Seeing someone you care about experience Alzheimer’s or another type of dementia is painstakingly difficult. Knowing what to say to someone who’s lost his or her memory can also be hard. However, how you approach conversations can have a significant impact on your loved one.
“The most important tip for communication with someone living with Alzheimer’s is to meet them where they are,” said Ruth Drew, director of Information and Support Services at the Alzheimer’s Association. “In the early stage of the disease, a person is still able to have meaningful conversations, but may repeat stories, feel overwhelmed by excessive stimulation, or have difficulty finding the right word. Be patient and understand that their brain is not working in the way it once did.”
As the disease progresses, communicating with that person may become even more challenging. However, if you recognize the changes and challenges that come with dementia, you will more easily be able to alter your conversations with that person to meet his or her needs.
“This may require slowing down and making eye contact with the person as you speak,” says Drew. “Use short, simple sentences, ask one question at a time, and give the person time to process and respond before continuing the conversation. If you are kind, gentle and relaxed, everything will work better.”
Read on for six helpful things to say to those with Alzheimer’s, and three topics and phrases experts recommend avoiding.
What to say: “Tell me about your daughter”
Although this type of question isn’t best for when you need to get specific information (see next item), it’s a great way to communicate with your loved one without them feeling as though they’re being quizzed or becoming frustrated that they don’t have the answer. For example, this approach is better than asking for specific details, such as, “How old is your daughter?”
“Open-ended questions are great when you want to have a conversation and connect,” says Drew. “People living with Alzheimer’s may enjoy talking about their families, friends, and the things they like in life, whether it’s a hobby, an old TV show, or their favorite foods.”
Keep in mind that while someone with Alzheimer’s may not remember events that happened earlier that day, they can often talk about their long-term memories with much joy.
“Most times they remember the past much better than the present,” says Douglas Scharre, professor of clinical neurology and psychiatry and director of the Division of Cognitive Neurology at The Ohio State University Wexner Medical Center’s Neurological Institute. “So discussion of old times is often very enjoyable.”
What to say: “Would you like some tea?”
When the purpose isn’t to simply chat, but rather to obtain information from your loved one, questions that can be answered with “yes” or “no” are best. “Asking a person “What would you like to drink?” may be overwhelming, because it requires the person to recall an array of options and then make a decision,” says Drew. Alternatively, asking “Would you like some tea?” is a more simple, straightforward question.
If you do end up asking an open-ended question, be prepared to follow up with a more specific one. “Help focus a response if the person is having difficulty,” Drew adds. “For example, if you ask, ‘What would you like to do today?’ and receive no response, follow up by asking, ‘Would you like to take a walk outside?’”
What not to say: “What’s my name? Do you remember?”
It may be tempting to gauge how much your loved one remembers on any given day, but it could just agitate him or her.
“Avoid asking questions that make a person feel like they are taking a test,” says Drew. “These questions can feel disrespectful and provoke anxiety, and they simply aren’t helpful. Questions should be for the purpose of connecting, giving people a voice, and finding out what they want and need.”
What to say: “Thank you for that information.”
Showing gratitude for whatever information your loved one gives you can help them feel confident and less anxious. Don’t get hung up on the accuracy of their statements.
“Typically you can just thank them for their answer, whatever it was,” says Scharre. “If the topic requires you to correct them for safety issues, then of course do so. But it may not be that useful to correct their reality if it will only cause anxiety and distress.”
For example, if your loved one is upset because they believe somebody stole their hairbrush, it may not be productive to say, “There’s no way that could have happened.” (More on corrections below.) Instead, simply say, “Thank you for letting me know. I’m going to keep my eyes open, and we’ll find it.”
What to say: “What do you think about this painting?”
Questions that involve opinions can be helpful for Alzheimer’s patients.
“Ask questions that do not have a right or wrong answer, such as ‘What do you think about this?’” says Robin Hamon, a caregiver support coordinator at the Sanders-Brown Center on Aging at the University of Kentucky. “You should keep the conversations light and easy. Even if you know the person well, try not to get too personal.”
This can also offer the opportunity for you to build that person’s self-confidence. Gently remind them that they’re an expert on a particular topic. “Reminiscing about accomplishments that a person can relate to, and feels good about, could be a nice way to build self-esteem,” Hamon adds. “If the person raised a family or built a company, they could be reminded of that when their opinion is asked for. For example, ‘You are the expert pie baker, Mom. Do you think these peaches will make a good pie?’”
What not to say: “You need to go take a shower now.”
When you’re caring for someone with Alzheimer’s, you may need to direct them to do basic tasks throughout the day, but be careful about how you frame these directions.
“No one likes being bossed or told what to do all the time,” says Scharre. “They may get defensive and not want to participate. Try to make it their idea or tell them you are going to do that activity as well.”
For instance, instead of telling the person they need to take a shower, you could say, “I’m going to take a shower. Do you want to go first?” Alternatively, Scharre suggests using the phrase “Can you help me?” with certain tasks such as getting ready to go somewhere or getting into the car.
What to say: “That’s happened to me before!”
Another way to foster healthy self-esteem in people with dementia is to relate to them when they forget something, rather than pointing out what they forgot.
“People with dementia will do better if they feel good about themselves,” Hamon says. “Help them save face when they make mistakes. If they are trying to say something and they can’t remember it, you can identify with it by saying, ‘That’s happened to me before! We will have to come back to that later.’”
Of course, make sure they have enough time to answer your question first, advises Hamon. It often will take someone with Alzheimer’s longer to express an idea than it used to.
What to say: “Today, we are going to see Dr. Smith, then we’re going out to a nice lunch.”
It may seem second-nature to prepare your loved one for an event that’s coming up, but too much preparation may just cause confusion.
“Often the person doesn’t have the ability to keep the details straight, and rather than being comforted by knowing what is going to happen, they worry about it,” says Hamon. “They remember something important is about to happen, but they don’t recall what, and they fill in the details with fearful ideas such as ‘They are going to take me to a nursing home!’ or ask many times, ‘Where are we going tomorrow?’”
Instead, take things day by day. In the morning, tell your loved one exactly what you’re going to do, and assure them that you will have a fun day together.
What not to say: “No, that’s not what happened.”
Again, playing teacher with your loved one won’t help the situation.
“Alzheimer’s destroys brain cells and alters how a person receives and processes information, and correcting or arguing with the person is not constructive,” says Drew. “Instead, listen and try to find meaning in what is being said. Focus on the person’s happiness and safety, and if someone says something inaccurate and it doesn’t hurt anyone, let it go.”
In fact, just talking about a memory—regardless of how accurate it is—can help someone with Alzheimer’s.
“The act of telling the story is usually good for the person by helping them to be socially involved, and is probably more important than the details being correct,” says Hamon. “Sometimes it is more important, like when the person is asked their medical history by a doctor, but this can be anticipated ahead of time and the caregiver can hand the doctor a list of current medications and medical events or symptoms.”
And although it’s difficult sometimes, try your best to be patient. Remember that it’s the disease, and not the person, responsible for disconnects in communication, Drew adds.
About The GreenFields Continuing Care Community:
The GreenFields Continuing Care Community in Lancaster, NY provides residential living at GreenField Manor and assisted living at GreenField Court. GreenField Terrace provides memory care and enhanced assisted living. GreenField Health & Rehabilitation Center provides 24-hour skilled nursing care, dementia care, respite care and myriad rehabilitation services.