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Ask the expert: communication is not always about talking

Ask the expert: communication is not always about talking


One of the misconceptions of dementia is that as the condition progresses, communication is entirely lost: Not so, communication, or some form of it, is possible in all stages.


Question: I look after my aunt who has been diagnosed with Alzheimer’s. Lately she has been having trouble communicating. She can’t seem to get the words out and often ends up in tears. I find myself getting more and more frustrated with her. Her doctor says this is a result of “aphasia.” How can I make communication between us easier?

Answer: Think of the frustration we feel when a word is on the tip of our tongues. Now magnify that exasperation tenfold and imagine living with it on a daily basis.

Dementia can have a serious effect on the part of the brain that controls language functions, causing communication abilities to deteriorate. This loss of language is called aphasia and it is a symptom that affects many people (not all) living with dementia.

This can result in individuals struggling to express themselves (finding or getting the words out), to recognize or understand words, or to follow a conversation. The level of aphasia differs from one person to another.

The golden rule is Patience.

You may need to give different approaches a try. Be prepared to observe and record what works and what doesn’t, and adjust as you go along.

Here are tips and strategies that may help you and your aunt.

1. There’s nothing in your question that suggests a lack of respect toward your aunt. Nonetheless you’d be surprised how easy it is to slide into a condescending tone or treat someone as if they were a child – especially when, as a caregiver, you may be pressed for time.

Always be conscious of your tone of voice and your body language when communicating with your aunt. Actions such as fidgeting, sighing, or visibly showing impatience will only produce more anxiety.

Instead, stay still, look her in the eye, smile reassuringly and if need be, pat her reassuringly on the arm. Make her feel as if you have all the time in the world for her.

2. You’ve heard of show and tell? Well, when verbal functions break down, we have to fall back on non-verbal communication.

Communicate by using hand gestures (e.g. pointing), visual cues for prompts (notes, photos, objects, etc.), or use your body (e.g. walking to the door and signaling for her to follow, etc.).

3. When speaking with your aunt, always face her directly and make sure she can see and hear you clearly. This will make comprehension on her part less trying.

4. Use sentences that are short and to the point. Avoid colloquialisms or any jargon that your aunt may be unfamiliar with.

5. Avoid overstimulus. It’s hard to concentrate on a conversation if there are too many people talking at the same time or if there’s added noise such as radio or TV blaring in the background. If the room is crowded, don’t hesitate to take your aunt to a secluded space.

6. When giving your aunt a selection, limit it to two choices and present the question to her as straightforward as possible (‘Would you like to eat apple pie or cherry pie?’)

7. If your aunt is struggling to get a word out, you can offer a guess but don’t interrupt – wait until she has taken a pause. If she gets anxious at your guessing game, stop immediately.

8. We all have our ways of processing information and at different paces. Someone with dementia may need a bit more time to process what has just been said to them. Do not rush or repeat yourself too soon. A good rule of thumb is to wait a minimum of 10 seconds before checking in gently with them.

9. Communication can take many forms. You may want to get your aunt involved in art, music, dance or other ways of self-expression (if she isn’t already). There have been known cases where, after playing a familiar piece of music for someone with dementia, the person is relaxed enough to speak with ease and fluidity.

I hope the tips above can bring you some solace. All my best to you and your aunt.

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Romina Oliverio

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