One of the most important requirements for being able to provide compassionate, effective care for a person living with dementia is to understand them. When we truly understand, we are clear on their wants and needs and have insight into how they feel. This allows our actions and responses to be aligned with the person in our care, and good things often follow. 

But to gain understanding we must possess some extra skills. That’s because language - the ability to communicate through words- will decline due to Alzheimer’s disease and other dementias. This makes the person in our care less capable of communicating with their words. As examples:

• They might not find the right word (aka word retrieval deficits).
• Sometimes they have no words at all. 
• Often, they may use “yes” and “no” interchangeably
• They may use a word like “no” but mean something entirely different.

This challenge leads to costly misunderstandings. Costly indeed, because we know communication breakdowns are one of the primary root causes of distress behaviors such as anxiety, resistance, and aggression. These behaviors cause problems for care staff such as stress, burnout or injury. Likely, the person exhibiting distress behavior is suffering.

We can use the awareness that “we must go beyond listening to words”, to create stronger communication that is embedded in all situations. This enables everyone to feel safe and valued, enabling care and social interactions to become more successful. There is no way to underestimate the power of understanding the person living with dementia. It is a vital underpinning for a quality care experience for all.

How to Decipher the True Meaning 

The old adage applies here - It’s not what we say, it’s how we say it. This is true for everyone and also for someone living with dementia. Let me explain. 

• Saying “no” could just be an expression of a preference without any emotional distress behind it. 
• Or, “no” could mean something is terribly wrong. 

How do you know the true meaning of the word “no”? Try this. 

• Say “no” softly, without any real emotion. For example, say it as if I asked you if you’d like to join me on a walk at lunch and you’re not interested now.
  How did it sound? How did you look? How did you feel?
• Now imagine I asked you if you are ready to go with me to take a shower, and you felt scared or threatened. This time say “NO” again but make it an emotionally charged statement. Look in the mirror while you’re saying it. 
  How did you say “NO” this time compared to the first? What are all the things that noticeably changed about you when the word “NO” represented your fear, and not simply your preference?

Using a Dementia Capable Care Approach

So, what can we do? It’s pretty straight forward. We must listen to far more than their words. We must perceive the whole person and the variety of ways they are sending their message including their tone of voice, facial expression, body language, and physical reaction. These are all the ways they will communicate their feelings and their intended meaning behind their words. 

Let’s normalize this. We all communicate our thoughts and feelings with far more than our words. The only real difference is that the person with dementia becomes more reliant on their nonverbal forms of communication. And they need us to have the patience, knowledge, and skill to decipher and to understand them.

Picking up on this idea of reading the whole person, I’ll give some examples framed in our “Observe, Stop, Evaluate and Respond” (OSER) approach from our Dementia Care Training. 

If you Observe any verbal or nonverbal indicators of stress like angry tone or facial expression, or physical reactions like pulling away, pushing or hitting….

• Stop!
• Evaluate the situation. Think, “Does no mean something more? What could this person be trying to tell me? What could be the cause of their distress and how can I help?”
• Respond to calm. Pick an approach that says, “I understand, and I care” and do what is needed to alleviate the source of their distress. This should deescalate and help to regain trust and agreement and restore safety for all. 

The next time you have a chance to interact with someone with dementia, try this out. It works. By the way, I bet you use this skill every day when interacting with young children as they too lack verbal communication ability. You also use it every day for everyone because we all send messages without words. Now put this skill into working in dementia care and you and those you serve will be far better for it. 

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