Key Takeaways
- Approach from the front, identify yourself, and speak slowly with simple words
- Ask yes/no questions instead of open-ended questions
- Never argue, correct, or say "Don't you remember?"
- Use validation (accepting their reality) when reality orientation causes distress
- Non-verbal communication (tone, touch, facial expression) may be understood better than words
Communication with Dementia Residents
Effective communication with dementia residents requires patience, flexibility, and understanding. As cognitive abilities decline, CNAs must adapt their communication techniques to meet residents where they are.
Communication Challenges in Dementia
| Challenge | Description |
|---|---|
| Word-finding difficulty | Cannot recall specific words (aphasia) |
| Losing train of thought | Forgets what they were saying mid-sentence |
| Difficulty following conversations | Cannot track complex discussions |
| Trouble understanding | Difficulty processing what others say |
| Repetitive speech | Asking same question or telling same story repeatedly |
| Making up words | Using made-up words or wrong words |
| Reverting to first language | May speak only in native language |
Verbal Communication Techniques
Speaking TO the Resident:
| Technique | How to Apply |
|---|---|
| Approach from front | Never startle from behind; make eye contact |
| Identify yourself | "Hi, Mrs. Smith. I'm Maria, your aide." |
| Use simple words | Short sentences, familiar words |
| Speak slowly | Give time to process each thought |
| One thing at a time | Don't give multiple instructions |
| Repeat if needed | Use the same words; don't rephrase (confusing) |
| Ask yes/no questions | Instead of "What do you want?" ask "Do you want water?" |
| Avoid arguing | Don't correct or contradict; redirect instead |
Listening TO the Resident:
| Technique | How to Apply |
|---|---|
| Be patient | Give time to find words |
| Don't finish sentences | Let them express themselves |
| Focus on feelings | The emotion is more important than accuracy |
| Watch for nonverbal cues | Body language, facial expressions |
| Respond to repetition kindly | Answer as if hearing it the first time |
Non-Verbal Communication
People with dementia often understand and respond to non-verbal communication better than words.
Effective Non-Verbal Techniques:
- Smile - Communicates warmth and safety
- Gentle touch - Reassuring (if culturally appropriate)
- Calm tone of voice - Even when words aren't understood
- Relaxed body posture - Open, non-threatening
- Gestures - Point, demonstrate, guide
- Eye contact - Shows attention and respect
Resident's Non-Verbal Communication: Watch for signs of:
- Pain (grimacing, guarding, moaning)
- Fear (wide eyes, pulling away)
- Agitation (pacing, clenched fists)
- Pleasure (smiling, relaxed posture)
- Discomfort (fidgeting, rubbing areas)
Reality Orientation vs. Validation
Two Approaches to Communication:
| Approach | Description | When to Use |
|---|---|---|
| Reality Orientation | Gently correcting confusion with facts | Early dementia; mild confusion; some residents prefer it |
| Validation | Accepting resident's reality; acknowledging feelings | Moderate-severe dementia; when reality orientation causes distress |
Reality Orientation Example:
- Resident: "I need to pick up my children from school."
- Response: "Mrs. Jones, your children are grown now and have their own families."
Validation Example:
- Resident: "I need to pick up my children from school."
- Response: "You love your children very much. Tell me about them."
General Rule: If reality orientation causes distress, use validation. The goal is comfort, not accuracy.
Handling Difficult Situations
When Resident Is Confused About Time:
- Use day/night cues rather than insisting on exact time
- "It's getting dark, time for dinner" vs. "It's 6:00 PM"
When Resident Asks for Deceased Loved One:
- Don't repeatedly remind them of the death (causes fresh grief each time)
- Redirect: "Tell me about your mother. What was she like?"
When Resident Wants to "Go Home":
- "Home" may mean childhood home or feeling of security
- Acknowledge feeling: "You miss being at home."
- Redirect: "Let's have some tea and look at photos."
When Resident Accuses You of Stealing:
- Don't argue or take offense
- Help look for the "lost" item
- Redirect after finding or after brief search
Communication DON'Ts
| Don't | Why |
|---|---|
| Quiz them | "Do you remember my name?" causes embarrassment |
| Argue about facts | They cannot reason; causes frustration |
| Say "Don't you remember?" | Highlights their impairment |
| Talk about them in front of them | They may understand more than they can express |
| Rush them | Increases anxiety and confusion |
| Take behaviors personally | The disease causes behavior, not the person |
When a dementia resident repeatedly asks the same question, what should the CNA do?
What is "validation" therapy in dementia care?
When speaking to a dementia resident, what type of questions should you ask?