“Dementia is not a specific disease,” Gauri Khurana, MD, MPH, explains. “It is a constellation of symptoms that include progressive loss of memory, language, problem-solving abilities, behavior, and an overall loss of reality that are severe enough to negatively impact daily life.” Dementia can be a stand-alone disorder, or it can be part of other illnesses, such as alcohol-related dementia and HIV-associated dementia. Alzheimer’s Disease is a form of dementia. Like any disorder that affects the brain, it can be important to choose your words carefully with your friend or loved one. “Dementia is a gradual illness in which a person loses touch with reality and isn’t aware of it,” Dr. Khurana says. “When they do realize, they often feel embarrassed and are reluctant to continue engaging with the world as they think they may make a mistake.” She adds that depending on the severity of their illness, they also may become combative and violent. Dementia can be an incredibly tough condition to face, for the person going through it and for those around them. Although this is undoubtedly a life-changing condition, when speaking with someone with dementia, it can be beneficial to maintain as much normalcy as you can. As Dr. Shana Feibel, DO, Attending Psychiatrist at The Lindner Center of HOPE and Assistant Professor of Psychiatry at The University of Cincinnati says, “Working on what words to choose from and being careful with those words is half the battle.” Read on to discover how to better choose your words when speaking to a loved one or friend with dementia.
What not to say to someone with dementia
Don’t speak in a language other than their native language
Even if you live in a bi-lingual household, it’s important to stick to the first language of the person suffering from dementia. “This can make communication more difficult, as native languages are often easier for people with dementia to access,” says Dr. Khurana.
Don’t speak to them like a child or talk too slowly
This form of speaking may sound very condescending to someone with dementia, as stated by Dr. Feibel.
Don’t scold them if they do something wrong
Again, you’ll want to avoid an approach like this so that a person with dementia doesn’t feel like a child. Dr. Feibel says, “They may feel like they are being unduly punished.”
Don’t turn away when talking
“People with dementia will lose subtle cues related to the current situation [if you turn away when talking],” Dr. Khurana says. “Caregivers are encouraged to speak directly and clearly to the person with dementia. It is important to note that our body language, facial expressions, and tone of voice set the mood more than we realize and affect those around us, including those with dementia as they are grasping for clues to understand what is going on in each situation.”
Don’t express frustration or yell
Even the most patient of people can be prone to frustration when caring for someone with dementia. But it’s important to keep in mind that no matter what they have done, you cannot raise your voice or yell in any way. Dr. Khurana says that even if they’ve done something like causing a fire while cooking, caregivers should try to be calm and set an even tone for people with dementia.
Don’t ask if they have forgotten many things that day
Dr. Feibel says, “This reminds the person that they are becoming forgetful, but they are already very aware that this is happening.”
Don’t ask complicated questions or questions that involve many steps at once
Instead, Dr. Khurana suggests trying to keep questions short and have clear answers. She says, “Do not give multiple steps/instructions at once, as a person with dementia does not have the short-term memory to process these instructions.”
Don’t keep pushing if a person with dementia becomes agitated or combative
This can be a common reaction when someone has dementia, so it’s helpful to avoid pushing them too much. “Try to redirect and distract them,” Dr. Khurana advises. “Having some easy physical activities, such as a puzzle, might help shift their attention.”
Don’t tell them if they remember something incorrectly if it’s about something trivial
People with dementia can have quite a bit of awareness, so if you say something like, “You forgot to put the lid back on the milk,” or, “Why didn’t you turn off your computer?” this will simply remind them that they are indeed losing their memory, as Dr. Feibel says.
Don’t tell them that someone specific has passed away
“This can cause them to grieve all over again,” Dr. Feibel points out.
Don’t focus on recent memories
Individuals with dementia struggle with short-term memory, which is why it can be beneficial, and even pleasant, to focus conversations on long-ago memories. “Try to reminisce about older memories, i.e., from 50 years ago as their long-term memory system is generally intact,” Dr. Khurana says. “Having photo albums handy and photos in their assisted living facility may help in keeping them occupied and remembering the good memories.”
Don’t ask them, “Do you remember this person or that event?”
“If they do not, it could embarrass and upset them,” Dr. Feibel says.
Don’t be rigid with your approach
From your conversations to the structure for each day, Dr. Khurana recommends being flexible and accommodating to fit what the person with dementia may need that particular day. “Moving to a different environment may be the thing to do to help distract them and keep them calm,” she adds.
Don’t bring up anything that you know could make them feel sad
Since dementia can cause “unstable emotions,” as Dr. Feibel says, try to avoid bringing up topics that can make the person feel sad.
Don’t ask too many open-ended questions
Open-ended questions can be very difficult for those with dementia. Dr. Feibel shares this example: instead of asking, “Do you want some fruit?” you can ask a specific question, like, “Do you want a banana or an orange?”
Don’t respond with harshness
“Try to incorporate as much love and understanding as you can as their symptoms worsen,” Dr. Khurana emphasizes. “The level of their dysfunction and difficulty is not their fault—this is a medical illness.”
Don’t offer too much help
As a caretaker, you naturally want to help your loved one with dementia as much as possible but toe the line between just enough and too much. Too much help may make them “feel like they are no longer competent,” according to Dr. Feibel.
Don’t speak about them to others while they are in the room
This could make a person with dementia feel unimportant or that they don’t exist. “They may feel like a child,” Dr. Feibel says. Next up, learn how to tell the difference between typical memory loss and dementia.
Sources
Gauri Khurana, MD, MPH, a psychiatrist in New York City.Dr. Shana Feibel, DO, Attending Psychiatrist at The Lindner Center of HOPE and Assistant Professor of Psychiatry at The University of Cincinnati.Alzheimer’s Foundation: “Facts and Figures”
