Having a conversation with a person with dementia

How do you have a good conversation with a person with dementia? In the early stages of a person’s illness, it will be easier for them to converse with you. They may forget what you say shortly afterwards but the conversation itself may be reasonably straightforward. You might have to repeat things, but you can still talk to each other. However, as the person begins to deteriorate, the flow of a conversation may become more difficult. The person may struggle to express their thoughts and you may find it difficult to understand what they are trying to tell you. Similarly, they may not be able to process what you are saying. In the moderate to severe stages of dementia, the person may struggle to complete sentences and articulate their thoughts clearly. In the latter stages of the dementia, when the condition is severe, the person will have lost their ability to speak.

Unfortunately, almost all forms of dementia involve difficulties with speech and writing. Loss of speech can occur not because the person is being awkward or doesn’t want to talk to you, but because they are struggling to express themselves and say what they want to say. They may not be able to find the right words, can’t follow a conversation or can’t translate how they are feeling into accurate words. This may lead to them becoming more frustrated.

What can you do about this? The first thing to note is that social contact is still important, even if conversations are one-sided or short-lived. Dementia experts often talk about the importance of social interaction, rather than just leaving the person alone in front of the TV. To help the person, it’s important to be patient, take your time when speaking and be prepared to repeat things without losing your temper. Short-term memory loss or an ability to understand what you are saying is not the person’s fault. Dementia is a disease of the brain, and messages can’t always be transmitted normally via the nerve cells. A person may take a long time to understand what you are saying, and then take a long time to respond.

Asking questions
When you ask a question, don’t make it too complex. It’s easy to load a question onto another question without realising. If you are offering someone who doesn’t have dementia a drink, you might say: ‘Would you like a drink? What would you like? Tea or coffee, or would you like a cold drink?’

For a person with dementia, this is too much choice. Keep the questions short and try to have an outcome that requires a ‘yes’ or ‘no’ answer. Break it down. Start with:

‘Hazel, would you like a drink?’

If the person says yes, ask if they would like a cup of tea.

If they don’t answer or say no, ask if they would like coffee.
If they don’t answer or say no, ask if they would like a glass of fruit juice.

Work your way through the options until you discover what they prefer. This takes time and patience, but the outcome will be better for everyone. The person will get what they want and you will have kept the conversation simple, which means the person will feel that they can still interact and make their own choices.

The same goes for food choices. When it comes to asking what they would like for lunch, don’t give them too many choices. If you are close to the person with dementia, then you’ll know what food they like. Ask them if they would like a sandwich, rather than asking what they would like for lunch so that they don’t have to try and think about different options.

Mention hobbies
When talking to a person with dementia, you can try to talk about hobbies or interests they used to have. My mother used to love ballroom dancing, and really enjoys watching Strictly. When the dancers appear on TV, I use it to try and build up her confidence. I will say to her: ‘You can dance like that can’t you?’ Even though she is no longer mobile, she will nod and smile. Then I will point out that I can’t dance and she’s a much better dancer than me. I’m sure she gets a mental boost from my admiration of her dancing skills. Anything you can do to build up the person’s confidence will help their mood and boost their self-esteem.

When you have a conversation that involves telling the person something, try to speak slowly. They may be able to understand what you are saying, but may need longer for the brain to absorb and process the information. Keep sentences short. Make stories short and concise. Don’t refer to lots of different people at once.

If a person with dementia is trying to tell you something, be patient and let them speak. Don’t undermine their confidence by filling in words.

If you are having a conversation with a person and they seem frustrated or distracted, then they may be in pain. They may have a headache or need to use the toilet. Asking them if they feel pain may get a ‘yes’ answer, but they may not be able to tell you where the pain is. Talk to your GP or the care home staff, and they may be able to prescribe general analgesia medication.

Tips for having a conversation• Speak slowly. The person with dementia will take longer to process what you are saying and longer to formulate a response.
• Don’t ask complex questions. Make questions straightforward.
• Use the person’s name when speaking to them and face them directly, at their level.
• Don’t assume that ‘no’ always means no. They may be saying no to interacting with you, because it’s very stressful for them. If they say ‘no’ to lunch then showing them a sandwich may generate a different response.
• Use visual cues to help, such as pointing at your watch when explaining that it’s time to go or pointing to the garden if suggesting that you both go outside.