Finding the Right Words When Talking to Loved Ones with Dementia

Just under 1.8 million people in Germany are living with dementia (see BMFSFJ 2022). The courses of the disease are as varied as the needs and life stories of people with dementia themselves. However, their daily lives are increasingly affected by limitations in their cognitive abilities: Not only do those affected experience increased memory loss, but dementia also generally impacts their perception, thinking, and communication skills. As a family member, as the disease progresses, you are confronted not only with providing care but also, increasingly, with conflicts and communication difficulties. So how can we find the right words when communicating with people with dementia?

Markus’s mother was diagnosed with Alzheimer’s three years ago. She manages well in her daily life, still lives independently in her small apartment, and Markus checks in on her almost every day. It’s actually been going well for a long time, but in the last few weeks, Markus and his mother have been arguing over and over again whenever he comes to visit. Recently, Markus’s mother told him he should finally send all those people away because the apartment was too crowded—even though no one else was there besides him. He tried to explain to her that there were no visitors in the house, but her mother didn’t calm down until Markus turned down the volume on the radio.

“Sometimes, it really is like I’m under a spell. I just don’t know what she wants from me—and then she gets angry! Or, on the other hand, she doesn’t understand what I want from her,” Markus tells his siblings. Not too long ago, they wanted to have dinner together, and Markus asked his mother to set the table. When, after 15 minutes, she still hadn’t put anything on the table and Markus asked her about it, his mother said irritably that she had already eaten a long time ago and had already cleaned everything up.

Many family members of people with dementia experience conflicts similar to the ones Markus has with his mother. As the disease progresses, those affected may forget everyday details, lose the ability to fully grasp situations, and have difficulty distinguishing between the past and the present. As a result, they find many situations overwhelming and stressful. This makes it all the more important for family members to be mindful of how we speak to those affected and to adapt our communication to the situation.

Talking to each other as equals

The attention span and comprehension of people with dementia can be significantly affected by the disease. As a result, when a conversation begins, they sometimes don’t feel that it’s directed at them, or they may, for example, Unable to identify the source of the shouts coming from the next room. It can therefore be helpful to make eye contact at the start of a conversation and make sure that the person we are speaking to can hear us and feels that we are addressing them.

Provide guidance

Longer conversations can be exhausting for people with dementia because of the challenge they face in taking in and processing the content of the conversation. But if we keep providing points of reference during the conversation and share information, for example, Repeating the same phrasing can make it easier for those involved to navigate the conversation. Creating a calm atmosphere and blocking out background noise from, for example, Keeping the radio or dishwasher at a minimum during a conversation can also help ensure that those affected
be able to focus and better take in what is being said.
Sometimes, people with dementia need more time to take in and understand what is being said during a conversation. When conveying important information, it can be helpful to speak slowly and clearly. If the people we’re talking to speak in a dialect or use certain words, we can incorporate those as well to make ourselves clearer to them.

Finding Solutions Together

People with dementia may have difficulty understanding situations or expressing their concerns in a way that we can understand. Perhaps they express themselves differently than they have in the past, or they have trouble finding the right words. In this situation, it can be helpful to paraphrase the word in question and ask, “Do you mean …?”
Since people with dementia may sometimes find it difficult to follow a conversation with others, it is all the more important that we, as conversation partners, be friendly and attentive, listen carefully, and pay attention to our conversation partner’s body language and underlying emotions. Especially when we don’t immediately understand what the other person means, or when those involved already seem irritable. As in the example of Markus and his mother, it can help to adapt to the reality of those affected and consciously defuse situations, rather than correcting them.
In that situation, it helped the mother when her son turned off the radio, so that the unfamiliar voices no longer occupied her thoughts. A discussion about whether or not there were people in the apartment could have led to frustration on both sides and further unsettled the mother.

Adapting to one another and consciously structuring conversations

In addition to a calm atmosphere, it helps those affected if we give advance notice of the topics we’ll be discussing and don’t switch subjects abruptly. This may also include avoiding negatives and pronouns, asking short, closed-ended questions, asking about only one thing at a time, and limiting choices to two options. Emphasizing what we say with gestures and facial expressions can further clarify what we want to convey. Conversations can be very exhausting for people with dementia, especially when the disease is advanced. When it comes to structuring daily life, it can therefore be helpful to involve those affected in everyday activities rather than engaging them in lengthy conversations. Specifying concrete, individual steps—rather than abstract procedures—helps people with dementia carry out each step on their own. Markus, for example, has his mother… asked to set the table. He could make things easier for her in the future by asking her to help with specific tasks, such as getting the glasses ready.

What is dementia?

Dementia is an umbrella term for more than 50 different conditions, primarily those affecting the brain. The course of these diseases often varies greatly, but almost always leads to impaired cognitive function, such as deficits in short-term memory, memory retention, attention, and the ability to comprehend and think.

You can find sources and additional information at the German Alzheimer’s Association, the BMFSFJ’s online portal “Wegweiser Demenz,”and the Unfallkasse’s magazine “Pflege daheim.”

Dementia and its associated limitations are diverse—adapting communication is just one aspect among many. We are happy to assist you with any questions or concerns regarding your family members’ individual situations.