The Importance of Conversing With a Person Who Has Dementia: Some Tips

  • After my dad had surgery to correct increasing fluid build up behind scar tissue from a World War II brain injury, he came out of the surgery totally demented. Whether the dementia came from a combination of his age and the scar tissue, anesthetic or something else, we didn't know. All we knew was that he came out of surgery with a voice in his head and very little ability to discern the difference between what was a happening in this head and the reality of this world.


    That he was irreversibly altered was obvious. It was heartbreaking for his family and friends. However, Dad needed people. We, the family, of course stayed close with daily time at the near by nursing home which became his own home. However, there were many friends and former colleagues who wanted to visit, but could not. They didn't know "what to say." It was "too hard to see him like that." He is "always sleeping if I do go, and I don't want to disturb him." We heard it all.

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    These are good people. The loved Dad and truly wanted to be there for him, but they couldn't jump the hurdles necessary to communicate with him. Then, too, the change in his was so disturbing that they couldn't overcome their own pain to give to him.


    There were exceptions, of course. But many just couldn't do it. My personal opinion is that many people who can't visit others in hospitals and nursing homes are actually afraid because they know that this could, one day, be them. Their own mortality is spotlighted when they see their old friend in this condition. So, they stay away.


    But how do you communicate with someone isn't in what we view as reality? How do you communicate with someone who can't remember what they said five minutes ago, say someone with advanced Alzheimer's disease? I'll admit it can be hard. However, these people need the human contact and communication as much as anyone does.


    I've written before about ways to communicate non-verbally. Music, touch, massage and other non-verbal communication all have great value. But verbal communication is still important, whenever possible.


    What to talk about?


    I advise people to talk to elders - even those without dementia - about decades past. I can tell you first hand that it was fun to see the surprise on my kids' faces when I talked of witnessing the civil rights movement of the 60s. I also believed they learned something in that discussion. They learned something factual, perhaps, but they are well educated, so maybe not. But they learned something about their mother, as well. It made for some good bonding.


    This type of conversation becomes even more important when someone has dementia, because many, especially those with Alzheimer's, get to a stage where all they remember is the past. As the disease progresses, they often view themselves as teenagers or young adults. I've seen many who have retreated into childhood.


    So what if they are no long fluent speakers or even if they don't connect the dots, so to speak. It doesn't matter a whit. Just start asking questions about their childhood, or their siblings (if relations were pleasant), or their parents. Ask about their first job. If you happen to know their history well enough to cue them, that really helps. Many forward looking nursing facilities have story boards outside, or just inside, the rooms to tell visitors (and staff) the history of the person inside. This is important. Read the information and you will get clues about what you can talk about.


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    If you don't know the person's history well, but you know an approximate age, you can gather clues with photos or words from their early decades. Make a little scrap book and bring it when you visit, or use a photo album with pictures from their past as a guide for conversation.


    A wonderful tool to help with communication can be found at This site sells books with large photos and simple phrases in large, bold type to use, as the name implies, as memory triggers for conversation.


    Any of us could have a good conversation with many an elder who has memory problems by holding one of these books from the 50s or 60s and saying, "remember when?" I'm not implying you can't do this on your own, but I find these books great tools and would like to see them in nursing homes.


    The most important thing is to find out who this person is. What is their history? What is their legacy? Then use these clues to visit with them, even if the conversation turns out one sided or seemingly garbled. It's the communication that matters, not the content.


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Published On: October 12, 2009