Challenging Their Reality with “You’re Wrong” or “That’s Not True”
When a person with dementia says something that contradicts reality, it is tempting to correct them. However, telling them they are wrong can cause unnecessary frustration, agitation, and distrust. The individual’s brain is no longer capable of processing information the way it once did, so their perception of events may be fundamentally different. Disputing their reality can make them feel embarrassed, insecure, and disrespected. Instead, it is more compassionate and productive to accept their version of events and focus on their feelings. For example, if they insist a deceased pet is in the next room, rather than arguing, you can respond with reassurance. You can say, “You love that cat so much,” acknowledging the underlying emotion of affection without reinforcing the misconception. This technique, often called validation, helps de-escalate situations and maintain a positive relationship.
Asking Memory-Dependent Questions like “Do You Remember…?”
While it seems like a natural way to spark conversation, asking questions that rely on short-term memory, such as “Do you remember what we did yesterday?” can be harmful. This can feel like a test to the person, reminding them of their cognitive decline and causing embarrassment and anxiety. Instead of quizzing them, communicate with a person-centered approach that focuses on the present moment and their feelings.
Better approaches include:
- Making a statement: Instead of asking, “Do you remember our vacation to the beach?” try, “I was just thinking about our time at the beach. It was so relaxing”.
- Using visual cues: Look through a photo album together and make observations about the pictures, such as, “Look how much sun we got on this day!”.
- Asking about long-term memories: People with dementia often retain long-term memories longer than recent ones. Consider questions about childhood or their early career, which are more likely to lead to a positive interaction.
Pointing Out Repetition with “I Already Told You That”
Due to memory impairment, it is common for a person with dementia to repeat questions or stories. A caregiver's frustration might lead them to respond with “You just asked me that,” but this can be hurtful and dismissive. From the individual's perspective, they may be asking the question for the first time. Pointing out their repetition highlights their disability and can make them feel ashamed and invalidated.
Instead, try these compassionate alternatives:
- Respond calmly and patiently as if it's the first time you've heard the question.
- Respond to the emotion behind the question rather than the factual query. If they keep asking where their keys are, they may feel anxious or insecure, and need reassurance.
- Use distraction by redirecting their attention to a pleasant activity or another topic.
Using Infantizing Language or a Condescending Tone
Speaking to an adult with dementia as though they were a child is disrespectful and damaging to their dignity. Phrases like “honey” or “sweetie,” when used with a patronizing tone, or talking about them as if they are not in the room, can make them feel diminished. It is important to remember that the person with dementia is still an adult who deserves respect. Even if their cognitive abilities have declined, their personhood has not.
- Maintain a respectful tone: Speak in a calm, conversational, and respectful voice.
- Make eye contact: This shows that you are focused on them and respect them as an individual.
- Address them directly: Even when communicating with another caregiver about their needs, always include them in the conversation.
Presenting Multiple Options or Complex Instructions
Giving a person with dementia too many choices or complex, multi-step instructions can be overwhelming and confusing. Their ability to process information is reduced, and they may become agitated or shut down when presented with an overload of information. For instance, asking, “What would you like to do today?” can be too broad and stress-inducing.
| Ineffective Communication | Effective Communication |
|---|---|
| “Do you remember what you ate for breakfast?” (Tests short-term memory) | “That was a tasty breakfast, wasn’t it?” (Makes a gentle statement) |
| “Let’s go get ready for our doctor’s appointment and then pick up lunch and visit your sister.” (Too many steps) | “Let’s get your shoes on.” (Breaks down into one manageable step) |
| “What would you like to drink?” (Open-ended question) | “Would you like some tea or coffee?” (Simple choices) |
| “You can’t go to work anymore.” (Highlights lost abilities) | “Why don’t we look through your photo albums today?” (Redirects to a pleasant activity) |
| “I’ve already told you that five times.” (Points out repetition) | “I’ll tell you again.” (Responds with patience) |
Conclusion: Prioritizing Dignity and Compassion
When communicating with someone who has dementia, the focus should always be on maintaining their dignity and ensuring their emotional safety. The ultimate goal is not to force them into our reality, but to enter their world with empathy and patience. By avoiding phrases that invalidate their feelings, test their memory, or condescend to them, we can prevent distress and build a stronger, more trusting relationship. Techniques like validation, distraction, and simplification are powerful tools for caregivers. The person with dementia still has a rich inner life, and by adapting our communication style, we can continue to have meaningful connections despite the challenges of the disease.
