Conversation

What is it?

Conversation is where most communicative ‘give and take’ happens. As such, it is central to sharing meaning, to helping people keep a sense of themselves and to fully participating in life.

We can act in certain ways to make conversation more likely to be fulfilling both for people living with dementia and for those around them.

Why is it important?

Most people living with dementia engage less in conversation as their illness progresses.

This may be due to problems experienced by the person living with dementia – their attention may wander, they may speak ‘off subject’, they may reply abruptly or keep talking while having lost their thread.

It may also be because others find it difficult to know how to interact with those living with dementia and tend to limit their conversation with them to very instrumental, task-based subject matter.

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

Key implications

Conversation is caring. You aren’t just chatting, you are acknowledging someone as a person.
Always introduce yourself if you haven’t met before, or if you think they don’t recognize you.
Use whatever a person living with dementia is doing or saying to give you a starting point for a conversation.
Conversational ‘tempo’ is really important. A person living with dementia will probably need more time to respond, so allow them this time.
Touching someone could be a good signal that you want to start a conversation.
If the person doesn’t understand, think of a simpler way to say what you want to say.
If the conversation contains information that you know isn’t right, or that you don’t understand, ask them a question to try to clear things up.
During the conversation, watch for non-verbal communication (‘body language’) that is telling you something different from the topic of the conversation.
To check that they are following you, use words that the person has used, or use words that have related meanings. Give them as many related cues and clues as possible to help them to understand what you are saying.
Pictures or pointing to something for reference may be useful in helping the conversation along.
Try using everyday tasks to get a conversation going. For example, ‘Would you like chicken or fish for lunch today? Which do you like best?’
Keep a sense of humour!
More or less everyone likes to gossip, so don’t restrict the topics of conversation to the neutral (such as the weather), or the instrumental (for example, getting everyday care tasks done).

When speaking

If the conversation relates to tasks or instructions, remember the acronym KISS: Keep It Short and Simple.
Make sure you have got the person’s attention.
Give directions with key words at the end.
Speak slowly and clearly.
Discuss one idea at a time.
Avoid negative questions (such as ‘Don’t you want coffee?’)
Don’t be too ready with stock answers.

When listening

It is important to give the person your attention.
Try to be aware that you might have distractions, too, be they emotions or concerns or your own.
Listen actively ‘with all your senses’ to pick up cues and clues.
Be aware of different listening styles. There may be gender or cultural issues which make you, or the person you are speaking to, more or less likely to listen attentively.

Focus on the positives – what a person can do, rather than what they can’t.

Make the person feel that you have valued talking with them by making a positive comment at the end of the conversation.