• Pam

9 Tips for Handling Difficult Discussions with Someone with Dementia


Do you find yourself feeling frustrated and at a loss for how to respond when an aging parent starts talking about something that has clearly been bothering them? Or do you know someone with dementia who is having trouble communicating their thoughts and feelings? It can be hard to know what to say or how to help. This blog post will provide 9 Tips on Handling Difficult Discussions with Someone Living with Dementia.


What is it like to live with someone who has dementia? Well, the truth is that the experience can be difficult and frustrating. The person with dementia may not understand what you are trying to say, or they may become agitated when you try to speak about certain topics. However, some people have found ways of getting through these tough conversations while still preserving their relationship. We will offer nine tips for handling difficult discussions and more.


As an R.N. of 40 years, I have had many clients in home health and hospice that struggled with dementia. It is our goal to bring you some tips and strategies to improve your communication skills and possibly avoid some arguments!


Maintaining a good relationship with an aging parent is difficult at the best of times. When dementia starts to set in, we can find ourselves stuck in conversations that go nowhere and over topics we've heard before. It's important to know how to handle these situations as they arise and make sure you're not making things worse by getting frustrated or arguing about what someone should or shouldn't do. Let’s jump in with our 9 Tips.


1. Be patient- dementia patients may have a shorter attention span

2. Make it clear what you are trying to communicate to the person with dementia. Speak clearly and slowly - dementia patients may have trouble hearing or remembering what you speak.

3. Use simple words and sentences in a calm tone of voice.

4. Break down complex tasks into smaller steps that can be completed more easily, for example "take out the trash" might mean "put on your shoes, go outside, open up the bin, throw away all your garbage"

5. Offer assistance when needed but don't force them if they refuse help or get upset about it.

6. Keep things interesting by changing topics often and asking questions that require more than just yes/no answers such as "what was your favorite color growing up?" or "What do you think is going to happen next?"

7. Use gestures and pictures as well as verbal communication when needed.

8. Avoid arguments or difficult subjects that might upset the person with dementia

9. Offer choices whenever possible - this gives people with dementia more control over their lives.



In order not to make the situation any worse, try and avoid giving in-depth arguments. Instead of talking about what is happening now or focusing on memories from long ago when your partner still knew who you are; focus more lighthearted topics like favorite foods that remind each other why we love them so much!


Try to remember that sometimes physically your loved-one with dementia may seem fine but remember their disability is their memory loss. The Alzheimer’s Association of San Diego put it in a simple way to understand. “Asking them (someone with dementia) to remember is like asking a blind person to see.”


The person with dementia such as Alzheimer’s Disease can be very paranoid. They fear everything and feel locked in a world that scares them. They become frightened and often truly fear for their lives. It is important to understand that their feelings are very real to them. This reminds me of a time early in my nursing career when I was tasked to bring my grandpa home from the nursing home for Easter dinner. He suffered from both Parkinson’s Disease and Late Onset Adult Alzheimer’s Disease. The pick-up went fine. He knew who I was and was excited to come home with me for a nice dinner with the family. After dinner and sometime visiting, it was time to take him back to the nursing home. He willingly put his light jacket on with some assistance and we walked out of the house, and I opened the passenger door of the same car we came in and he would not get in. He proceeded to tell me I was a foreign spy trying to kidnap him and take him away. We could not coax him into the car. You could see the fear in his eyes, and he was NOT getting in a vehicle with me or anyone else!



One of two things could have happened here. First, we could have tried to reason with him and try to make him understand who I was and why he needed to get into the car. This would have surely escalated the situation and he would be become extremely agitated and acting out in fear of his life. The second choice caused us a bit more of a “hassle” so to speak but it was the right choice to keep him calm and make him feel he was safe. We told him we were sorry he felt that way and we would not make him get into the car. We went back into the house, changed the subject and tried to engage in a conversation with him about things long ago that he may remember and make him feel more comfortable and in control. About 45 minutes later, grandpa calm and relaxed went through the same routine to get ready to leave. Slow and steady and not rushing him at all he willingly got into the car with me as I said I was “taking him home”. The ride back was uneventful. Patience can carry you a long way with these types of situations. Getting inpatient and “pushy” in this situation is a recipe for disaster.


Here are some other suggestions when communicating with a person suffering with Dementia.


1. Be calm, cool and collected. There's no need to raise your voice or get emotional as this will only agitate the person with dementia. They may not understand what is happening around them anymore so try to keep it lighthearted if at all possible! If a serious conversation is not going well don’t push it. Change the subject and try get them calm and try approaching the subject at a later time.


1. Try talking about something unrelated until you can find a better time for more serious discussions. Be careful when saying things like “don’t forget this” or “don’t forget that..” These types of discussions only help to remind them that they have a problem with remembering and will feel inadequate and feel a lack of control. “Don’t treat me like a baby, I have been around a lot longer than you have” They may lash out as they try to come to terms with their illness. Listen to what they are saying and try to go beyond the words. Why are they saying that? What are they feeling that may put those words in their mouth? A great piece of advice here, is not to take what they say personally.


2. Don't hurry into arguments. Remember forgiveness is so important here. Try to realize they are not trying to “tick you off” they are only functioning in a world that is created in their mind and reality may not be showing up. They are not intentionally making things up. What they say and do reflects what they see as real. This was a hard pill to swallow for the spouse of one of my dementia patients. She had Alzheimer’s Disease and got to the point she often did not remember her husband. She would refer to him as his dad or worse, yet he was “that man sitting over there that wants to kill me.” This was heart breaking for her husband. All he wanted to do was comfort her and try to make her feel safe in their home. Once in a while she would remember him clear as day that he was her husband and those were always their best days. Another reason to forgive is that everything they do they feel they are doing for a good reason. My patient’s husband could never find his glasses. Every day they were some place different and often tucked away in a drawer or other “hiding place”. This task was not done to try and aggravate her husband but in her mind, she was trying to put the glasses in a safe place so her husband wouldn’t lose them! Try to understand why they are doing some things and look to find a good reason vs. assuming they are doing it for a negative reason.


3. Use distraction techniques when things are getting escalated when discussing certain topics.


4. Keep interactions short. Short sentences as well as short explanations. If you need to go over it again use the same words. Try to agree with them as much as possible. It is o.k. to take the blame for something even if it is clear, it is not your fault. This will go a long way to keep the conversation from getting ugly. Walk away if you have to.


5. And don’t forget – always ask before touching they may feel you are going to try and hurt them.




Behavior challenges: Behaviors can occur in one of two forms or both.

1. Behaviors that can hurt themselves

2. Behaviors that can hurt other.


Sometimes the extremes occur with a person with dementia. They may drink from the bottle of shampoo. They may drink from the cleaning solution bottle. This is usually not intentional, but you always need to be careful that in a clear moment they are not trying to hurt themselves because they don’t want to live like this anymore.

Wandering may be another behavior that would cause themselves harm.


With one of my dementia patients, we did have to put locks on the windows and doors along with alarms to keep her safe especially in the middle of the night. Her husband would go to bed with a flashlight turned on to make sure he could see if she got up during the night and tried to leave. She was often fixated that this was not her home and she needed to go home. We looked at old pictures to try and determine what home she was talking about, and it often was the first home she and her husband lived in a couple hundred miles away. We also ended up putting all liquids, medications, cleaning supplies, toiletries, etc. in a locked cabinet. We put locks on the cabinet doors as well.



Behaviors that can hurt others include aggressive behavior, hitting, swinging objects such as canes at people, pushing, and nasty verbal exclamations! Again, going back to one of my patients, her faith was always so important to her, and she would hold Bible study at their home, etc. When she would act out, she would cuss and swear and use language no one had ever heard her use before, and it bothered the entire family. Remember to look at how this person might be feeling and how you can make them feel safe before jumping to conclusions. To calm this patient down I often when back to the Bible. This was her sense of comfort. Reading a passage from the Bible would often calm her right down and give her a sense of peace. Try to focus on ways to comfort this person. They need to feel safe and secure.


Offer choices when possible. Instead of letting them pick out their clothes for the day and they may choose inappropriate items, pick out two outfits and let them choose which one they are going to wear for the day. The same thing with meals or other topics. Try to give them two choices whenever possible. Try to limit their choices because too many can overwhelm them.


The hardest part of the behavior challenges is that they can come completely unexpected and out of nowhere. One trigger may be the fact that they are recognizing their memory deficits. One trigger for one of my dementia patients was the fact they he and his wife lived alone for many years as their children were all grown. Now all of a sudden there are many family members back in the home and he felt he no longer had any privacy and could not understand why everyone just didn’t go home and leave them alone!


I remember one time my Alzheimer patient wanted to go for ice cream. This was a favorite outing for this couple. We went to their favorite spot and things were going fine until she realized she did not have nuts on her sundae. The granddaughter tried to tell her it was ok that they would get nuts for her the next time and would not forget. She would not let it go. I could see in her eyes we were getting ready to go to a bad place in public and I couldn’t let that happen. All I could think about is how embarrassed the family would be if she acted out in public. I went up to the counter and asked for a “side” of nuts and brought it back to her and she cheerfully poured them on her sundae. Smiles came back to her face, and we all felt we just avoided a potentially very bad situation. In extreme situations you may need to consult the doctor for medications to try and control aggressive behaviors.



Distraction can be your best friend here. I used the Bible in one case. Try to identify something that will more often than not, calm your loved one. If you are not getting anywhere sometimes another person may have better luck and truly there is no rhyme or reason to who it may be sometimes.


Some great examples taken from the article by the San Diego Alzheimer’s association. I have included the link to their article in the resource section of the blog post. We have included one, but we encourage you to read the article for some more helpful examples of communicating properly with dementia family members or friends. This is a great way to look at how you can change your dialog to improve your communication with your loved one with dementia.


“What doctor’s appointment? There’s nothing wrong with me.” Don’t: (reason) “You’ve been seeing the doctor every three months for the last two years. It’s written on the calendar, and I told you about it yesterday and this morning.” DO: (short explanation) “It’s just a regular checkup.” (Accept blame) “I’m sorry if I forgot to tell you.”



The best way to help someone with dementia is by being patient and understanding. By breaking down complex tasks into simpler, smaller steps, you can make it much easier for them to follow along and complete the task on their own. If they refuse assistance or get upset about it, don't force them to do anything that they're not comfortable doing! Instead of just yes/no answers like "yes" or "no", try asking questions that will require more than a one word answer such as what was your favorite part of today? This will keep things interesting and should also spark some conversations between you two.


It is important to understand that there are no quick fixes for dementia. Many people with the condition find it challenging if not impossible to complete complex tasks, so try breaking down more complicated chores into smaller steps which can be completed one-by-one. For example, if they have difficulty dressing themselves you should offer assistance but don't force them - instead consider helping by only providing clothing appropriate for warmer weather or lighter clothes like t-shirts and shorts rather than sweaters and pants. The most effective way of communicating with someone who has Alzheimer's disease or other form of dementia is using simple words in a calm tone of voice while being patient when waiting for an answer. You may also want to change topics often as this will help keep their mind busy.


It’s important not to get frustrated when someone refuses help or gets upset about it - because that will only make things worse! The key tip here is that if you want to encourage your loved one to take care of themselves, then be there for them while still respecting their independence. I know this can be a tall order and you are bound to get frustrated at times. If you want access to more articles and information on wellness and aging gracefully in place, join our email list here. We look forward to seeing you back here soon and thanks for taking time out of your busy day to be here. Drop us a comment we would love to hear from you on what topics would be helpful for you.


Thanks for stopping by,

Pam


Resource List:

https://www.alzsd.org/dos-and-donts-of-compassionate-communication-dementia/

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