Conversation

Conversation is a process of ‘give and take’. It is central to sharing meaning, to helping people keep a sense of themselves and to fully participating in life.

Most people living with dementia engage less in conversation as their illness progresses. This may be a result of problems that the person living with dementia is experiencing (for example their attention may wander). It may also be because others find it difficult to know how to interact with them and tend to limit their conversation to very basic subject matter.

Certain relatively simple strategies can be employed to make conversation more satisfying for both parties.

Thinking about approaches to conversation

Try to think through how it might feel to struggle to communicate if you were living with dementia and think about what might help – and what has helped in the past.
Conversation is caring – you aren’t just chatting, you are acknowledging each other as people.
Communicate naturally where you can but be prepared to lead and re-direct conversation if it is helpful.
Discussing activities that you or the person living with dementia are engaged in is often a good starting point.
You can circle around an important point of conversation with someone living with dementia – and find that you get where you want to go eventually.
Time of day may be important – some people living with dementia find it much easier to communicate first thing in the morning and some at night, for example.
Try to walk away if you can if you are getting irritable – it helps no one.

Listening

Give people your full attention.
Speak slowly yourself and be prepared to wait for a reply. Let people formulate ideas, which can take time. People living with dementia often say they need to gather their thoughts – and how frustrating it is when they have done so but the discussion moves on before they can say what they wanted to say!
Take seriously everything that people say to you and if it seems confusing think about what they might mean. For example, if people ask ‘to go home’ it often means that they are feeling worried and anxious.
Listen for tone of voice – it is an important part of the way we all communicate.
While it isn’t helpful to mislead people living with dementia, it may sometimes be right to enter into the world that people momentarily believe they are in; responding as if you are a friend that the person recognises, for example. This is a fine judgement!
Look for clues in people’s behaviour and try to get a feel for what they might mean.
We often have an ability to understand one another that isn’t based only on what is being explicitly said, even if we would find it very difficult to explain how.
Be prepared to be surprised and to learn. Many people who appear to have very limited skills are able to communicate effectively when they are feeling comfortable and are given time.
Focus on positives where you can, listening for what people can do rather than what they find difficult.

Speaking

Speak slowly – people living with dementia may find it difficult to concentrate through very rapid speech. Use simple words where you can and keep sentences simple – don’t discuss too many ideas at once.
Think about what you are saying and what has been said to you and be honest in replying unless it is unnecessarily hurtful.
Deafness or other communication issues may be relevant. Speak loudly where appropriate and let people see your lips where you can. Using hand gestures is natural and often helps.
Be prepared to go through what you said several times and be prepared to re-frame questions by putting them in another way – and don’t worry if the conversation seems to go somewhere you weren’t expecting. Listen anyway, but be prepared to say, ‘I’m sorry, I didn’t understand what you said’.
Sometimes pointing to examples or having pictures handy may be helpful.
Often people with dementia will be trying to explain something in a roundabout way that you may be able to understand after a while. Sometimes, however, it may be impossible to find a shared meaning.
Find humour where you can. People rarely enjoy being laughed at but often enjoy laughing together.
It is generally not right to mislead people but always insisting on the truth may be unrealistic, so there is sometimes a case for deflection. For example if someone asks to see their mother it is more appropriate to say something like: ‘What were the kinds of things you liked to do with your mother’ than ‘your mother will be coming soon’ because it may lead to disappointment or ‘your mother is dead’ because it makes people sad without helping much.
At the end of a discussion, try to make it clear what you have understood and explain what you will do next.