Challenging the "Always Use a Formal Name" Myth
Many well-intentioned people believe a rigid rule about using a person's formal name is necessary when communicating with someone who has dementia. This belief often stems from a desire to show respect and maintain dignity. However, this approach can sometimes be counterproductive. The truth is that communication with a person living with dementia is not a one-size-fits-all process. The most successful strategies are rooted in flexibility, empathy, and a deep understanding of the individual's history and preferences.
A person's sense of self and their memories are often tied to specific periods of their life. For someone who has forgotten their later years, a name from their childhood or a beloved nickname might feel more familiar and comforting than their formal name. The goal is to establish a connection, not to enforce a social convention. Respect and dignity come from validating the person's current reality and emotional state, not from adhering to a rule that may no longer be relevant to them.
The Role of Person-Centered Communication
At its core, person-centered communication is about putting the individual's needs, preferences, and feelings first. This means abandoning strict rules in favor of an approach that prioritizes comfort and connection. A caregiver or family member should consider a few key things when deciding how to address their loved one:
- History and Familiarity: What name did the person prefer to be called during their life? Did they have a nickname that they loved? This can be a powerful emotional touchstone.
- Emotional Response: Observe their reaction when you use a certain name. Do they seem confused, uncomfortable, or do they respond with warmth? Their emotional response is often the most important guide.
- Stage of Dementia: In the early stages, a formal name might be perfectly appropriate. As the disease progresses, however, their relationship with their name may change, and a different term might become more suitable.
Practical Strategies for Addressing a Person with Dementia
Instead of adhering to the rule when communicating with a person with dementia, you must always use their formal name, caregivers and family members can adopt a more flexible approach:
- Ask Themselves: If the person can still answer, ask them directly what they would like to be called. Their answer might surprise you.
- Use Nicknames with Love: If they were known by a nickname (e.g., "Betty" instead of "Elizabeth"), using that can be a powerful way to evoke positive, familiar feelings.
- Terms of Endearment: For spouses or children, terms like "my love," "dear," or "honey" can be comforting, especially if the person no longer recognizes names.
- Listen to Others: Pay attention to what other close family members and friends call them. What is their natural, pre-dementia term of address?
When A Formal Name Is Best
There are certainly scenarios where using a formal name is the right choice. For example, if the person has always insisted on being called by their formal name and still responds positively to it, there is no need to change. This is all part of the person-centered approach—what works for one individual may not work for another. The key is to assess and adapt, rather than assuming a universal truth.
The Impact of Names on Identity
For many, their name is intrinsically linked to their identity. As dementia progresses, this connection can weaken or become tangled with past memories. Forcing a name that no longer resonates with their internal sense of self can create confusion or distress. By using a name that feels natural to them, even if it's a nickname, you are helping to validate their current reality and make them feel seen and respected.
Communication Beyond Names: A Broader Approach
Beyond just the name, effective communication with someone with dementia involves many other considerations. The name is just one piece of a larger puzzle.
The Comparison: Rule-Based vs. Person-Centered Communication
| Aspect | Rule-Based Approach | Person-Centered Approach |
|---|---|---|
| Core Principle | Follow a predetermined set of rules. | Adapt to the individual's needs and preferences. |
| Use of Name | Always use formal name. | Use name that is most comforting and familiar. |
| Basis | General societal norms and respect. | Individual history, emotions, and comfort. |
| Potential Pitfall | Can cause confusion or distress if the rule contradicts the person's inner reality. | Requires careful observation and flexibility. |
| Overall Effect | Can feel rigid and impersonal. | Fosters a more genuine and empathetic connection. |
Important Communication Best Practices
- Maintain Eye Contact: This helps establish a personal connection and shows that you are focused on them.
- Speak Clearly and Calmly: Use a moderate tone and speak slowly without shouting.
- Keep it Simple: Use short, simple sentences and avoid complex instructions.
- Use Positive Language: Frame requests positively. For example, say "Let's get your shoes on" instead of "Don't forget your shoes."
- Use Body Language: A warm touch on the arm or a reassuring smile can convey more than words.
- Create a Calm Environment: Minimize background noise and distractions to help them focus.
- Be Patient: Allow plenty of time for them to process and respond. Don't rush them.
Conclusion: Prioritizing Connection Over Rules
The idea that when communicating with a person with dementia, you must always use their formal name is a fallacy that prioritizes rules over the needs of the person. Instead of following a rigid, universal rule, the most effective strategy is a person-centered one that adapts to the individual's changing reality. By using the name that is most familiar and comforting to them, and by incorporating other key communication strategies, you can foster a sense of security, love, and connection that truly upholds their dignity. For more comprehensive guidance on communicating with individuals living with cognitive decline, the Alzheimer's Association offers valuable resources.
Remember, the goal is not to be a perfect communicator but a compassionate and flexible one. The best approach is to lead with love and to observe what truly brings comfort and clarity to the person you care for.
