Alzheimer’s disease, a brain disorder that affects more than 5 million Americans, erodes the ability to think, reason, and remember. As dementia progresses and mild symptoms become more severe, difficulties using language intensify, making it harder for people with the disease to express their thoughts, wishes, and feelings to others.
But there are strategies that families, friends, and caregivers can turn to when traditional methods of communication fall short.
“What we advocate is really meeting the person where they are and connecting with them in the way that they’re able to communicate,” says Ruth Drew, a licensed mental health counselor and the former director of information and support services at the Alzheimer’s Association. “When people are struggling, oftentimes there are things we can do that just make it easier.”
There is no foolproof or one-size-fits-all approach, Drew emphasizes. “Communicating with someone who has Alzheimer’s can look different from one person to the next, and from one stage to the next,” she says. Even a technique that helps a person one day may not work for that person on a different day.
Still, there are some general strategies that can make a difference. Here, Drew offers her best tips.
1. Let the Person With Alzheimer’s Set the Pace
When people with Alzheimer’s dementia struggle to name a familiar object, lose their train of thought, or ask the same question again and again, remind yourself that this is because they have a disease that has damaged their brain. Instead of giving voice to any frustration or anxiety you may feel, try to remain calm and relaxed and let the person have all the time they need. “It really helps to just take a deep breath and go at their pace,” says Drew.
If the person is trying and failing to find a word, for instance, don’t rush to fill in the blank. “You can check in with them and ask, ‘Does it help if I guess at what the word is, or would you like me to just wait and let you come up with it?’ What works for one person might be different from what works for someone else.”
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2. Avoid Distractions During Conversations
When you’re trying to communicate with someone in the middle stages of dementia, having a one-on-one conversation in a quiet place is ideal, says Drew. It can be harder to connect when there are distractions, like other people milling around or a TV blasting.
For a person with more advanced dementia, using simple words and simple sentences can help. If the person with dementia asks the same question repeatedly, your natural impulse may be to rephrase your response slightly each time to make it more comprehensible.
“But usually you answered just fine the first time,” Drew says. “It’s their ability to hold on to the answer that’s impaired — it’s like you’re pouring water into a bucket with a hole in it.” Instead of trying to recast your answer, respond the same way with the same words, Drew advises.
3. Talk to the Person With Alzheimer’s, Not Over Them
Cognitive ability declines as Alzheimer’s advances, but that doesn’t mean a person with dementia has no awareness of the world around them. “In the early stages, the person still has so many capabilities — they just might need a little bit of help,” says Drew. “We never want to talk over them or talk to other people in the room about them in front of them. We want to speak to them, and not exclude them.”
This is true for people with more advanced Alzheimer’s as well, who may still be able to experience moments of clarity even as a deeper confusion takes hold. Even if you’re not sure they understand you, address them as if they do.
“I was talking with a hospice physician who told me he always speaks to Alzheimer’s patients as he would any patient,” Drew recalls. “And he told me about doing the usual checking, the vitals and everything, on a woman who according to the staff hadn’t said a word in a year or two. And just as he would with anybody else, he said to the patient, ‘You know, Mrs. Smith, it was nice to see you today.’ And she looked up at him and she said, ‘Of course it was.’”
4. Use Body Language to Help Convey Your Message
Gestures, facial expressions, and other types of body language are important for any kind of human communication, but they become even more essential when you’re trying to connect with a person who has Alzheimer’s.
“If I was talking to somebody who has Alzheimer’s and I wanted them to come over to the table and have a cup of coffee with me, I could come up with a pretty long sentence about that, inviting them over,” Drew says. “Or I could just put my hand toward the table with the coffee and say, ‘Coffee?’ and go and sit down in front of my cup, and they probably would follow suit.”
Maintaining eye contact can also make a difference. If the person with Alzheimer’s is seated, for instance, Drew says, “I like to crouch down and get at eye level. And I like to offer my hand. Because you know what happens when you do that? They reach back — it’s a natural response that most people have. That’s a nice way to connect.”
5. Connect With All 5 Senses, Not Just Words
Touch can be a powerful way to show affection for a person with dementia when words no longer convey what they once did. So can methods that tap into the other senses.
“I know one woman who gives her mother hand massages with her mom’s favorite scented lotion,” Drew says. “It’s connecting and using touch and a familiar fragrance in a way that’s comforting.”
Simply going outside together on a nice day — enjoying the sights and sounds and feeling the sun on your faces — can be a way to connect, Drew adds.
6. Don’t Argue, Even When They’re Wrong
“If someone is telling a story all wrong, don’t contradict them,” says Drew. “Don’t try to pull them into your reality. Just let them have their way. I'd say that’s true 99 percent of time.”
The exception is when a person makes assertions that raise a safety issue or cause them great distress. “If someone is saying ‘There are people who are trying to hurt me and steal from me,’ and you know that this is not true, then I wouldn’t validate this. You would want to say things that are comforting and help the person feel safe.”
Drew also points to strategies that can reduce arguments that arise during moments of tension in daily life. “For instance, if you know that your mother is never going to be happy about going to the doctor, there’s probably some other way to help her get ready and be happy about getting ready,” Drew says. “I know one family that always goes to get ice cream before they go to the doctor. So leaving the house is about going to get ice cream and, oh, then they go to the doctor when they’re already out, already dressed, and already in the car.”
7. Treat the Person With Respect
Ultimately, communicating with someone who has Alzheimer’s hinges on one thing: respect. Despite their impairment, the disease does not erase their human dignity or make them less deserving of honor for the lives they’ve led.
“It always worries me when I hear people say, ‘It’s like she’s a child,’” Drew says. “No, she’s not a child. She is an adult with a lifetime of experience. And we do better when we treat people with the respect that comes with that.”
Overcoming the issues that get in the way is not always easy, but there are numerous resources for those who need help. The Alzheimer’s Association’s 24/7 helpline (800-272-3900) is one, offering free, confidential advice to people living with Alzheimer’s, caregivers, and families.