August 1, 2021

don’t know what to Say?

Tips for Conversations with a Memory-Impaired Person

Talking with a memory-impaired person can be difficult. You might feel like you are repeating yourself or asking questions that the person is not able to answer (such as “What did you have for breakfast?”). Enjoying a great conversation can be easy if you follow some of these tips:

• Limit distractions. To encourage focus, pick a quiet place free of visual and auditory distractions. This means turning off the television, asking children to play in another room, shutting the door to the room, and the like. Move close to your loved one, establish friendly eye contact, and use your loved one’s name; if necessary, introduce yourself. Don’t be upset if they do not remember you. Maintain eye contact so they keep their focus on you.
• Start with an observation, not a question. Begin with something easy to process such as “What a beautiful shirt you are wearing!” A simple, upbeat remark helps one relax and be more receptive to a conversation. Avoid questions such as “How are you?” or “Do you know who I am?” as they create stress, which makes conversation more difficult. If you must ask a question, wait until you have had a few successful exchanges and then offer choices for the answers if appropriate. For example, if the question is what to eat for lunch, instead of asking, “What would you like to eat?” ask, “Would you like to eat the club sandwich or garden salad?”
• Touch. Use a light touch on the shoulder or hand to focus attention to the conversation. Touch can express affection, comfort, and reassurance.
• Use simple language. Don’t raise your voice and speak in an overly simplified manner. Instead, speak slowly, clearly, and in an even tone. Choose shorter words to convey meaning and break questions and/or tasks down into multiple, simpler parts. Communicating this way may help you avoid overwhelming the person.
• Identify where they are. Before going further in a conversation, try to identify where and when the person currently thinks they are. If in their mind they are a child waiting for their parents to arrive then they will be confused if you talk about their current situation. Don’t correct them if they do not remember who you are or mistake you for someone else. To help them, you can make a simple statement such as “I came to visit you today.”
• Prompt for more details. Ask them to tell you more. For example, if they are looking for their cat, then ask, “What does your cat look like?”  If they tell you a story that does (or does not) make sense, then say, “That’s interesting! Please tell me more.”
• Be positive. People with dementia might not remember what you say or ask, but they will remember how you make them feel. Keep an upbeat tone and repeat yourself as necessary. Smile. Tell them you are happy to be spending time with them. Your goal is to make them feel good about themselves.
• Use nouns instead of pronouns. Try to be specific in your language. For example, if your wife leaves the room,  don’t ask, “Where did she go?” Instead, ask “Where did Mary go?”
• Be patient. It is OK to step in and provide words when your loved one is struggling but don’t overdo it. Intervening too often could discourage your loved one from sharing. Acknowledge their feelings with a statement like “It must be frustrating when you can’t find the right word.” Meanwhile, keep eye contact and maintain an encouraging expression. Silence is OK.
• Redirect and distract. If your loved one becomes upset, then redirect the conversation to a new topic or distract with a hug, a stretch, or an invitation to go for a walk. Avoid correcting, arguing, or using logic. The Alzheimer’s Association gives this example: your loved one who is no longer able to handle their own finances may become suspicious of any large transactions. Suppose they discovered a legitimate, routine bill paid out of their account.

Loved one: “I didn’t write this check for $500. Someone at the bank is forging my signature!”
You:

Don’t Argue and say something like: “What? Don’t be silly! The bank wouldn’t be forging your signature.”

Do Respond to Feelings: “That’s a scary thought.”

Do Reassure: “I’ll make sure they don’t do that.”

Do Distract: “Would you help me fold the towels?”

• Take a break. The mental energy to process the environmental stimulation is exhausting. Take frequent breaks. When resuming the conversation, summarize if needed.

Memory loss can make it difficult – but not impossible – for a person to communicate. Since memory can change throughout the day, try to visit either early in the day or after your loved one has a rest. Scale down your questions and responses to your loved one’s ability. If you need to make a decision, then write down the things you discussed and the final outcome. Establishing a written record enables your loved one to recall the conversation, see that all of their concerns were addressed, and what and how the decision was reached. Documentation helps prevent feelings of “you didn’t tell me.” Most of all, stay positive and recognize that repetition will be necessary.

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