H(OT) 5: How Strong Communication Skills Increase Your Impact on Patients Living With Dementia

Rachel Read, OTD, OTR/L, BCG, CAPS: Hi, and welcome to the H(OT) 5 series: Tips for communicating with clients with dementia. I’m Rachel.

Jenn Ruoff, OTD, OTR/L, BCG, CDP: I’m Jenn.

Rachel: And we’re going to go right into it with our tip number one.

Jenn: Number 1 tip: Approach from the front. When having a conversation with someone with dementia, it’s important that you start a conversation from the front. So what you want to do is turn towards them. Engage.

“Hi, Rachel. It’s Jenn. Nice to see you again.”

Rachel: “Oh, hi. How are you?”

Jenn: “I’m good. I’m good.”

Rachel: “You’re so cute!”

Jenn: “Thanks. Thank you. I like your glasses.”

What you don’t want to do is come in…

Rachel: “Oh, get away. Who are you?”

Or …

Jenn: “Hi.”

Rachel: “Why are you touching me? Why is she touching me?”

Jenn: So number one tip approach from the front.

Rachel: Alright, so tip number two is a little similar to tip number one in that you want to converse at eye level.

We’re talking about when their peripheral vision is decreased so you don’t want to approach from the side. You don’t want to scare them. But you also want to get down to their level so that they can see you approaching.

So what you do want to do is, say that Jenn’s sitting here in a wheelchair. I want to come from the front and get down to her level.

So I’m going to get down. I am often getting down to the floor and talking to her.

“Hi, how are you?

Jenn: “I’m good.”

Rachel: “Good.”

This allows us to make an eye connection, and that’s how you really establish rapport with people.

So what you don’t want to do is: You don’t want to stand over the person. So if they are sitting down, you want to get down to their level. You don’t want to approach them and be standing on top of them. You’re viewed as an authoritative figure in that sense.

So get down to their level.

Jenn: Tip number three: Never argue or disagree. This is extremely important and can actually either really hurt your relationship with an individual or it can really help it.

So what you want to do if you approach someone is to have a conversation.

“Hi, Rachel. It’s Jenn. It’s time for therapy.”

Rachel: “Oh … okay. I don’t think I have therapy today. ”

Jenn: “Oh, you’re right. Would you mind coming with me though? I could use your help with something.”

Rachel: “Oh, sure.”

Jenn: So rather than me arguing with her and saying, “No. Do you know that you have therapy today?” I’ve kind of reversed, joined her reality of maybe what she wanted to do, and then asked her to help me.

What you don’t want to do is:

“Hi, Rachel. It’s Jenn. It’s time for therapy.”

Rachel: “Oh, I don’t have therapy today.”

Jenn: “No, yes, you do. Today’s Monday. Remember?”

Rachel: “No, today’s Sunday.”

Jenn: “No, today’s Monday. Did you look at your calendar when you left your room this morning?”

Rachel: “Of course I looked at my calendar.”

Jenn: “It’s Monday. If you were to look at your calendar, it’s Monday.”

Rachel: “It’s Sunday.”

Jenn: “Alright.”

Rachel: “Alright, you can leave now.”

Jenn: “Alright.”

See: totally broke down our relationship. So tip number three: never argue or disagree.

So bonus tip-off number three: Never say, “remember.” I don’t know if you noticed I asked her to remember that today was Monday. Never use the word remember for someone with memory issues.

Rachel: Tip number four is to keep it simple. One- to two-step directions so that the person who you’re talking to is able to understand what you’re saying and has the ability to process the directions that you’re giving them.

Anything more than one to two could really delay your ability to get something out of them or execute what it is that you’re intending them to do.

So what you do want to do is provide those one- to two-step directions.

“Hi, Jenn.”

Jenn: “Hi.”

Rachel: “How are you?”

Jenn: “Good. How are you?”

Rachel: “Let’s walk.”

Jenn: “OK.”

Rachel: “Come on.”

What you don’t want to do is provide too many commands.

“Hi, Jenn.”

Jenn: “Hi.”

Rachel: “Let’s go take a walk. I’m going to go to the kitchen, and we can make some cookies. We can take out all the stuff from the refrigerator and go in the pantry and we can knead some dough.”

Jenn: “No.”

So what you do want to do with validation is join them in their communication and how they’re feeling and match their concerns.

So this is what you do want to do:

“Hi, Rachel. How are you?”

Rachel: “Good.”

Jenn: “Good. We’re gonna head down to the therapy room and do some exercise.”

Rachel: “I’m waiting for my husband to come home, so no thanks.”

Jenn: “Oh, he actually called and he said that if you come with me, he’ll meet us down in the therapy room. He is running a little late.”

Rachel: “Oh, okay.”

Jenn: “Alright?”

Rachel: “Yeah.”

Jenn: Alright, what you don’t want to do. Same situation:

“Hi, Rachel. How are you today?”

Rachel: “I’m good.”

Jenn: “I’m going to have you come with me down to the therapy room.”

Rachel: “That’s okay. I’m waiting for my husband. ”

Jenn: “Oh, your husband’s not coming today. It’s Tuesday. Remember?” Don’t say remember.

Rachel: “He lives here. We live together. He’s coming home from work.”

Jenn: “Yeah, he’s not coming today. He wasn’t able to get here. Remember, you live here now? No?”

Rachel: “What?”

Jenn: “Yeah.”

That is what you don’t want to do.

So to wrap it up the five tips when talking with someone with dementia. First, approach from the front.

Rachel: Second: Converse at eye level.

Jenn: Never argue or disagree for number three.

Rachel: Keep it simple.

Jenn: And number five, validate. And remember, don’t say remember.