Ways to support communication

We communicate for all sorts of reasons:

• to express needs
• to convey information – or to gain it
• to develop understanding
• for pure enjoyment
• to meet social or psychological needs, such as expressing feelings, establishing relationships, asking for help and reassurance, or giving an opinion

Good communication uses both our output and input systems. Our output – or expressive – system involves our ability to speak, sign, gesture, use body language and write or type. It relies on other abilities such as the organisation of our thoughts, our ability to recall words and put them into sentences, as well as the muscles needed to speak and to write or type. 

Our input or receptive system involves our ability to understand the speech, sign, gestures and body language of others, as well as our ability to read or understand symbols. The input system relies on us hearing words and understanding the meaning behind them. This system also stores our ability to know how and when to use an item, such as when a fork might be better than a spoon or why a dog might live in a house, but not a fox. Dementia can affect all of these abilities and make communication a struggle. It’s important to remember communication needs to be enjoyable and not just a means to an end, it’s important to make time for chatter and not just to communicate about needs.

Dementia can affect how a person is able to communicate, which means they might need support to understand and express themselves.

There are two aspects of communication; expressive and receptive. Difficulties with expressive communication may mean that the person has difficulty thinking of what they want to say, remembering the right words or in actually producing words and sentences. 

Sometimes people with dementia have difficulties saying what they want to say in socially appropriate ways. They may struggle to interact with others, take turns in conversation, or to follow social rules. They might also find expressing themselves through writing difficult. 

Dementia also affects receptive communication, making it hard to understand what is being said or to follow instructions or plot lines. It can mean that a person doesn’t follow advice because they simply hadn’t understood the information. A person may also have difficulties understanding gestures or body language, or have problems understanding what they are reading. 

When a person with dementia has difficulties with either expressing or understanding, you might observe that they:

• Ask the same question a number of times
• Tell the same story or give the same piece of information a number of times
• Have difficulty starting up a conversation and keeping it going
• Have trouble following and participating in a conversation, especially when there’s a group of people talking
• Drift from the pointing conversation
• Struggle to think of names of people, places, objects or muddle up words
• Have trouble following TV programmes
• Change the subject unexpectedly
• Talk about the past a lot
• Start to say something and then forget what they were talking about
• Swear in a way that is out of character
• Say things that are not true
• Withdraw and not participate
• Experience frustration

Difficulty communicating can make it hard to maintain relationships. You might find that that the person with dementia starts to withdraw from social situations or avoids interacting with others. It can be hard to know how to help them stay involved. What can be particularly challenging is knowing how to connect with people who are in the advanced stages of dementia.

There are things that you can do to make communicating easier for you both, and this can lead to more meaningful and enjoyable interactions. Communication is about connecting and there are lots of ways you can do that.

Here are a few ideas:

This can be easier said than done. It’s very natural to correct or contradict someone when you feel they don’t have accurate information. However, confronting a person with dementia with their mistakes will only create a negative atmosphere. Try instead to say something that incorporates the truth and that acknowledges the feeling behind what they are saying.

For example, if a person says they need to go to work but you know they are retired, ask them about what they used to do or make a comment about how much they enjoyed working or how busy they were at work. Also consider what feeling might lie behind their comment, could it be a need to feel useful, to be busy, or to feel valued? Is there a way you can help them to meet this need?

Become comfortable with pauses when they are trying to think of a word or when they are processing what you’ve said. Try not to overwhelm with information and give one piece of information at a time. It can be difficult for people with dementia to take in lots of verbal information so supplement what you are saying by using gesture, objects, photos and/or writing.

Having to answer questions can make people feel under pressure. A different technique, that can have the same outcome but avoid the stress of having to think of an answer, is to use a statement. For example, instead of saying ‘would you like a drink?’ try ‘I’m thirsty, I think I’ll have a cup of tea’ or instead of ‘when did you last see Karen?’ try ‘I haven’t seen Karen recently’. These statements can also be ways of getting the conversation started.

If someone is struggling to find a word, it can be tempting, if you know the word they are searching for, to say it for them. Some people may not mind this but others could find this irritating. It’s best to check. Ways in which you can help someone find the word are to ask them if they can describe what they are thinking of or see if they able to think of a different but similar word. Or you could reflect back what they have said to see if it triggers the word eg. ‘you checked the fridge and you need to buy……’

You can also use questions to help narrow things down, if this is not too stressful. Instead of bombarding someone with lots of ideas you could try one idea at a time eg. ‘is it a drink or is it something else?’ If it’s something else then keep going with gentle questioning. Sometimes however it is just not possible to get to the word and it’s important for you both to be OK with the fact that this happens now and then.

When someone has significant communication difficulties it can feel like there is no way to interact with them, but there are things you can try to help you connect ‘in the moment’. It helps to take the focus away from verbal communication but to value other ways of connecting such as eye contact, facial expression, gentle touch. Sometimes people make sounds/vocalisations and it is thought that these might be attempts to engage. Knowing this might help you to respond non-verbally to encourage an ‘interaction’ between you. Sometimes it is about shifting what we think as meaningful communication.

And finally it’s important to remember that not everything will work all of the time and that’s OK.