This post offers ten do’s and ten don’ts for effective communication for all caregivers.
Local LBD support group member Dorothy Adams sent me info about the “Dartmouth Memory Handbook” recently. She said:
I have not read the complete book, but I am so impressed with every section. I especially liked Section 4: “Taking Care of People with Memory Disorders” gives a list of do’s and don’ts for effective communication is very specific to guide/help us in learning how to speak kindly and communicate with a person suffering with dementia. How we say something, our voice tone, inflection, patience, impatience, comes through to the loved one. I learned some of this in a class, but it is the first time I have been able to review it!
The handbook, edited by Dr. Robert Santulli of Dartmouth-Hitchcock Medical Center, was published in 2011. Much of the content was written in 2010. You can read the handbook at no charge online, download it and print it yourself, or order a copy that will be sent at no charge.
Here’s a link to the online version:
This 341-page handbook contains 13 sections. Like Dorothy, I recommend Section 4, Taking Care of People with Memory Disorders. As with the other sections, section 4 contains a few items written by Dr. Santulli and lots of items reprinted from other publications, mostly those that focus on Alzheimer’s Disease.
One of the more useful items is Dr. Santulli’s “Do’s and Don’ts for Effective Communication.” The ten-item list of do’s and ten-item list of don’ts are copied below. (It’s section 4.1 of the handbook.)
I do NOT recommend Section 3.4, Lewy Body Dementia/ Dementia with Lewy Bodies (DLB). This section is a reprinted fact sheet from the “Lewy Body Dementia Directory” (zarcrom.com). There are better, more accurate fact sheets available from other sources, such as the LBDA (lbda.org).
If anyone else finds other worthwhile nuggets, let me know!
4.1 Do’s and Don’ts for Effective Communication
Robert B. Santulli, M.D
Revised September, 2010
Below are suggestions for attitudes to have and techniques to use when interacting with someone with Alzheimer’s disease or other dementia. There are also a set of suggestions for interactions to avoid.
1. Do have “Unconditional Positive Regard”
No matter how difficult the behaviors of the person with dementia can be, respond with patience, without anger, and with affection.
2. Do make all communications short, simple and clear
Give only one direction; one question; one idea at a time.
3. Do tell the person who you are if there appears to be doubt
4. Do call the person by name
5. Do speak slowly
The person with dementia may take longer to accurately process and understand what is being said.
6. Do use closed-ended questions which can be answered “Yes” or “No”
For example, ask: “Did you enjoy the roast beef at dinner?” rather than: “What did you have for dinner?”
7. Do find a different way to say the same thing if it wasn’t understood the first time(s)
Usually, a simpler, more concrete statement, with fewer words will be better understood.
8. Do use distraction, partial truths, or even “fiblets” when necessary, if telling the whole truth will upset the person with dementia
For example, in answer to the question, “Where is my mother?” it sometimes might be better to say: “She’s not here right now” rather than “She died twenty years ago”.
9. Do use repetition as much as necessary
Be prepared to say the same things over and over because the person with dementia can’t recall them for more than a few moments at a time
10. Do use techniques to attract and maintain the person’s attention
Smile; make eye contact; use gestures and touch
1. Don’t ever say:
“Do you remember?”
“Try to remember!”
“Did you forget?”
“How could you not know that??
2. Don’t ask questions that directly challenge short term memory.
Don’t say, “Do you remember what we did last night” because the answer will likely be “no”, and this may be humiliating for the person with dementia
3. Don’t talk in paragraphs.
Persons with dementia may be unable to follow a complex set of ideas presented. Offer one idea at a time. One noun and one verb in one sentence is enough for the person with Alzheimer’s disease
4. Don’t say anything that points out the person’s memory difficulty
Avoid remarks like: “I just told you that” or “We already talked about that” — just repeat it again (and again)
5. Don’t talk in front of the person as if he or she were not present
Always include the person with dementia in any conversation when they are physically present.
6. Don’t use lots of pronouns
Avoid “there, that, those, they, him, her, it; use nouns instead. For example, “why don’t you sit in the blue chair” rather than
“why don’t you sit there”
7. Don’t use slang, unfamiliar words, or jargon
The latest expressions in common parlance may not be understood by the person with dementia.
8. Don’t use patronizing language or “baby talk”
Even very demented persons are sensitive to being “talked down” to or patronized, and will feel offended, angry or hurt.
9. Don’t use sarcasm, irony; be cautious with humor
This kind of humor may be well-intended but can easily backfire and cause hurt or confusion.
10. Don’t be impatient.
If you ask a question, wait for a response. Give the person time to process the question and think about their answer