Dementia is a collective term for patients with neurological changes that lead to abnormal decline in brain functions; it is also a disease that occurs due to the loss of brain functions. It affects patients' memory, thinking, language, comprehension and decision making ability. The impaired comprehension, memory and language abilities often causes communication difficulties between the patient and the carer and would lead to other behavioral and mood problems.

Factors leading to communication problems:

1. Patient's factors:

• memory loss and difficulties in retaining information, difficulty in finding a word to express themselves
• decreased judgment and comprehensive abilities, unable to understand the conversation of others and have difficulties in carrying out complex tasks. They may misinterpret the facial expression, tone and gestures of others
• difficulty in concentrating
• deteriorating in writing and reading skills
• unable to express their emotions, mood swing and increased level of irritability
• forget about the social etiquette, sometimes interrupt others during conversation and fail to give appropriate response to others

2. Carer's factors:

• speak too fast or in a high-pitched voice, causing stress to the patient
• provide too much information; or unnecessary gestures which may distract the patient's attention
• lose calmness and patience when communicating with patient due to being too tired and feeling frustrated
• improper tone of voice, e.g. shouting may cause patient to feel threatened and offended

3. Environmental factors:

• noisy environment
• poor lighting
• lack of appropriate visual cues or signage

Key points for good communication:

1. Maintain a quiet environment; turn off radios or televisions if necessary
2. Communicate with the patient face-to-face, and try to maintain eye contact at all times. Prepare appropriate glasses for the patient if necessary
3. Speak slowly and clearly. Encourage the use of hearing aids in patient with hearing problems. Do not shout at the patient nor speak too quickly
4. Keep the sentences as simple as possible. Convey one message at a time. Avoid the use of pronouns such as he/she/it, and use the names instead
5. Ask one question at a time and keep the question simple. Ask close-ended questions with limited choices such as 'Would you like an apple or an orange?' instead of asking open-ended question like 'What fruit would you like?'
6. Pay attention to facial expressions and body languages (e.g. smiling or wincing) in order to provide appropriate response accordingly, e.g. nodding and smiling can be signs of encouragement to the patient
7. Repeat yourself or prompt the patient by repeating the last part of the sentence if necessary
8. When necessary, show relevant objects to aid communication. For example, show the patient the clothes, a towel and soap to indicate it is time for a bath
9. Conversations should be concise as patient has difficulties in concentrating for long periods
10. If the patient is tired, pat him on the shoulder, call his name or hand over a drink for refreshment. Take a break before starting again
11. Do not debate or argue with a patient, try to change the topic to divert their attention to calm them down

Summary

As every dementia patient's situation and background is different, the carer can refer to the above principles and match the individual's need and the disease progression to adjust the communication skills used. Together with patience and empathy, many misunderstandings could be prevented. Please consult advice from relevant professionals if necessary.

Related Audiovisual and Booklet Package(s):

Practical Tips for Carers - Dementia Care
Practical Tips on the Carers of Elders with Moderate to Severe Dementia - Dementia Care II