Living with Dementia: Tackle Challenging Communications
For nursing home residents who are living with dementia, conversations can become challenging. How can you respond when a resident insists on something that doesn’t make sense to you? What does the resident need? Here are some insights and ideas that can help staff and family members alike. Take a look at three examples:
1 - A person says, “I want to go home.”
Insight: A person may not be thinking literally. The desire for “home” can be symbolic of a secure emotional state and a sense of well-being. The person may be feeling overwhelmed, confused, or insecure in the current environment. They may be experiencing anxiety or fear. They may not feel happy or safe or loved. They may miss friends, neighbors, or family members.
If you are a family member hearing this from a loved one you have transferred to nursing home care, you don’t need to take the request literally—or personally. A statement of “I want to go home” is not cause for guilt. To the contrary, it’s a message about difficult emotions that can pair with dementia in any care situation.
Idea: Take a close look at the environment and identify anything that may be triggering feelings—too much noise, for example. Try prompting the person to talk about home with simple questions, such as: “What do you do in your home?” Listen for the person’s needs and offer caring reassurance. You may also apply what they share to an activity. Gentle redirection into looking at photos, talking a walk together, listening to music, or having a snack can be helpful. For example, if a person tells you, “I like eating ice cream at home,” maybe you can segue into an ice cream snack.
2 - A person asks to see a loved one who is no longer alive (parent, sibling, friend)
Insight: The person may not remember the death. The desire to see a particular loved one can suggest an unmet need. For example, a person could be asking about “mother” because they’re feeling a need to be comforted.
Idea: Without trying to correct someone, encourage the person to talk about the loved one. Be alert to the emotions behind the request, and look to meet the emotional need with reassurance. For example, maybe the person is feeling afraid or lonely. Maybe the person misses gardening with a spouse. You can offer companionship and walk to look at flowers in or around the facility. Also be alert to physical needs, such as hunger or pain, and aim to meet these needs.
3 - A person says “someone is stealing from me” (or other delusions)
Insight: Delusions are common in dementia as it progresses. “Confusion and memory loss—such as the inability to remember certain people or objects—can contribute to…untrue beliefs,” explains the Alzheimer’s Association. Understand that a delusion is real to the person experiencing it.
Reasoning rarely works. When statements or behaviors don’t make sense to you and there are no safety concerns, you can accept what the person is saying and “just go with it,” advises Dr. Daniel Heiser, Senior Vice President, Behavioral Health at GuideStar.
“A person with dementia is trying to make sense of his or her world with declining cognitive function,” says the Alzheimer’s Association. Trying to correct someone or arguing the point will not help, because the brain is working differently. In fact, it will likely rachet up the level of distress.
Idea: Acknowledgement is helpful. For example, you can say, “It’s OK” or “I’m sorry to hear that,” suggests the UCSF Memory and Aging Center. They add, “It is generally best to acknowledge their experience with a matter-of-fact tone of voice without endorsing or denying it. For example, you might say something like, ‘Oh, that’s interesting,’”—and then move on to another topic of conversation. If possible, find or provide the item a person is looking for. You can also redirect the person by switching to a new activity.
Your approach matters
In all communications, keep in mind that “People with dementia may use your emotions as cues for their own,” according to UCSF. It helps to manage body language and the emotion being conveyed. A calm, caring approach, warmth, and touching a patient’s arm or holding a hand can be very effective. The emotional message you share has much more impact than the words you say.
By acknowledging what someone living with dementia is feeling—and discerning their needs, you can make a positive impact on their quality of life.
Looking for educational materials? A simple infographic from the National Institute on Aging can help family members with communication. See Do’s and Don’ts: Communicating with a Person Who Has Alzheimer’s Disease.
See more communications tips for nursing home caregivers, and find out how to redirect behaviors in the GuideStar Eldercare blog.