How To Talk To A Parent With Dementia

Preparing to Communicate With a Parent With Dementia

Dementia is quite common, with recent estimates suggesting it affects 55 million people worldwide, with 10 million new cases each year. It is the seventh leading cause of death and a major healthcare challenge for individuals diagnosed with dementia and those who care for them.

For those with loved ones with a dementia diagnosis, it can be very painful to watch the changes occur as dementia progresses. As you prepare to communicate with your parent with dementia, it is important to keep in mind what stage of dementia they are in. In earlier stages, memory changes are milder, and your parent may deny experiencing any changes at all. Your parent may be defensive and not open to hearing about changes they may expect to see over the next several years.

To set the stage for success, ensure you set aside enough time for an open dialogue. You should also:

• Avoid challenging your parent’s beliefs about their condition.
• Stick to factual statements.
• Use simple, easy-to-follow language.
• Choose a comfortable place.
• Speak slowly and clearly.
• Try not to take it personally if your parent gets irritated.
• Ensure your parent isn’t hungry or thirsty.

As dementia progresses, your parent may begin to have difficulty recognizing familiar people (including you), get lost more often, and show personality and mood changes. Your parent may start having a harder time following your conversation, and you may find that you are repeating yourself many times, even within the same breath.

At this stage in your parent’s dementia, it is unlikely they will be able to retain any new information you provide. Focus on providing supportive statements and keep the conversation simple. At this stage, ensuring your parent is feeling, eating, and sleeping well will likely be the mainstay of your conversations. These may seem like basic things to talk about, but asking about these things will alert you sooner that your parent is developing a medical condition or depression.

Individuals with dementia are at risk for developing depression and anxiety. Estimates indicate that nearly 80% of individuals with Alzheimer’s disease develop depression during their illness. Likewise, an episode of depression that occurs later in life increases the likelihood of the development of dementia by two times.

Things to Consider About Conversation Topics

Ideally, you would have already discussed their concerns and wishes regarding their medical care. As their dementia progresses, your family member may no longer be able to make rational decisions about what procedures they want done.

When having everyday conversations with your parent, reminding them of the current date and season, who the president is, and some current events is helpful. This helps keep your loved one aware of their surroundings and lowers the risk of them becoming disoriented. Keep conversation topics light and focus on how your family member is feeling and doing. Ask if they are eating all their meals, how they are sleeping, and how they are spending their time. This will give you an idea about how they are feeling and coping with their condition.

The following are some specific topics to consider discussing.

Advanced Directives

Advanced directives are documents that you and your parent can complete together that state what kinds of lifesaving measures your parent would like done in the event of a medical emergency. Some individuals do not want to be put on a breathing machine. Some individuals do not want to endure CPR, which involves chest compressions and can sometimes lead to broken ribs, particularly in more fragile older adults.

Finances

It is also important to consider who will manage their finances, as they will not be able to pay bills or keep track of expenses on their own. The earlier you consider these issues, the less likely they are to fall behind on bills.

Living Arrangements

It would be good to understand your parent’s wishes for their living arrangements and your ability to assist with that. Many individuals want to try to keep their loved one at home as long as possible, but it can be a very big emotional and financial strain to do so. When dementia progresses to a point where a family member cannot remember how to return home or recognize familiar people, they are no longer safe to live on their own and need professional assistance. Fortunately, there are many care options for older adults including assisted living and skilled nursing care. As the disease progresses, those with dementia will often need 24/7 supervised care.

Tips for Listening to a Parent With Dementia

The key to listening to a parent with dementia is to focus on the emotions behind what they are saying and less on the specific situation or scenario they are describing because there is a high likelihood of inaccuracies in what they describe.

For example, they may become suspicious that people are breaking into their house and stealing their things. Your instinct may be to convince them otherwise, and you may provide a good argument as to why this is unlikely to be the case. However, this will be an unhelpful conversation, as it is more likely to upset your loved one, and they may think you are part of the problem and working against them. You won’t be able to convince your parent that their thinking is untrue. Instead, empathize with how the situation makes them feel without directly reinforcing what they are saying. “You sound pretty upset that your bracelet is missing. I’m sure you looked everywhere and couldn’t find it. How about if I come and help you take a look?”

Try to take in your parent’s words with an open mind and without judgment. Their belief that someone is breaking into their house is likely causing them anxiety about leaving the house. Use that as an opportunity to discuss ways to help them feel safer. Even if a story sounds outlandish, don’t automatically dismiss what they are saying. There could be some truth to what they are saying, but they have misconstrued the situation. For example, someone from the electric company may have come by to check the electric meter, so they may think there is someone following or spying on them.

Be patient and see how your parent views the situation before sharing your opinion.

Ways to Communicate With a Parent With Dementia

It can be challenging to communicate effectively with a parent with dementia. They may not remember the situation you are describing, and you may find the conversation going in circles when you try to remind them of the details.

Some things to remember when effectively communicating with a person with dementia include:

• Keep your statements brief and to the point.
• Try not to rely on past experiences that they are unlikely to remember.
• Use open, nonjudgmental language, and try not to put your loved one in a defensive stance.

If you don’t understand what your parent is saying, ask an open-ended question to get more details.

• “I’m not sure I know what you are referring to. Can you tell me a little more?”
•  “What do you think happened? How come?”

Whenever you can, add statements that show you care about what your parent is saying, even if you are not sure what they are describing happened. “Wow, that sounds scary! How did that make you feel?”

Sometimes, people with dementia forget about major events that happened, such as a spouse passing away. It can be traumatic to have to repeatedly remind them about such an event. Refrain from correcting everything your parent is saying or answering every question. They won’t remember what you said a few hours later, and you will have to remind them and upset them again. You can tell them something factual without misleading them and say something like, “They aren’t here right now” or “They went away.”

Tips for Asking Questions

When communicating with your parent with dementia, it is important to keep questions brief and direct. The longer the question and context, the harder it will be for them to follow the thought all the way through.

Avoid judgmental questions or putting your parent in a defensive stance. Use language such as “How come?” instead of “Why?” which has less of an accusatory tone and comes across as curious and interested.

If you do not understand what your parent is saying, ask clarifying questions. Start with an open-ended question, like, “Can you tell me more about that?” If they have difficulty elaborating, you can make your questions more specific, like, “Can you explain more about what you think happened here?”

It’s ok to ask questions to try to understand scenarios your parent is describing, but you may find yourself getting more confused with more details, especially if your parent is describing a scenario their memory is filling in for them. Focus on how your parent is feeling and how you can help them move forward from what happened. It helps to understand what your parent is expecting from you.

What to Do if the Person Has Difficulty Understanding

If you have a difficult time talking to your parent, first pause to see if you understand what is causing the breakdown in communication. Remember that your family member has experienced changes in their brain, and some concepts may be too tough to understand. They have a limited ability to learn new information.

Think about the necessity of them understanding what you have to say. If they are having a hard time understanding what you are saying, maybe it isn’t something that they need to hear or know. If it is a serious topic, such as something about their end-of-life preferences, hopefully, you have had enough discussions before this time to have a good idea about what they would like. If you have yet to discuss it directly, do your best to honor the spirit of what they would have wanted.

If you feel that what you have to say is important to convey to your parents, see if involving another family member can help. They may be able to rephrase things so your parent can understand.

Things to Avoid When Talking With a Parent With Dementia

When talking to your parent, try not to directly challenge their statements, even if you know they are incorrect. This doesn’t mean that you have to pretend what they are saying is true, but it is unlikely to be helpful to try to dissuade your parent from what they are saying and will likely lead to both of you getting upset and frustrated.

If they are making statements about people breaking into the house, you can indirectly point out that the neighborhood is safe and that you haven’t heard of any break-ins in the last few years. You could empathize with their fears and suggest some reasonable measures, such as installing an additional lock on the door or purchasing a safe for valuables.

If your loved one has forgotten events from the past, consider whether it will be helpful to remind them about these events. Remember that they may not recall what you say a few hours later, so sharing that information may upset them without benefitting them.

Avoid judgmental statements even if you are upset that your parent did something careless. They can’t think as clearly as they did in the past and are vulnerable to people taking advantage of them. Absorb that information without blaming your parent and use it as an opportunity to address and put in measures to protect them from future occurrences.

When to Seek Professional Help

If your parent has not been formally diagnosed with dementia, they should see their doctor for a full evaluation. There may be reversible causes that can be treated. Other mental health conditions can look like dementia but can improve if identified early and given the appropriate treatment.

Ensure your parent checks in with their doctor regularly. It is important to ensure your parent’s vision and hearing are optimized, and their prescriptions are up to date. If they cannot see or hear clearly, this will worsen their confusion.

If your parent already has a diagnosis of dementia but suddenly becomes much more confused, angry, and aggressive, bring them to be evaluated by their doctor. Sudden changes are usually a sign of a new medical condition, such as a urinary tract infection or pneumonia. Older adults often don’t show the same symptoms that younger adults do. There may not be a fever or other obvious signs other than the worsening confusion.

If you notice that your parent is becoming more withdrawn and isolated or so fearful they don’t want to leave the house, bring them to see their doctor to evaluate for depression and anxiety. Sometimes, the signs can be more subtle, and undiagnosed depression and anxiety can also contribute to more confusion and memory issues.

Sometimes, people with dementia can become physically aggressive. They may think they see something or someone attacking them and lash out. They may become so fearful they think there are people out to get them. If you become afraid your parent is going to attack you, bring them to their doctor to discuss treatment options. You may also need to call 911 (in the U.S.) if you think your parent is about to seriously harm themselves or others.

How To Deal With Dementia

It can be a challenge to deal with dementia in a loved one. It is upsetting when your parent no longer recognizes you and when they are unable to take care of themselves. It can be tiring having to worry about your parent and trying to prevent them from getting lost or hurting themselves.

Fortunately, there are resources available to caregivers of those with dementia, so you don’t have to feel alone.