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How Communication Can Be Affected at Different Stages of Dementia
Early Stage
The person living with dementia
⇒ Is able to follow and maintain meaningful conversations with difficulty in articulating certain words
⇒ May display some difficulties in giving/receiving instructions and understanding difficult ideas
⇒ May ask questions to confirm information frequently or repeat conversations
⇒ Able to communicate in brief social interactions with difficulty functioning in prolonged social settings
⇒ Difficulty with following lengthy conversations
⇒ May follow what is said, but forget it after a brief period
⇒ Jokes and sarcastic remarks can be confusing, and may provoke sensitive feelings towards context
⇒ May feel overwhelmed by excessive stimulation
Moderate Stage
The person living with dementia
⇒ May be able to follow simple one-step instructions
⇒ May start to show more difficulty in following and maintaining conversations
⇒ May understand written information in a word-by-word process
⇒ May have decreased use of words for conversations
⇒ May repeatedly ask questions
⇒ May withdraw from the interaction if interaction is demanding
⇒ May experience personality and behavioural changes; E.g. suspiciousness and delusions which may hinder meaningful conversations
Advanced Stage
The person living with dementia
⇒ May not be able to articulate meaningful statements
⇒ May start to repeat after the person in the conversation
⇒ May experience difficulty with verbal communication as ability to recall vocabulary may be reduced
⇒ May not be able to understand simple words being spoken to them
⇒ May express themselves verbally in patches or strings of words and sounds
⇒ Conversations may be disconnected
⇒ May not be aware of conversations directed to them, and may not be able to talk with others at all
⇒ May rely more heavily on visual cues, context, tone of voice, and touch to understand what others are communicating to them; use of non-verbal communication methods is recommended
⇒ May lapse into a familiar language used in their native country or their mother tongue
Adapted from: Communication Skills with Persons with Dementia by Khoo Teck Puat Hospital and Living with Dementia: A Resource Kit for Caregivers (Providing Care) by Agency for Integrated Care
How to Communicate With Persons Living With Dementia
For Caregivers
Interacting with the CARE approach
Source: Dementia-Friendly Singapore Initiative
Speaking with persons living with dementia
Source: ForgetUsNot Project by LIEN Foundation
Caregiving in public spaces
Source: ForgetUsNot Project by LIEN Foundation
General Tips for Interaction With Persons Living With Dementia
As the condition of a person living with dementia progresses, the way in which others communicate and interact with them should also change in order to tailor the interaction to their needs, and to make the most of each conversation or interaction.
1. Do not test the memory of persons living with dementia by asking them what they did recently.
2. Simplify activities and communication.
3. Offer reassurance and praise.
4. Do not argue with the person living with dementia.
What they see, hear or recall may not be the same as what you saw, heard or know.
5. Identify and remove triggers to unhelpful behaviour.
6. Identify underlying reasons for behaviour changes.
7. Keep up with social activities.
Most persons with dementia would benefit from physical or social activities regardless of the severity of their condition. Social activities ensure that they remain in contact with other people and offer a sense of well-being. Those at mild to moderate stages of dementia would enjoy being with family and friends in small gatherings as they would still be able to converse.
Recreational activities such as card games or hobbies could be enjoyable to them too. However, persons at a more advanced stage of dementia would more likely prefer a one-to-one interaction as they would need more visual and verbal cues.
8. Enjoy safe, outdoor activities.
Care needs to be taken to prevent falls when the person with dementia is walking in public spaces — steps, stairs, roads and crowded shopping malls — especially if they have osteoarthritis, heart problems or had a stroke previously.
Public spaces where there are even footpaths and seats available for rest would be ideal for them to visit. Some activities they could participate in include visits to neighbourhood parks and community gardens, tai chi/qigong with a community group, or the Memories Cafe or the Family of Wisdom programme organised by Dementia Singapore.
Adapted from: HealthHub.sg
Tips for Conversations With Persons Living With Dementia
Face to face interaction
Approach the person from the front.
Attract the person’s attention.
Maintain eye contact.
Tone and volume of voice
Speak slowly and clearly.
Use a tone of voice that is gentle, calm, and reassuring.
Use positive and good-natured humour to lighten the mood.
Avoid using at a higher pitch and loud voice.
If the person living with dementia has hearing difficulties, consider encouraging them to use hearing aids, and use pictures/diagrams to help facilitate the conversation.
Conversation topics and activities
If you are having a chat with a person living with dementia, these are some suggestions for what you can do:
Talk about shared experiences: You can recount your experience about a certain event or memory. This may trigger memories in the person living with dementia.
Look at photographs together: You can look at photos from books and newspapers to get a conversation going.
Look at memorable items together: If the person living with dementia has items that are especially precious to them, you can look at them and talk about them.
Read together: If the person is able to read, you can ask them whether they would like to read a favourite book of theirs. You can also read their books to them and share your thoughts about them.
Listen to music together: You can play popular music or music that is special to them from an earlier period in their life, and talk about this music with them, mentioning the names of the musicians and the pieces of music. You can also sing or move to the music together.
Phrasing of sentences
Keep sentences simple, short, and direct.
Avoid lengthy conversations that require complex thinking. Break down tasks with clear, step-by-step instructions.
Use simple words that the person living with dementia can understand.
Ask questions one at a time as multiple questions can be overwhelming.
Ask close-ended questions answerable with a “yes” or “no.”
Ask, “Would you like some coffee?”
Avoid asking, “What would you like to drink?”
When providing the person choices, limit the number of choices to two.
Be patient
Allow the person living with dementia adequate time to respond. Do not interrupt or finish sentences unless they ask for help to complete a sentence.
If they do not respond, repeat yourself in a gentle, calm, and reassuring manner.
Take time to listen to what the person living with dementia feels, thinks, or needs.
Be supportive
Offering comfort and reassurance can encourage them to share their thoughts to you.
Sometimes, the emotions expressed are more important than what they say. Look for the intentions behind words or sounds. Observe their body language.
It is okay if you do not know what to do or say; your presence is the most important indication of support to the person living with dementia.
Treat the person living with dementia with dignity and respect
Avoid talking down or facing away as if they are not there.
Keep eye contact as much as possible and acknowledge your understanding of their expression and words.
Do not exclude them from conversations with others.
Adapted from: Communication Skills with Persons with Dementia by Khoo Teck Puat Hospital and Living with Dementia: A Resource Kit for Caregivers (Providing Care) by Agency for Integrated Care
Communicating with Persons Living with Dementia in End-of-Life Stages
Tips for interaction
⇒ Maintain eye contact as much as possible with the person living with dementia.
⇒ Talk about things of interest to them or reminisce about things from the past, even if you do not think they can follow what you are saying. They may respond to the tone of your voice and feel a level of connection with you even if they may not understand what you are saying.
⇒ Use appropriate physical contact such as holding hands or a hug to reassure them that you are there for them.
⇒ Take your time and look for non-verbal signals.
⇒ Non-verbal communication – gestures, body language, facial expression and touch – can help facilitate communication.
Visiting Relatives and Friends Who Live With Dementia
Understand Dementia
Understanding how dementia develops will allow you to better understand what your loved one is going through. It will help you to understand some of the behaviours or feelings your loved one is experiencing.
Always Introduce Yourself
Make the Visit Fun!
Acknowledge Your Loved One’s Feelings
Have an open mind and be flexible: Your visit may not go according to how you have planned, but that is all right. Have an open mind on how your visit with your loved one goes, adapting to your loved one’s energy levels, mood, etc. Dementia can cause your loved one to experience feelings of anxiety, anger and agitation. Acknowledge how your loved one feels to provide some assurance.
Adapt Your Communication Style
Explore other methods of communication other than talking. Hold your loved one’s hand, give him/her a hug, a shoulder rub or hand massage to complement or replace conversation.
Communicate clearly by asking closed ended questions instead of open ended questions. Listen patiently and allow him/her time to respond. With dementia, your loved one’s ability to express himself/herself may be affected. Try not to finish his or her sentence. Instead, listen patiently as he/she speaks and searches for the right words.
Keep in Touch
How Not to Interact With Persons Living With Dementia
Source: Health Promotion Board
The following video contains negative examples of how members of the public interact with a person who appears to have dementia and is lost when in different settings. It also provides alternative examples of how members of the public can help in the same situations by recognising the ABCDs of Dementia Progression
Source: Dementia-Friendly Singapore
Tell us how we can improve?
- Khoo Teck Puat Hospital. (2010). Communication Skills with Persons with Dementia. Retrieved November 21, 2019.
- Health Promotion Board (n.d.). How to Communicate With a Loved One With Dementia. HealthHub.sg. Retrieved May 3, 2021, from https://www.healthhub.sg/live-healthy/994/how-to-communicate-with-a-loved-one-with-dementia
- Agency for Integrated Care. (2018). Living with Dementia – A Resource Kit for Caregivers, Providing Care. https://www.aic.sg/resources/Documents/Brochures/Mental%20Health/4%20Books/Book%203%20-%20PROVIDING%20CARE.pdf
- Agency for Integrated Care. (2018). Living with Dementia – A Resource Kit for Caregivers, Planning Care. https://www.aic.sg/resources/Documents/Brochures/Mental%20Health/4%20Books/Book%202%20-%20PLANNING%20CARE.pdf
