Principles of Behavior Management and Communication with Dementia – Principle No. 5

This is another post in a series about managing problem behaviors with older adults due to dementing illnesses, whether residing in nursing homes, assisted living facilities, or in their own homes. Because the person with dementia is gradually losing normal brain function and mental ability, caregivers need to adjust their caregiving approaches to avoid overwhelming the patient and, at the same time, not to overestimate what the patient can understand or accomplish.

One of the early changes occurring with dementia is the difficulty with language and self expression. Word finding difficulty is very common, and even though the person has an idea of what he is trying to say, he can’t put it into words. This is aphasia. It leaves the person frustrated and vulnerable to high distress if he cannot make his needs known, or express hunger, or pain, or need to use a toilet.  In terms of receptive language skills, the person with a dementing disorder can easily give the false impression that he fully comprehends words that are spoken by the caregiver. Though appearing as if he understands, in reality, there is little or no comprehension, thereby raising the caregiver’s frustration level, as well.

To compensate for these losses in language skills, keep communication as simple as possible, limited to short phrases and directions. Instead of a question like, “Would you like to come to the dining room and listen to some nice music, or would you rather sit outside in the nice sunshine?” Rather, “Would you like to listen to music or sit outside?” is a simpler question, and a simpler choice. If you have to repeat yourself, repeat the same words exactly to avoid confusion that comes with trying to process the first question, and now hearing a different one. Also, if the person is having trouble finding the right word, it is a good idea to supply the word, if you know it. Simple sentences, simple choices, reassurance, good eye contact, and patience help to keep the frustration level to a minimum.

There’s a useful saying that applies to care with the dementia patient:  pay now or pay later. Taking a little longer to understand a patient’s communications, even when rushed, prevents bigger problems later on when the behavior problems and distress escalate. Prevention is the key to behavior management. For more insights into these issues, see the CoHealth online courses on differentiating among depression, dementia, and delirium, improving quality of life in long term care, and on managing problem behaviors in dementia patients.