One of the first things often noticed when someone develops dementia is that they become less communicative. Friends will say that they can no longer have a conversation. Family will remark that the person with dementia is quieter and seems less involved in family occasions and notice that they no longer initiate a conversation. Sometimes communication difficulties may be spotted long before any formal diagnosis.
Friends and family often discount such difficulties at first as they seem to be temporary and may be put down to tiredness, depression or ‘getting old’.
Communication difficulties are one of the common symptoms of almost all dementias and may involve speech, writing, reading, using a keyboard, understanding the written or spoken word, being able to follow directions or understand symbols (such as road signs) or any combination of these. Not everyone with dementia suffers from problems in all these areas to begin with.
The first thing to remember is that the person with dementia is not refusing to communicate because they do not wish to do so. In nearly every case, people would like to be able to express their feelings and point of view.
Carers, family and friends can do a lot to help with these problems.
Most conversation happens at a rather fast rate (think how difficult it is to understand conversation in a foreign language if you are just starting to learn it). Someone with dementia may begin to listen to another person speaking and then lose track of what is being said. This may result in them retiring from any interaction. When speaking to someone with cognitive problems speak a little more slowly, keep to one main point and use short sentences.
Keep in mind that memory is impaired. It may be very difficult for someone with dementia to recall what has just been said. Most of us try to avoid repeating ourselves too much but when speaking to someone with dementia repetition is a good thing. You may feel a little silly repeating yourself often but you will be doing the right thing.
Wait for replies. People with dementia process things more slowly. It can take quite a while for them to understand what you have said, arrange their thoughts and formulate an answer. If you never give time for replies they may give up on the conversation altogether.
Use helpful gestures
As dementia progresses, it is helpful to use actions as well as words and to make use of as many senses as possible. For example, use gestures much more than you might normally. Pull out the chair in which you want someone to sit, pat the table on which you want them to place something, hold up the book or newspaper you are referring to, pick up the coat you want them to put on.
Everyone wants to be able to join in with conversations and to express their point of view. Making a few changes to the way we speak and get involved with people who have dementia can really be helpful.
Mary works for a national dementia charity and is an Associate Director of ELM (End of Life Management Ltd). She has had considerable experience of caring for elderly relatives and friends and worked in the NHS for 9 years. Earlier publications include books on Caring and on GP Practice Management, in addition to articles in nursing and social care journals and magazines. Mary is the author of ‘The Essential Carer’s Guide to Dementia’ published by Hammersmith Books £12.99 in print and £5.99.Last modified: June 9, 2021