By Ken Schmidt

This time we will focus on more tips for caring for and communicating with persons with dementia, and tips for caring for yourself as a caregiver.

More communication tips

The reason communication tips are so important is that this will be your main contact with your loved one who has dementia. You may not be caring for your loved one on a full-time basis, but you will hopefully be talking with your loved one often to keep their brain active and let them know they are loved and are not alone.

Reminder: We do not know by nature how to communicate with a person with dementia. Improving your communication skills will decrease your stress and will improve your relationship with your loved one. Good communication will also equip you for handling challenging behavior.

To connect with a person who has dementia:

• Approach them from the front (due to decreased peripheral vision). Make eye contact and call them by their preferred name.
• Smile and maintain a normal tone of voice. Watch your body language (avoid crossing arms in front of you, which sends a message of anger).
• Encourage two-way conversation, albeit simple communication.
• Identify yourself (as dementia progresses, people even forget the names and faces of loved ones who are near and dear to them). This also helps the person feel safe and comfortable. They will know you are someone who cares about them.
• Allow your loved one time to understand and respond to what you say. Speak slowly. Possibly allow five seconds for them to respond.
• Eliminate background noise and other distractions while talking (turn off TV, radio, etc.). Background noise makes it hard to concentrate and understand communication.
• Avoid arguing, using logic, scolding, yelling, showing anger, or making fun of your loved one.
• Use other methods of conversation such as gentle touch—stroke the forearm; put your loved one’s hand in your hand, and then put the other hand over the top to provide assurance.
• If your loved one becomes agitated when you are speaking to them, distract with a fun activity like offering a snack or going for a walk.

When engaging in a daily activity like dressing or getting ready to leave for an appointment:

• As the dementia progresses, do not expect your loved one to understand non-specific prompts like “Please get dressed” or “Get ready for your appointment.” They may not remember what getting dressed means or all the steps to go through to get ready for an appointment. For example: If you need to help your loved one get dressed, you may need to say, “Here is your shirt. Put your arm in here.” Or if your loved one is to get out of bed, you may say, “Roll toward me. Sit up. Hold here (point to headboard). Stand up.”
• Give the person with dementia simple either/or choices. For example, don’t say: “What do you want for lunch?” Rather ask: “Do you want salad (point to a salad) or soup (point to a bowl of soup)?”
• Use reassuring words often with the person, like: “Take your time. You can do it.” “Good job.” “Everything is OK.”
• If your loved one is having difficulty expressing themselves, you may help by guessing what they are trying to say. For example: “Are you worried about making your appointment?” or “Are you saying that you don’t like the food?”

Visual cues/reminders

• Put signs or pictures on cabinets that indicate what is in the cabinet.
• Put an arrow on the wall to direct the person with dementia to the toilet.
• Put a picture of a toilet on the bathroom door used by the person with dementia.
• If the person with dementia can follow written instructions, put a sign on the bathroom mirror prompting them, saying, “Brush teeth,” “Wash your face,” “Comb your hair.”

Non-verbal messages/behavior

Persons with dementia may not be able to communicate verbally what they are feeling or want, but they may do so with actions. For example: repeated visits to the kitchen may indicate hunger; a sad face may indicate being unhappy or uncomfortable with surroundings (temperature, lighting, sound) or clothing or pain or sickness; smiling may indicate enjoyment of an activity; grabbing clothing or taking clothing off may indicate they are feeling too warm.

Prompts or cues to increase participation in activities

If a person does respond to verbal directions, you may need to demonstrate what to do and/or use tactile prompts. For example: guiding their hand to paint or color. Using your hand over their hand to assist them with feeding themselves.

Activities—Encourage your loved one with dementia to do as much as they are able to do safely. Example: involve them in household chores like washing the dishes, sweeping the floor, sorting socks, or folding laundry. Play simple board games with them; take a walk in the park; go to sporting events that involve young people; talk about memories from their childhood.

Spiritual activities—People with dementia often still value their spiritual life and spiritual activities. Involve them as much as you are able and as much as they will tolerate. Understand there may come a point where they may get overstimulated by a lot of activity and the volume of the music and complexity of worship practices. If that happens, then the pastor can be asked to visit your loved one as a “shut-in” so their spiritual needs are met. 

Hallucinations/delusions—A person with dementia may think that their deceased mother is still alive or may think someone took their possessions or clothes when that is not the case. Understand that is their reality. Do not argue or try to use logic. Rather, go along with the person’s belief of what they think is true. Say something like, “Your mother can’t come today…your mother is safe.” For “missing” possessions, say, “Those clothes are really important to you” or “You’re concerned about having clothes to wear. What was your favorite color dress?”

Addressing aggressive behavior (hitting, pushing, pinching)—Triggers for this behavior are numerous. They could be pain, lack of sleep, eyesight or hearing problems, medication side effects, change in routine, stress, fear, loss of control, etc. Determine the trigger and address it. Minimize aggressive behavior by avoiding loud noise or too much activity, and avoid sudden changes. If you have to make changes, make them gradual. Keep familiar objects around. Plan stressful activities when your loved one is well-rested. Limit choices. Pace cares (like getting dressed, bathing, eating a meal, etc.). Establish a routine. If a person believes something that is not true, agree with them and change the subject.

Caring for yourself—stress relief for caregivers

Interacting with and/or providing care for a loved one with dementia can be very stressful. Signs of caregiver stress include:

• Irritability and impatience with your loved one
• Sleep problems
• A change in appetite
• Problems with concentration
• Withdrawal from others
• Feelings of depression

How to prevent caregiver stress

• Take time out for yourself and stay connected with others.
• Take breaks from caregiving, even if it is only 15 minutes at a time.
• Take a walk and make time for physical exercise.
• Make time for family and friends. Call friends and family regularly.
• Laugh—take time to laugh! Watch comedy shows.
• Learn and practice relaxation techniques (deep breathing, etc.).
• Maintain your spiritual life through regular worship, daily devotions, Bible reading, and prayer.
• Ask for help from others—other family members can take turns with care.
• Hire a paid service to stay with your loved one for a few hours or consider an Adult Day Care Center for day programming.

How to relieve stress when it does occur

• Do deep breathing.
• Listen to music.
• Do visual imagery (picture a relaxing scene in your head and imagine yourself in the midst of it).
• Practice progressive muscle relaxation.
• Pray/read Scripture.

For more information on dementia and addressing concerns about dementia-related behavior:

• The Alzheimer’s Association: alz.org or 800.272.3900
• The National Institute on Aging: https://www.nia.nih.gov
• Search “dementia behavior management” on the Internet

In closing, remember that your loved one is a person who has been created by God, but unfortunately now has dementia as a condition that is affecting their brain. Accept them as they are. Accommodate and support them knowing that they would be their old self if that were possible, but it is not. Love them, spend time with them, and assure them of your love and care—knowing that you might be where they are right now some day in the future, wanting the same love and care!

Thanks for caring for your loved one—one of God’s loved children!

If you are a caregiver and are struggling and would like to talk with a counselor, call us at 800-438-1772 or click here to request an appointment. May God bless you for the important caregiving work that you do!