repetition. We all know about that, and script like speech. The scenario here is that a parent repeats the same question about when a doctor is going to visit despite being given repeated reassurance about that appointment. Well, here's an effective solution that you could try. Acknowledge the underlying need. Like certainty and routine, and provide consistent script and a visible schedule. Offer a short, concrete answer plus a shift to a different task. Get their mind off of that one. So good takeaway for you here is repetition often signals a need for reassurance and routine. Structured responses reduce frustration for both of you. In this group, we're going to address nonverbal communication and cues. So let's discuss the first issue in this group: misinterpreting nonverbal signals. A loved one becomes agitated when the caregiver's body language appears rushed or closed off This happens daily. So an effective solution for this situation: use open posture, a soft voice, slow your pace down, mirror their expressions of calm, and avoid rushing or interrupting them. Accompany speech with a gentle touch if appropriate. Make sure they're okay with being touched. And a good takeaway here is that nonverbal warmth and presence convey safety and respect, and often much more effectively than words. Okay, next issue. This one deals with ambiguity conveyed by tone rather than content. A caregiver's brisk tone makes a simple instruction feel like a demand, triggering resistance on the part of the person living with dementia. An effective solution here is to use a warm tone and phrasing like, "Would you like to blah blah blah?" and pair it with a gentle hand gesture or demonstration. The takeaway for this is that your tone can override content. Soft, collaborative language does support cooperation. Next issue: having difficulty interpreting sarcasm or jokes on the behalf of the person living with dementia. So a person with dementia, we've probably all been there, done this, may often misread humor and feels mocked, which can lead to extreme withdrawal. They feel embarrassed. Like, 50% know that they have cognitive issues anyway, so it's just kind of rubbing salt into the wound, if you will. So an effective solution for that scenario is to stick to straightforward, positive statements and use humor carefully. And I'm not saying don't use it, 'cause everybody loves humor. It lights us up. Just be careful in how you present it, ensuring that they're gentle and clearly non-targeting. Their deficits. Monitor reactions and back off if misinterpretation does occur. And the takeaway here is humor's great, but it should be simple, kind, and clearly non-threatening to avoid their confusion. So we're on Group C, which involves reading and visual processing challenges. So this is the issue at hand: difficulty following spoken directions. And here's a scenario to illustrate this. Instructions like, "Eat your lunch before we go outside" become confusing because their ability to process words slows down dramatically. So the effective solution for this: break those instructions into single sequential steps. Pair the verbal directions with visual cues using pictures or checklists or colored arrows, for example. And the takeaway for this scenario is that visual cues support and complement spoken language, and as a result, reduce cognitive overload. Next issue: trouble with multi-step tasks. And eventually this will begin to occur as they progress through the stages of dementia. So let me give you an example. Getting dressed. Becomes disorienting when asked to choose items or give them shirts that need to be buttoned, tying shoes in one breath. So make it simple. An effective solution: just offer them one-step choices at a time. Demonstrate each step to them, but let them do it. Use labeled containers and labeled clothes arranged in order. But what's your takeaway here? Sequential prompts and demonstrations preserve their autonomy while minimizing their confusion. Okay, we have just a few more to get to now. This one is, uh, having difficulty with abstract language or figurative speech. And keep in mind that every one of these issues that I'm going over with you today are real issues that show up with dementia very commonly. So these are everyday occurrences that you could be prepared for if and when they do occur. So this scenario involves a person living with dementia, She may misunderstand your expressions like, "Oh, it's a piece of cake," and that could cause confusion or embarrassment. There may have been a time where she knew what that expression meant, but with cognitive decline and malfunction, she's probably going to think it's something literal and will be very confusing. To her. So an effective solution is to use literal language and avoid idioms and adages. Confirm understanding with a simple recap. The takeaway: plain language reduces misinterpretation and embarrassment. And then Group D, we're going to cover behavioral communication and de-escalation. Here is the second to last issue, or no, there's two more, and this one pertains to communicating during agitation or aggression. And here's a scenario to illustrate this situation. A person with dementia all of a sudden becomes verbally aggressive. Because the routine changed. They like routine because it represents familiarity, safety, and security to them. So the effective solution, if they are feeling this way, they just are at a loss because something has changed that's not familiar, acknowledge their feelings first because that's what they are going to react on first is emotion. All logic has pretty much gone by the wayside. Validate that they're safe and calmly describe what the upcoming plan is to reassure them. And then you can offer two simple choices to regain their sense of control. So takeaway for this one, calming language. And actionable choices do help de-escalate tension. Next one. The issue: communicating with someone who's new to a care setting. So in this scenario, a new memory care resident seems withdrawn and misreads the staff, leading to fear and resistance to the care. So, here's an effective solution: introduce staff by their name and their role, use a consistent daily routine, assign a friendly staff anchor for the resident, and use familiar objects from their home to ground conversations. Once again, and I've mentioned this several times already today, takeaway: familiarity, familiarity, familiarity, consistency, consistency, consistency, and clear instructions. These will ease transitions and build trust between you. And our last scenario is Dealing with language barriers and cultural considerations. A caregiver from a family with limited English proficiency navigates medical questions and care instructions. Sometimes that can be difficult. What's the saying? Lost in the translation? Yeah, something like that. So an effective solution: request an interpreter. There's a service by an interpreter or bilingual staff. Translate essential documents. You can use culturally relevant visual aids and plain language materials in the home language. Takeaway for this, and this does occur pretty regularly because a lot of our care staff English is not their first language. And remember what we talked about earlier, the farther along in the dementia that they are, the more difficult they, difficulty they have processing the information. So you add an accent onto that and makes it even more difficult for them. Accessible care and cultural respect improve understanding and adherence. So that wraps up today's episode for the Truth, Lies Alzheimer's Show. I'm Lisa Skinner, your host, and I want to thank you again. I appreciate every one of you taking the time to be here with me today to learn more insightful information about living in the world of dementia. And trying to make sense out of it and create a harmonious environment for everybody involved. So please come back next week. I will have another new episode prepared for you then. And in the meantime, have a great rest of your week. Stay happy, be healthy, and I will see you back here next week. Bye for now.

Thank you for listening to Truth, Lies and Alzheimer's. We hope you found something in today's episode that helps. We understand that caring for a loved one with dementia can be the challenge of a lifetime, but you don't have to do it alone. If you're ready for exclusive access to even more great content and resources, head on over to Facebook and join Lisa Skinner Skinner's Minding Dementia support group, where a community of like-minded We're committed caregivers and we're here to help.