Dementia caregivers—including family members, friends, and professionals—wisely say, “It’s obvious that people living with dementia need and want social connections more than ever, but enjoying a social visit is easier said than done.” Dementia care communication can be difficult for the patient as well as the caregiver.
Last week, I spoke to a woman who was caring for her mother from a distance. She explained that their long social visits on the phone had all but disappeared. She said, “Mom was a chatty Kathy! We used to talk for hours about anything. Now her answers are short, and our calls are over in minutes. I miss our social time together, and I believe she misses it too.”
Other caregivers report their face-to-face visits falling flat. “Recently, my visits with Dad feel more stressful than fun. We spend most of the time rehashing the difficult situation without solutions, which is upsetting for us both.”
Dementia caregivers and the people they support would like to spend quality leisure time together, but communication breakdowns during social visits can leave everyone feeling unsatisfied. Good news—when caregivers understand why social visits are challenging and master a few simple communication strategies, they can recreate quality social time that feels better for everyone involved.
Gathering Information: Dementia Care Communication
So, why do social visits fall flat for dementia caregivers and the people they support? The problem seems to have multiple root causes:
- The person with dementia experiences chemical and structural changes in multiple areas of the brain that make socializing more difficult (e.g., short-term memory loss, impaired formal language understanding and production, and decreased emotional control).
- The caregiver’s standard approach to visiting (sitting together and talking) might expose the person’s losses AND fail to maximize their remaining strengths (e.g., preserved long-term and emotional memories, social chitchat, conversational rhythm, and the ability to understand visual cues).
- Furthermore, the environment may also present additional challenges for both people during a social visit, making it more difficult to connect physically and emotionally (e.g., the place is too cold, too loud, too dark, too busy, etc.—or the context lacks interesting things to see, taste, touch together).
Consider This Scenario
Sara is a young woman visiting her grandmother in the dementia care unit at the assisted living facility. Sara hopes that her visits will help the two maintain the positive social and emotional connection they’ve always enjoyed. However, Sara recognizes the visits feel more stressful lately, and the two ladies are having trouble connecting. Sara greets her grandmother in her grandmother’s private bedroom, pulls up a chair, and tries to start a conversation. Her grandmother doesn’t immediately recognize Sara, so Grandma peppers her with her own questions at the start of the visit like, “How do I know you? Why are you here? How are we related? What’s happening?” As Sara tries repeatedly to explain the family tree and how the two ladies are related, her grandmother’s questions increase, and mutual frustration grows. Noticing her grandmother’s escalating upset, Sara cuts the visit short and leaves, feeling sad.
On closer look, a particular type of memory loss associated with early- to middle-stage dementia is at play during the start of Sara’s visit; it’s called situational memory.
Situational memory allows us to understand how things got this way. The key to situational memory is stringing events and facts together in a logical order. The situation started with A. Then, A led to B, which led to C, which led to D, and that’s how we got here. We take it for granted, but understanding our family tree (how we’re all related to each other) involves a timeline of events. Similarly, understanding why we’re in this place and how we got here requires putting facts together in order—something that people with dementia struggle to do.
Sara tried to line up facts for her grandmother, but without situational memory, it didn’t hang together.
A breakthrough happens when caregivers shift attention away from the facts (less emphasis on the logical order of the current situation) to focus more on creating a positive emotional vibe and tapping long-ago memories. In fact, the person with dementia might know they know you (feeling connection and belonging, which are preserved with emotional memory), even if they can’t trace your exact relationship. You can read more about emotional memory in our previous blog on the subject of answering repeated questions. Following are more ideas to apply this concept and make social visits more enjoyable and improve dementia care communication.
Ten Communication Tips for Improving Your Social Visit with Someone Living with Dementia
- Prepare yourself to start the visit with a positive emotional vibe. Plan the visit at a time when you’re not in a rush. Prepare a few topics of conversation or simple activities to do together that will fuel more conversation. Think ahead of simple questions you might ask to keep the conversation flowing. Take a few deep breaths, and enter calmly.
- Approach without startling. First impressions matter, so try to get the interaction started on the right foot. For example, approach the person from the front to avoid startling them. Announce yourself, so they can hear you. Give the person time to see you before entering their personal space. Offer your hand; it’s a simple visual cue that alerts the person you’re coming closer to greet them. Move to the side, and get on their level. Offer a friendly social greeting once they see you, and give the person time to respond. Read more about the science behind the caregiver’s approach in this full article .
- Keep your tone of voice friendly and respectful throughout the visit. As a person with dementia struggles to understand formal language (informational words), they are listening carefully not just for what you say, but how you say it. Preserved emotional memory catches the tone, vibe, pace, pressure, body language, how fast or slow it sounds, and how intense it feels. Emotional memory puts it all together and decides how the communication feels—separate from the words.
- Let the chitchat flow (plan a longer list of things to talk about). Social chitchat is stored separately in the brain, apart from formal language. This rhythmic social language, characterized by automatic questions and responses, is also stored in one’s long-term memory—so people with dementia may shoot the breeze better than they speak about the facts. Caregivers who keep the tick-tock rhythm of social chitchat are said to have “the gift of gab,” a prized dementia care skill!
- Tap long-term memories. Tell favorite stories from long ago. If the person has trouble storytelling, and you know how the story goes, try filling in parts and telling the story together.
- Focus more on the feeling and less on the facts. Let mistakes slide. Don’t sweat the small stuff; facts might not be 100 percent because of the changes in situational memory and formal language. Rather than correcting the mistake, offer a familiar phrase or word to cue them to tell the next part of the story. Go with the flow. Learn more about how to appeal to the person’s feelings with your communication, especially when upset feelings arise.
- Use humor. Laugh when the person is laughing—it shows that you’re listening, and you get it! If you know what makes the person smile or laugh, tell those jokes to create a more relaxed, friendly emotional vibe.
- Show more visual cues. Formal language begins to fade in early-stage dementia, and by moderate stage, the person is misunderstanding 50 percent of words they hear and having similar trouble finding the words to express themselves. Showing the person what you’re talking about can be a tremendous help. Use your body to show gestures. Show objects, point to things in the environment, and demonstrate what you want the person to do. Ask the person questions about things that you can both see.
- Incorporate music and rhythm. Many people with dementia can sing better than they can talk. Try singing or listening to music of their era. Music can work wonders to set a positive emotional vibe, tap long ago memories, and fuel fun and interesting conversations.
- Notice what works and what doesn’t, and adapt. Even a great idea is not guaranteed to resolve your challenge on the first try. Tune in to what’s happening in the situation during your next social visit, as you try one or more of these communication strategies. As you redesign your social visits based on what works for you and your loved one, celebrate that you are becoming a more adaptive caregiver!
Dementia Care Success Stories
Sara decided to try a few new strategies in her next visit with her grandmother. First, Sara invited her grandmother to the garden at the assisted living place. Sara felt the relocation would offer a less stressful environment for both of them and lend more visual cues during the visit. Sara also decided to bring a few props (things they could both see, touch, and talk about) to the visit, so she picked up a few ears of corn at a grocery store on the way to her grandmother’s place.
Grandma greeted Sara with her usual question, “How do I know you?” but this time Sara answered briefly, “I’m Sara,” and showed her the fresh ears of corn. Sara asked: “Do you know how to fix these?”
Grandma: “Of course I do. I’ve done that my whole life.”
Sara: “Would you help me get this corn ready?”
Grandma: “Sure. I’ll help you. Where are we going?”
Sara: “Let’s go outside. I’ll show you the way. Come with me.” Sitting together in the garden, the two shucked the corn together, taking breaks to talk about Grandma’s history of farming, cooking, and raising her family. Sara recounted stories of her grandmother teaching her meaningful food traditions. Sara felt more prepared to let her grandmother’s mistakes slide when Grandma got a fact or name wrong in her stories. If Grandma got confused, Sara redirected her back to a familiar part of the story or cued her to look at the ear of corn in her hands. Through the activity, the two felt close, as they had during countless visits at their family home.
At the end of the visit, Grandma said, “Thank you honey, I needed that.” As she left the visit, Sara felt more confident that she and her grandmother had many more good times ahead.
Practical Application: How to Talk to Someone with Dementia
Notice how rhythm works in your social conversations. Have you noticed a person with dementia can keep the tick-tock rhythm of chitchat better than fact-based discussions? Do you know someone who can sing better than they can talk?
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 visit socially with someone living with dementia?
Many of you have 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!
Additional Resources to Learn More about Dementia Care
Here are some more “communication do’s and don’ts” to improve your social visits and foster meaningful connections with people living with dementia.
For more about dementia care communication, especially dealing with your loved one’s distress, check out the full article.
Learn more about non-verbal communication and dementia.
By: Jennifer Savage, Occupational Therapy Student, East Carolina University, and Dr. Heather McKay, Partnerships for Health.