When a loved one is living with dementia, it can be challenging to communicate. They may ask repeated questions, become upset during personal care, try to “go home,” or refuse help altogether. It’s natural to wonder, Why are they doing this? A more helpful question is, What are they trying to tell me?
I’ve been a Home Care nurse for 10 years and met hundreds of families living with dementia. I’ve learned that every behaviour expresses an unmet need. Is the person tired? Frightened? Physically uncomfortable? When we consider the world from their perspective, their distress – and ours! – often decreases.
Here are some strategies that help me keep interactions calm and positive:
Make dignity the goal.
Rather than “complete this task”, I frame my primary goal as, “Keep them comfortable, and preserve their dignity”. It really helps things go more smoothly!
Approach from the front.
Dementia often reduces peripheral vision, so approach slowly from the front. Make gentle eye contact and smile.
Fewer words.
My formula: Say their name to connect, share simple information, then end with a clear request. For example: “Hi Bill! Time for medication! Can you drink this?” Allow extra time for their response.
No quizzes.
Questions like “Mom, don’t you remember me?” create instant anxiety. Try introducing yourself immediately, then redirect to something positive: “Hi Mom, it’s your daughter Marie! I brought you a cookie!”
Respond to the feelings, not the facts.
If someone believes their spouse is waiting for them, denying that reality will upset them. Instead of correcting the facts, respond warmly to the feeling behind the words. You might say, “You’re such a caring partner! What’s your wife’s name?” When people feel validated, it’s much easier to redirect them: “Oh, Rose is a beautiful name! I love roses, do you like flowers?”
Take their perspective – literally!
Behaviour is communication, especially when words become difficult. When your loved one is distressed, look around from their perspective. Jackets hanging in the hall may remind them of leaving – tuck them away. The tiny red light on an appliance could create an eerie glow at night – cover it with tape. Small changes can make a big difference!
Keep it collaborative.
Indirect questions can feel less demanding: “I wonder… chicken noodle or cream of mushroom today?” “Blue sweater, or green?” Offering simple choices preserves dignity and a sense of control.
There will still be some difficult days, but by taking their perspective and responding to the feelings rather than the facts, we can reduce distress and even create moments of genuine connection. We can’t control the other person’s behaviour, but excellent care can start with changing the way we see the situation.
Michael Rix is a Registered Nurse and the founder of Blue Sky Home Nursing, providing expert elder care all over the GTA. www.BlueSkyHomeNursing.ca
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