Common Communication Challenges in Dementia Caregiving

Welcome, welcome, welcome to the Truth, Lies, and

Alzheimer's show. I'm Lisa Skinner, your host. I have a

brand new episode prepared for everybody today. You don't want

to miss this one. This is really filled with a lot of really

helpful information for caregivers caring for people

living with Alzheimer's disease and related dementia. The name

of this episode is Communication Challenges in Dementia

Caregiving. I'm going to share with you some effective

solutions to go along with these challenges that I know you face

every single day. So here we go. Did you know there's a 92nd rule

in dementia care? There is. It's a real thing. I'm going to tell

you what it is. It's a communication strategy allowing

individuals, and the individuals are the folks living with

dementia to give them between 60 and 90 seconds to process

information and to respond to the caregiver or family member's

requests because this reduces frustration and agitation, and

the reason why is because, as we know, the dementia impacts brain

processing speed. So the care partners, the family members,

anybody who is speaking to a person living with dementia

should wait at least 60 to 90 seconds after asking a question

or giving instructions before repeating them or acting upon

them. So these are the key aspects of the 90-second rule.

Number one is the processing time that I just mentioned.

People with dementia often experience significantly delayed

cognitive processing. Therefore, allowing 60 to 90 seconds to

process your words can definitely help prevent them

from feeling completely overwhelmed by too many words

that are being spoken to them typically too quickly. We forget

that we're talking at a normal speed, and they have a difficult

time processing that. It reduces agitation. This allows a pause

and prevents retriggering or overwhelming the person, which

can cause them to become extremely upset or even shut

down. This encourages independence by giving them time

to understand and complete a task like putting on a jacket

themselves, rather than having us immediately do it for them.

It offers better communication abilities. If no response occurs

after 90 seconds, try using nonverbal cues, tactical

prompts, or break down the request into smaller steps. It

is vital for caregivers to understand that dementia is a

physical breakdown affecting comprehension and not just

memory loss. So implementing this technique can prove to be

extremely effective for you, for both, for everybody involved. As

people living with dementia continue to decline cognitively,

and as they progress through the stages of disease, communication

with them does become increasingly challenging in

dementia care. I think we all agree with that. So each one of

the following scenarios follows a consistent structure that you

can implement into your daily routines. May include whatever

the issue is at hand, and this is a brief scenario with an

effective solution, a practical action, and a takeaway for all

you care partners and family members out there. So the first

one is related to language decline and understanding. The

issue is that progressive language loss makes basic needs

hard to express. I think we can all agree with that. Here's the

scenario that I've created for you to relate to. A 79-year-old

with Alzheimer's disease increasingly struggles to name

objects and express thirst, hunger, or even pain. The care

partner misinterprets silence as agreement and misses some of the

cues that the person living with dementia is trying to

communicate, so here's an effective solution for this

use yes or no questions with clear, concrete

choices. Pair the questions with nonverbal cues, like a gesture

or even a photo, maintain a pain symptom checklist that a person

could point to to show you where they hurt. So the takeaway for

this scenario is: when words fail, rely on simple choices and

observable signals. Keep a calm, patient tone to reduce anxiety.

The second scenario: the issue is with word finding troubles

causing frustration and miscommunication. So here's the

scenario I created for that topic: a person with vascular

dementia often pauses mid-sentence. They become

extremely frustrated, and the care partner fills in with

assumptions. This happens all the time, leading to mismatched

actions. Makes sense. So here's an effective solution: accept

the pauses as part of them processing the information being

delivered to them, giving extra processing time, using broad

nonverbal prompts, pointing to items, showing options, and then

validate attempts even when words are imperfect.

The takeaway here is patience and validation prevent

misinterpretations and preserve dignity during conversations.

Number three, the issue is repetition and script-like

speech. Here's the scenario: A parent repeats the same question

about when a doctor is going to visit, despite repeated

reassurance from the adult child. So, an effective solution

to address this is acknowledge the underlying need. Why are

they keep asking this question? It's because they're concerned

about something. The certainty of the doctor coming, that it's

part of the routine. So provide a consistent script and a

visible schedule, you can offer a short, concrete answer, plus a

shift to a different task, that often helps with getting their

focus off of this question that they repeatedly ask you. The

takeaway here is repetition often signals need for

reassurance and routine. Structured responses reduce the

frustration for everybody. And the next topic is nonverbal

communication and cues. The issue that typically shows up

with this is misinterpreting nonverbal signals. So here's a

scenario that hopefully you can relate to this particular

a loved one becomes agitated when the care partner's

body language appears rushed or closed off, this is true.

They're going to pick up on your emotions, your movements, your

body language. So this can set somebody off. So an effective

solution is to use an open posture, a soft voice, a slow

pace, and mirror expressions of calm. Avoid rushing or

interrupting, and accompany speech with gentle touch. If

appropriate, the takeaway here: nonverbal warmth and presence

convey safety and respect, and often much more than words. I

like that one. Okay, the next one, and the issue here is

ambiguity conveyed by tone rather than content. So here's a

scenario for you: a caregiver's brisk tone makes a simple

instruction feel like a demand. What do you think that's going

to do? Oftentimes, it triggers resistance. The effective

solution for this one is use a warm tone phrasing like "Would

you like to? and pair it with gentle hand gestures or even a

demonstration. Takeaway for this is tone can override content.

Soft collaborative language supports cooperation. Next

difficulty interpreting sarcasm or jokes. A person with

dementia may often misread humor and feels mocked, leading to

withdrawal. An effective solution: stick to

straightforward, positive statements. Use humor carefully,

ensuring they're gentle and clearly non-targeting. Monitor

reactions. reactions, and back off if misinterpretation occurs.

And here's your takeaway: humor should be simple and included

when it's appropriate. But keep in mind that humor can easily be

misinterpreted when a person is living with dementia, it should

be kind and clearly non-threatening to avoid

confusion. If they're having difficult with reading and

visual processing challenges, here's an issue that that

creates difficulty following spoken directions. So

instructions like eat your lunch before we go outside can become

confusing because again the processing of what you're saying

to them has slowed down, and that may be too many words. So

here's an effective solution: break those instructions into

single, sequential steps. Pair verbal directions with visual

cues, like pictures, checklists, colored arrows, and the takeaway

is that visual prompts support and complement spoken language

and reduces cognitive load. Next issue: trouble with multi-step

tasks. So the scenario is person is getting dressed, and they

become disoriented when asked to choose the items to dress, like

button your shirts, tie your shoes in one breath. So here's

an effective solution for that: offer one step choices at a

time, demonstrate each step. You can use labeled containers and

labeled clothes arranged in order of how they might like to

put them on. The takeaway is sequential prompts and

demonstrations preserve autonomy while minimizing confusion.

Okay, continuing on the issue, difficulty with abstract

language or figurative speech, and here's the scenario: a

person living with dementia may misunderstand expressions like

"it's a piece of cake, causing confusion or embarrassment. They

don't know what that means anymore. An effective solution:

use literal language. They may take that one literally, but

they're not understanding exactly what you mean by that.

Avoid idioms. Confirm understanding with a simple

recap. The takeaway here is plain language reduces

misinterpretation and embarrassment. So the next topic

is. Behavioral communication and de-escalation-that's something

that we all need to be very proficient in. So the issue is

communicating during agitation or aggression. A person with

dementia becomes verbally aggressive when routines change.

What's an effective solution here?

First, acknowledge their feelings, validate to them that

they are safe and you are with them, and calmly describe the

upcoming plan. Offer two simple choices to regain a sense of

control. Takeaway: calming language and actionable choices

help de-escalation tension. Next issue: communicating with

someone who's new to a care setting, like a new memory care

resident seems withdrawn and misreads staff, leading to fear

and resistance to care. So, a possible effective solution

could be to introduce staff by their name and their role. Use a

consistent daily routine. Assign a friendly staff anchor for the

resident. Use familiar objects from their home to ground

conversations. And the takeaway for this scenario is

familiarity, consistency, and clear introductions ease

transitions and build trust. Okay, next one: language

barriers and cultural considerations. A care partner

from a family with limited English proficiency, navigates

medical questions and care instructions. So, an effective

solution is you might want to request an interpreter, a

service, or bilingual staff member to translate essential

documents, use culturally relevant visual aids and plain

language materials in the home language. The takeaway is

language accessible care and cultural respect do improve

understanding and adherence, and I have seen this be problematic

for the decades and decades that I have been working in the elder

care industry. A lot of our care partners, English is not their

first language, and therefore, even though they're speaking

English, they typically speak with a bit of an accent, and

that accent alone can really make comprehension of what the

care partner is trying to communicate to somebody even

more difficult, the processing their processing speeds are are

much much slower, and then you throw you know an accent in, and

we all know that sometimes it is difficult to understand people

speaking with some type of an accent, so be mindful of that.

It can be problematic for especially people living with

dementia. So that's what I have for you today. I hope this has

been really helpful, and that you will take some of these

recommendations and implement them into your caregiving day,

so I'll be back next week as always with a brand new episode

of the Truth, Lies, and Alzheimer's show. I'm Lisa

Skinner, your host, and thanks so much for being here with me

today. Hope you have a great rest of your week, and that you

are always happy, and that you stay healthy, and I'll see you

back next week. Bye bye.