By Judd Matsunaga, Esq.
Talking to an aging parent with dementia could be one of the hardest jobs that you are ever going to do. And for most of you, it was something that was thrust upon you, i.e., you did not sign up for this.
You keep explaining, reasoning, and repeating, and your aging parent keeps misunderstanding, arguing, and shutting down. Your heart’s in the right place, but you’re also not speaking the right language to communicate with a person with dementia.
In this Rafu Shimpo article, we are going to cover some techniques to help you end the chaos and start connecting with your aging parent once again. The information contained herein comes from a neuropsychologist and dementia care specialist, Dr. Camille Sinclair, founder of the Confident Caregiver Academy. (Source: /www.youtube.com/watch?v=_fced4crXzA)
We will cover: (1) what’s actually happening in a dementia-affected brain; and (2) some techniques for you to learn “their language” to make things a little bit easier for you to communicate.
When dementia progresses and your aging parent is arguing with you or even getting angry with you, it is not that they are trying to be difficult. It is just that, for many dementia types, the brain actually changes. Their brain is slowing down, and they have a frontal lobe that is struggling.
The left frontal lobe, which processes the meaning of words, starts to weaken with dementia. As a result, a few key systems in your loved one’s brain start to shift, which affects how they interpret or understand language in most dementia types.
Here’s the key!!! The dementia brain hears emotion, not words. The words are going to be gone in seconds, but the emotionality is going to linger longer because it is tapped into the more dominant side of their brain.
Their brain is struggling with working memory, i.e., step-by-step directives. That is too overwhelming for a dementia-affected brain. As dementia progresses, you have to learn a different form of communication. You cannot effectively communicate with your loved one the same way you always have.
We are so used to engaging in verbal communication with our loved ones. But the words you are saying are going to be gone in seconds. As the left hemisphere gets weaker, the amygdala and parts of the right hemisphere start to become more dominant. That is the side of the brain that interprets emotion, i.e., the tone of voice, the rhythm of voice, and the emotionality that you are bringing to the conversation.
So, as dementia progresses, it becomes less important what you are saying and more important how you are saying it.
So, even if you are trying to be very diplomatic, i.e., using measured and kind words, your loved one with dementia is going to pick up on the tone first. If you have a bit of anger in your tone, or annoyance in your facial expression, their brain is going to pick up on that first. It will probably make them feel a bit more unsettled.
So when your loved one with dementia is getting agitated and/or overwhelmed, it could be that you have come into the conversation with too much negative emotion.
So if you say, “I’ve already told you five times,” with a face that looks irritated and/or angry, that emotion is going to create distress inside of them. Typically, when they start to get frustrated or overwhelmed, they will either withdraw or lash out back at you. For example, “I don’t want to take the medication,” “Leave me alone,” or “Stop bossing me around.”
Once you understand how and why the dementia brain works, you will start to understand there are responses that you should never do, and what to do instead.
To illustrate, think of your loved one’s brain as a translator at the United Nations. To understand a speaker from Nigeria, translators are given headphones. But the headphones your loved one has been given are faulty. What the speaker is saying is not clear, i.e., there is static coming in and out. There are missing pieces to what the speaker is trying to say.
That is pretty much what is happening with your loved one with dementia. They are not getting the full story. It is too staticky. They are missing pieces. And unfortunately, the brain fills in those missing pieces with emotion.
So, if you try to communicate with your loved one with a little bit of anger and frustration, they are going to match that emotion with anger and frustration. That is because their dominant side, the right hemisphere, will pick up that negative emotion from you. The result will often be lashing back at you with anger and frustration.
When they are confused and the connection is staticky, make sure you are not “coming in hot,” i.e., with tone and/or facial expression.
You will need to start communicating more with your tone of voice, with the rhythm and emotionality in which you are speaking. You will also need to watch your body language and facial expressions as well, as they are going to become more and more significant as dementia worsens.
As you communicate with your loved one, keep tone and rhythm in mind. Can you use a lighter tone? Perhaps a calmer, more rhythmic tone. Perhaps less frustration in your face.
You may walk away shaking your head, thinking, “I put all that effort into trying to say it nicely.” But logic does not land. You put the effort into the wrong thing. Your tone and emotionality are what will communicate more than your words ever will.
Also remember that the dementia brain cannot hold long sequences of information and reasoning. So when you say to your loved one, “We have a doctor’s appointment at 3:00, so let’s eat your lunch and then take your medicine and then grab your boots upstairs,” that is too much information.
You are hoping their working memory, i.e., their ability to hold information and sequence it, will do a lot. But their working memory is struggling and can no longer reason and sequence that information. You have already lost them at “We have a doctor’s appointment at 3:00, and then I need you to take your medication.” That is a long sequence of information and reasoning you are asking your loved one with dementia to process.
Another response you might see is that they completely shut down. They do not say anything and look frozen. It may look like they are ignoring you. They are not ignoring you; it was overload. It was too much. So your loved one yells at you, saying, “Leave me alone.” Out of frustration, you might even start to yell back, “I’m just trying to help. I need to get you to the doctor’s office.” Yikes!!!
So be careful when they appear to be ignoring you. Try not to repeat yourself, i.e., giving more information that overwhelms their brain. That will lead to even more shutdown. It is a terrible cycle. You give more information, overwhelm their brain even more, and your loved one matches your frustration and yells back at you. Then it escalates from there. When they have shut down and appear to be ignoring you, now you know that they are not.
The next concept to understand is using short sentences with long pauses. Their brain is processing information more slowly because of the dementia-related changes that are happening progressively or because of damage that has already occurred. You have to go slower for your loved one with dementia.
It will feel painfully slow to you, but it will be exactly what their brain needs. One way to remember this is to think short sentences, long pauses. Try to give one idea per sentence.
You want to give one idea per sentence, and that is it. You also want to slow your rhythm and pacing. For example, “Dad, let’s have breakfast (pause), and then we’ll take your medication.” The pause allows their brain to catch up with the information you are trying to convey. It will feel painfully slow to you, but this is the new way you have to communicate with a dementia-affected brain.
If you go too quickly, it becomes overwhelming for both working memory and processing speed. You are going too fast for them. It starts to sound like static. It is too much.
If they get upset, sad, or angry, you should “match” that emotion by offering what they need, i.e., reassurance or a gentle touch. Offering support can go a long way. Remember that communication goes beyond words. When someone is upset, you can sit beside them or hold their hand. A gentle squeeze or tap on the hand or leg can help. Pair touch with reassurance by saying, “I’m so sorry that happened. I’m here for you.”
Unfortunately, we do not live in a perfect world. Communication breakdowns will happen. From time to time, you will argue and disagree, i.e., you will “butt heads.” Even if your loved one with dementia struggles to remember the conversation, they will remember how you made them feel afterward. When breakdowns happen, try to repair them immediately.
Give yourself some grace. You are learning a whole new language. The good news is that there are ways to repair communication breakdowns. A simple “I’m sorry I upset you,” or “I’m sorry I moved too fast for you,” goes a very long way, dementia or not.
Repair is the most powerful communication skill we have, but few of us use it. You do not want to make that mistake in dementia care. There is not enough time to waste holding on to disagreements.
Finally, the power of rhythm and ritual. Familiarity is soothing to the brain, dementia or not, but especially with dementia. If you say the same thing in the same tone at the same time, it builds consistency. It signals safety. For example, with medication, if you say to your loved one, “Hey Dad, it’s time for your medication now,” using the same tone, rhythm, and time of day, the brain starts to anticipate what is coming. That is what a dementia-affected brain needs.
In conclusion, there are many ways to communicate with a dementia-affected brain. Your job is not to make them understand logically. Your job is to make them feel safe enough to trust you. You are tapping into a new brain and a new way of communicating.
Even though words may fail your loved one with dementia, emotion becomes the bridge that allows you to continue connecting with good old Mom and Dad.
Judd Matsunaga, Esq., is the founding partner of the Law Offices of Matsunaga & Associates, specializing in estate/Medi-Cal planning, probate, personal injury and real estate law. With offices in Torrance, Hollywood, Sherman Oaks, Pasadena and Fountain Valley, he can be reached at (800) 411-0546. Opinions expressed in this column are not necessarily those of The Rafu Shimpo.