Dementia caregivers, including professionals and families, can agree that answering the same question over and over can be stressful. In fact, the negative health effects related to caregiver burden may begin early in the dementia care journey, largely due to broken communication. The frustration is mutual, as people living with Alzheimer’s disease and other types of dementia struggle to get and hold information about their situation. For those reasons, I’m dedicating the next few editions of Connecting the Dots to the most popular topic in my caregiver consultations: communication, starting with answering repeated questions.
When stuck on the Q&A merry-go-round, caregivers and those they support find it difficult to move past the questions and on to other activities that are more meaningful and satisfying. Good news—when caregivers understand why the repetitions happen and modify their responses for better communication, life feels easier for everyone involved!
So, why do people in early-and middle-stage dementia ask the same questions repeatedly?
Most people know that dementia takes some memory files and spares others throughout the progression of the disease. For example, starting in early-stage, a person may have trouble with short-term memory (e.g. what they had for breakfast) but preserved long ago memories (what they did in high school).
However, this particular communication challenge involves more than just short- and long-term memory. There are more areas of brain function involved—including those that are lost, as well as those that are preserved.
Have you noticed a person can ask the same question back-to-back in a matter of seconds? The rapid repeat indicates loss in immediate recall. Immediate recall is even faster than short-term memory. You’re using immediate recall to understand what just happened, what was just said.
Consider this scenario.
Caregivers tell me, “I’ve answered the question 100 times, and it’s not even breakfast yet.”
A gentleman with early-stage dementia wakes up with one question on his mind, “What time will my daughter be here?”
His wife responds all morning, “She’ll be here at three…She always comes at the same time, three o’clock…I expect her later around three.” She’s answering for the forty-eleventh time, and he’s fixing his mouth to ask it again. That’s an immediate recall problem.
The wife is curious about something else she’s noticed during this morning ritual. She explains that answering the same question is tiresome (naturally!), but as soon as her sweet response slips to something more frustrated “THREE O’CLOCK” she said, “He’ll wheel around and shout, ‘I don’t need that kind of attitude from you!’ I can’t win.” She wondered how her mistake registered with her husband more than her numerous previous responses.
I point to another type of memory spared long into dementia—it’s called emotional memory. The man can’t hold the facts, but emotional memory sticks.
Emotional memory acts like a radar scanning for the feeling in every interaction. Think to yourself, what’s the difference between three o’clock and THREE O’CLOCK? The facts are the same, but the feeling is different. Emotional memory catches the tone, the vibe, the pace, how fast or slow it sounds, the pressure, how intense it feels, the body language. Emotional memory puts it all together and decides how something feels separate from the facts.
One of the most important lessons I’ve learned is this: I’ve got that emotional memory radar, and so do they. People with dementia are better at catching a vibe than remembering the facts, so I shift my focus from the facts to the feelings.
Top Four Tips for Answering Repeated Questions
- Answer with a friendly, respectful tone. Granted, managing your own tone can be easier said than done under the stress of caregiving. However, your tone of voice could make or break the whole interaction. Remember the emotional memory radar and try taking a deep breath to answer the question like it’s the first time.
- Keep your words consistent. If a person struggles with immediate recall, then even a slight change in your answer demands processing new information. A common mistake was adding to the challenge in our story example. The first time the wife answered, she said “Your daughter will be here at three.” Next time she said, “She always comes at the same time, three o’clock.” Then, “I expect her later on around three.” Every time, the words changed slightly. It was like she was throwing him curve balls. He has a better chance of holding the information if it doesn’t change. So, try to pick an answer, and stick to it.
- Pair your words with a visual cue. In addition to the memory challenge, a person with dementia may have trouble understanding the words they hear. Pointing to something they can see may help them process the information. If reading is a preserved skill, try posting the information in a convenient location (e.g. whiteboard on the refrigerator or written reminder in the front pocket). Anticipate the person will need reminders to look at the visual cue, but with repetition, they may feel more confident to find the information where and when they need it.
- Capture attention with meaningful activities. When caregivers help the person put their mind on something they enjoy, the benefits of meaningful engagement extend beyond just distraction. Whether it’s taking a walk to check the mail, making a favorite snack, or going for a ride in the car, simple meaningful activities provide new scenery, conversation starters, and more positive feelings.
In each blog, I will share success stories I’ve heard from caregivers and others, related to the topic at hand. Here’s an example of a group of caregivers adapting to the challenge with teamwork. A certified nursing assistant (CNA) working in assisted living described a challenging situation. A resident woke every morning asking for her husband, “Where is he? When will he be back?” The woman’s husband visited every morning at the same time, but she couldn’t remember his routine. She worried, cried, and paced the hallway every morning, repeating questions to each caregiver she encountered.
As the CNA reflected on her new knowledge and the situation, the CNA noticed that the resident received numerous different responses from the caregivers in the hallway. The CNA shared the information and strategies with her colleagues, and together the team planned a new approach. They agreed to offer the same response, pay careful attention to the tone each time, and invite the woman for a coffee break while they wait together for her husband. The CNA said, “The first morning I saw this resident enjoying a coffee break with a caregiver and her neighbors, I knew we’d made progress. She still had a few questions about her husband, but nothing like before. She seemed happier to pass the time with friends, which made the morning easier for us all.”
Notice how interactions leave you with different feelings based on someone’s tone of voice. Have you noticed a person with dementia responding to different tones or non-verbal cues in different situations?
Based on these stories, tips, and what you’ve tried in the past, do you have at least one new idea to try the next time you respond to questions in your situation?
You’ve likely discovered additional effective strategies from your own experience. Freely share your stories and tips in the comments below. In your opinion, what is it about your strategy that makes it work? I bet we can apply your effective strategy in more than one situation!