Things People With Dementia Say: Common Phrases and How to Reply
Communicating with someone who has Alzheimer's disease or some other form of dementia can be exceedingly difficult. The confusion and memory loss caused by dementia can cause your mother to falsely accuse you of stealing from her, or your dad to shout out lewd comments to women on the street. It may also make it hard for your elderly loved one to tell you when they're hungry, tired, or in need of something.
Teepa Snow, M.S., an occupational therapist and dementia education expert outlines three of the most common communication breakdowns caused by dementia, and how caregivers can respond in a way that will diffuse tension and make their elderly loved one feel better:
Breakdown: "That new caregiver you hired, she stole my purse"
Response: "I hear that your purse is missing, I'm so sorry that that happened. Could I look around one more time? I'd hate to find out it just got put somewhere to keep it safe..."
Explanation: If your loved one has dementia they might be prone to falsely accusing people (including their caregiver) of things like stealing, and abuse. This behavior is not only hurtful, but potentially incriminating. In these situations, it's important to remember that your loved one is only saying these things because their brain is telling them that they are true. Your loved one's mind is trying to fill in the information gaps caused by their dementia. This can result in something called, confabulation, also known as "honest lying."
Confabulation can be so powerful that, according to Snow, people with dementia have passed lie detector tests while lying because they truly believe their story to be true. Your mother may say that the home care worker you hired stole her purse because: 1.) Your mother currently can't find her purse, because she hid it in a "safe place," and now she cannot remember where she put it, and 2.) Your mother saw the care worker pick up her own purse and leave the house with it. In this instance, your mother's mind is making up a story using separate, but related pieces of information to help make sense of the fact that she can't find her purse.
In this scenario, you won't be able to convince your mother that she is wrong, so Snow says to avoid confronting her about it. Instead, it's important to validate your mother's feelings and display empathy by saying that you're sorry her purse is missing. Asking your mother's permission to look for the purse will hopefully allow you to find it. Once you recover the purse you should just apologize again. You should also avoid saying the equivalent of, "I told you so," as it may make your mother defensive and less likely to trust you in the future.
Snow points out the unfortunate reality that elders will be more prone to accusing the people that are most involved in their care (caregivers, other family members) because those are the people that they see most often. This can be extremely hurtful, but she says that it's important to try and let it go and view these accusations as brain failures, rather than personal attacks.
Breakdown: "Boy is that woman a fatty! Hey sweetheart—lay off the cupcakes!"
Response: Stay calm--"Hey Dad, let's go take a trip to the bathroom so we can wash our hands before our food comes."
Explanation: Dementia can cause your loved one's impulse control to decrease—essentially stripping them of their mental filter.Snow says that it's also likely that the disease will cause significant damage to the left side of your loved one's brain first. This is the side that keeps track of vocabulary and higher speech functions. The right side of the brain is the side that helps people to engage in social chit chat and keep the rhythm of speech, and is generally not as affected as the left side. The right side is also where most curse words are stored.
So, when your father has a not-so-nice thought about a heavyset woman that he sees in a restaurant, he can't help but blurt out what he's thinking. In addition, he may also sprinkle in a few expletives to his description because he can't mentally access other words.
This can be extremely embarrassing, especially in public places, but Snow says that making a big deal of these outbursts will only make them worse. She suggests acknowledging your loved one's feelings and removing them from the situation that is causing them to act out. Take your dad to the bathroom and when you get back, try to get him to sit in a seat where he won't be able to see the overweight woman.
Breakdown: "Honey, I need something…"
Response: "Ok, can you tell me more about it?" Or "Could you show me what you do with it?"
Explanation: The automatic response to this question is generally, "What do you need?" While it may seem like the most logical follow-up, Snow says that you should try to avoid asking this question because your loved one's inability to answer it may cause them to become angry and confused. Instead, Snow suggests that you should try to help your loved one find the answer on their own by encouraging them to describe it further.
For example, your mom says she needs something in the kitchen, but she can't tell you what it is. Snow says that a good response to this would be, "Ok, you need something in the kitchen, could you tell me more about it?" Then, she might tell you that what she's looking for is cold, and mime drinking something. You could say, "Alright, so it's something that's in the kitchen, cold, and you drink it. Let's go check the kitchen to see if we can find what you need."
It's important to repeat the specific information that your loved one gave in their description because it helps them remember what they said, and indicates that you are willing to listen and help them.
Snow also says that it may also be a good idea to move around with your loved one and assist them in finding what they're looking for. Visual cues are generally more helpful than verbal cues for people suffering from memory loss, so going into the kitchen with your mom and heading towards the refrigerator might help jog her memory.