Generally speaking…

One of the most difficult things to deal with when communicating with someone with dementia is a demented individual’s tendency to speak in generalities and ambiguities.  This creates an environment in which the non-demented individual has to act as a communication detective and a typical guessing game ensues.  This can be very frustrating for both parties and can cause arguments and anger, but what if it doesn’t have to be such a struggle?  IS there a way to make this communication easier?  Absolutely!

First of all, it is important to understand that just as language and understanding develops when we are children, it disappears in a similar way in dementia.  In childhood, we first learn the name of a particular item, then we learn that similar items also have the same name.  We then learn to distinguish these items from others and what their specific features or uses are.  In dementia, we tend to lose the ability to know the specifics about an item, we then lose the ability to distinguish items, and finally we lose the words for the item and how they are used.

I’ll give an example that I recently encountered with a demented client and her daughter to illustrate the issue and how to resolve it:

My client’s daughter was frustrated that her demented mother was constantly looking for something, but couldn’t get the right words out to tell her what she wanted.  The daughter would sometimes try the “guessing game”, but this tended to frustrate her mother and then her mother would get upset with her.  Often, her mother would use a word that was not even related to what she was looking for which made the “guessing game” even more difficult.  What made things even more trying was that her mother would always put things where they didn’t belong so keeping track of her mother’s things was difficult.

The exchange would often sound something like this:

Demented mother:  “I can’t find it!  Have you seen the…um…you know…”

Daughter:  “Seen what, mom?”

Mother:  “You know…the thing!  I can’t find it.”

Daughter:  “I don’t know what you’re talking about.”

Mother:  “Yes, you do!  I had it last night!”

Daughter:  “You had a lot of things last night!  Which thing are you talking about?!”

Mother:  “Oh you’re no help!”

Daughter:  “Is it the pen?”

Mother:  “No!”

Daughter:  “Is it the telephone?”

Mother:  “No!”

Daughter:  “Is it the remote control?”

Mother:  “No!  Nevermind!  You don’t know anything!”

The resolution:

1.  Use ambiguity and generalities back to them.  For example, if she says, “I can’t find ‘it’,” reflect back this statement in a form of a question using the general term that she did, “You can’t find ‘it’?”  This opens the ability for her to either describe ‘it’ or to possibly find the word for ‘it.’  At this point it doesn’t really matter what ‘it’ is – what matters is that you have allowed her to try to find a way to describe ‘it’ or find the right word for ‘it.’ on her own.

2.  Maintaining the ambiguity, ask him/her to describe ‘it’.  “What does ‘it’ look like?” or “Where did you see ‘it’ last?”  This will help give you clues as to what ‘it’ is and/or will allow her to come up with the word on her own.

3.  Use visual cues.  Sometimes, just showing the demented individual a picture of an item will help them to find the word.  For example, I had a recent client who could not remember her son’s name in a conversation until I showed her a picture of her son.  She then, immediately was able to come up with his name.

4.  Label things.  Sometimes, labeling items with words or pictures helps demented individuals to be able to remember their names or to put things where they belong.  For example, labeling the garbage can as “trash” and the clothes hamper as “dirty clothing” may help to remind what goes where.

5.  Don’t correct them.  If the demented individual says that the dog is a “cat”, use a generality to reply such as, “Yes, that is a very nice animal, isn’t it?”  Oftentimes, they will catch their own mistake and if they don’t, what does it matter anyway?  Self esteem is more important than correctness.

Here’s what the exchange would sound like using these resolutions:

Demented mother:  “I can’t find it!  Have you seen the…um…you know…”

Daughter:  “You can’t find it, mom?”

Mother:  “Yeah, it was here last night.”

Daughter:  “What does it look like and I’ll help you find it.”

Mother:  “It’s brown and it has these pointy things…”

Daughter:  “Pointy things?  What do you do with it?”

Mother:  “I need it to fix my hair.”

Daughter:  “Oh…are you looking for your hairbrush?”

Mother:  “Yes…have you seen it?”

Daughter:  “Let’s look in the bathroom near the sink where the hairbrush basket is.”

Mother:  “Ok…  There it is!”

This was a very simplified example, but it shows the difference in using ambiguities rather than the guessing game.  Do you have any other suggestions?  Send them to me via my contact page.

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