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How to Talk to a Loved One with Dementia Molly is a 90-year-old former teacher who asks her children repeatedly when her late husband is going to come to take her home. How should they respond? Sam is an 85 year old banker who no longer can do simple math, but often forgets and demands that his son return his check book. Alice is a 79 year old retired factory worker who is frequently awake at night and wanders into the bedroom of her daughter where she is staying. These examples are, of course, not real, but representative of the many kinds of problems that develop when people get dementia. Dementias can be caused by many things. Alzheimer’s is the best known. But confusion of this sort can be caused by vascular problems in addition to many others less frequently occurring diseases and conditions. The consequence is often that the people who love those suffering from dementia have a great deal of difficulty understanding how to continue to relate. How do you spend time with someone who can’t think clearly, gets confused, or even believes things that are clearly not real? This communication problem causes a great deal of pain and discomfort for everyone. Some family members will undertake the futile job of correcting the confusions, while others will simply give up visiting or cut their visits short. But if families can learn a few simple communication skills, much of the pain of dementia for both patient and families can be reduce dramatically. Professionals in dementia care use three basic techniques with confused or memory impaired people. Let’s use Molly who is looking for her deceased husband to demonstrate: I. Reality Orientation is gently correcting a resident's misperceptions. An example would be reminding Molly that her husband has died when she forgets. If she responds "Oh right, I forgot for the moment," you know this is a good technique. However, as memory loss increases Reality Orientation can be ineffective or even distressing. It is no longer appropriate if Molly doesn't accept or believe the reminders about reality, or worse becomes angry at having her sense of reality challenged. “He most certainly is not dead!” At the extreme, if Molly doesn’t remember the death of her husband, each reminder can carry the pain of hearing it for the very first time. It would be cruel to subject Molly to the shock of learning of her husband’s death over and over again. II. Validation is used when reality orientation is no longer beneficial. With validation you enter Molly's world neither agreeing nor disagreeing her misperceptions. Her children would neither tell Molly that their father had died nor confirm that he is living. Instead they would have Molly talk about their father. They might ask, “Wouldn’t he normally be at work at this time?” Or, “How did he win all those athletic trophies in the den?” “Does he still look as good as on their wedding day?” Families might bring up a favorite memory--do you remember when dad did such and such...Folks with memory problems generally have better long term than short term memory and do better talking about things in the past rather than more current happenings. Feelings can also be validated and acknowledged. Molly’s children can comment that she seems to be missing their father’s presence right now. III. Redirection (also called distraction) involves gradually steering your confused loved one to a different topic that is less upsetting. If Molly wants to go home with her husband, her children could perhaps share memories of their childhood home and gradually lead her to other topics like the gardening she used to do or the antics of the family pet. She could also be redirected to something immediate in the environment as the play activity of a grandchild or the aroma of lunch cooking. With Molly’s poor memory, if she can be redirected, she might easily forget altogether what had her upset or even that she was upset a few minutes ago. There is no magical formula for when to use one technique rather than another. However, gradually as more memory skills are lost, validation and redirection are used more often and reality orientation less. The goal of communication becomes less to exchange information and more to have a positive, loving experience together that enhances the self-esteem and sense of well-being for the memory impaired. This can involve a painful sense of loss for families as their loved one becomes less of a confidant, friend, advisor or companion. There are other things that can ease relationships with people who have severe memory problems. Longer visits are often not as valuable to them as short, frequent visits. Interactions benefit significantly from structure. Instead of sitting and trying to talk, take your loved one for a walk, for a meal or for some other familiar and comforting activity. Tangible reminders of visits can be introduced, like having a memory book that every visitor signs and can be reviewed in subsequent visits, or leaving a card or small gift that marks the time of the most recent visit. Making the effort to learn how to communicate with someone you love that has dementia is very valuable. While people who are confused often are not aware of important details of their environment, they are often very aware of the relationships they have and, yet, have a reduced ability to pursue and nurture these relationships. If they are to continue to benefit from this support, their loved ones need to make the extra effort to learn how to communicate comfortably with them. |