Wednesday, 9 October 2013

Caregiver Wednesdays--When the Conversation Doesn't Make Sense

This is the final instalment in my series on communication with a person with dementia.

A person with dementia lives in a different reality from yours. What is real and true and makes perfect sense to them may sound like disconnected babble to you. Or, the words and even the concepts may make sense, but you still have no idea what the person is talking about. You need to leave your reality behind for a while and enter theirs.

How do you do this? Here are a few examples.

"I'm going home, now." or "I have to catch a bus and get home. Mother is waiting."
("Tell me about your home. What does it look like? What will Mother be doing when you get there? Will she have a snack for you? What do you like to do together?)

This conversation doesn't try to convince the person that they can't go home to a house that is long gone, or a mother that has been dead for 50 years. That kind of conversation only causes agitation and anger. Instead, listen and pick up on some part of what they are saying. Turn it into a reminiscence. Gradually change the tense from present to past.

"They are stealing from me. I can't find my purse/nightgown/money"
(That must be frustrating for you. Can I help you look for it?")

Again, this listens and validates the conversation. During the "looking" the conversation could be turned to other things ("That's a lovely blouse. Do you like to shop?" and the "missing" items might be forgotten. For now. It may resurface, possibly several times a day, and the same technique would need to be used.

"Can you bring me some knitting needles and wool? I want to start knitting again" (Lady is blind.) ("Sure, I can do that. What would you like to knit? What did you used to make?")

"Is Mother okay? I haven't seen her in such a long time."
("Yes, Mother is fine. What do you like to do best with mother? Where did she used to take you? Was she a good cook?") Notice I changed the tenses. People often move in and out of the understanding that their parents are dead. This person may be able to talk about memories of her mother from the past and not remember she was thinking about her as alive a few minutes ago.

When "conversation" is disconnected words or phrases that make no sense at all, make liberal use of conversational noises "uh huh, oh really, is that right, um hmm" etc. Occasionally the person may say something where you can pick up a conversational thread.

The bottom line--respect. This is a person who deserves it, and you are able to give it by entering into their reality and communicating with them.


  1. Thank you for this series on communication. I found it very helpful. My mother has dementia, and it is beginning to progress rapidly. Any tips for when patients get angry, aggresive or violent?

  2. Thank you Gail. There's nothing I love better than to find out something I wrote helped someone.
    Thanks for your input, too. I will tackle aggression next month. As with all interventions, nothing works all the time, but I have some insights and suggestions that might help. Blessings on you as you care for your Mom.