How to Talk to Dementia Patients

Dementia Research & Resources

With an estimated 6 million Americans living with Alzheimer’s or some form of dementia, healthcare professionals—particularly those who work with older adults—are likely to encounter dementia patients in their career.

Understanding their condition and how to communicate with these individuals is key, but many healthcare professionals are not prepared to work with dementia patients. In fact, in some cases, dementia is a secondary diagnosis, or it may not have been diagnosed yet, and behaviors may be misunderstood as aggression.

It’s easy to write these patients off as difficult, but with a better understanding of what stage of dementia your patient maybe in, you can better care for them and improve their experience while also getting them the care they need.

“As caregivers, we don’t always understand the organic reason a patient is being combative,” said Marianne Dexter, a regional director of quality and risk for Encompass Health. “They may seem like they are being non-compliant, but it might be our approach.”

Dexter and Jennifer Howland, therapy team lead at AnMed Health Rehabilitation Hospital in partnership with Encompass Health, are creating a playbook on caring for patients with behavioral challenges for Encompass Health rehabilitation hospitals. Though it is designed for the rehabilitation setting, they said some of the recommendations can be useful to anyone working with dementia patients or any patient with behavioral challenges. First, they said, you have to understand the patient’s diagnosis and what stage of dementia they are in.

Is it Depression, Delirium or Dementia?

Dementia is a disorder characterized by loss of memory with one or more of the following:

  • Aphasia
  • Personality changes
  • Confusion/disorientation
  • Decreased function
  • Visual and spatial dysfunction

While these are all symptoms of dementia, they can also present in other conditions. Often, depression and delirium can be confused for dementia.

“It’s kind of tricky to tell the difference between delirium and dementia or depression and dementia; it’s even been called a pseudo dementia,” Howland said. “The main thing with delirium is its rapid onset. “

So how do you tell the difference between the three? Talk to family members.

Delirium and depression can both be side effects of someone who has had a prolonged hospitalization or was recently diagnosed with a life-changing illness. Dementia symptoms are likely something family members and loved ones have noticed over time even if the patient has yet to be diagnosed with dementia.

“Dementia is not a quick change like delirium,” Howland said. “You need to have lots of talks with family members. Sometimes they are relieved when I start poking around because they’ve been noticing changes but didn’t know what to do.”

What are the Stages of Dementia?

As with most diseases, dementia is staged from mild to severe.

Patients in the mild stage can still function independently and maintain a social life. This phase typically lasts between two and four years.

In the moderate stage of dementia, the patient may have trouble expressing thoughts and more severe memory issues than those with mild dementia. Communication becomes difficult in this stage, and the patient may not be able to follow conversations. Behavior changes, such as aggressiveness, depression and hoarding may also be seen at this time. Lasting anywhere from two to 10 years, this is the longest stage of the disease.

The final stage is severe dementia, also referred to as late stage or advanced dementia. Memory continues to worsen, and they may not remember family members and could revert to an earlier time in their lives. Severe stage dementia patients require extensive assistance with activities of daily living and might not be able to walk or eat on their own. This stage typically lasts one to three years.

Tips for Caring for Dementia Patients

As the population ages, the likelihood of caring for dementia patients increases. If you find yourself treating a dementia patient, follow these tips to help both the patient and yourself.

  • Have flexibility. Dementia patients work best on their routine, not yours. Be flexible and see how you can adjust your schedule to fit theirs.
  • Talk to their family. Ask them about their triggers and ways to help them feel comfortable. What deescalation strategies work for them?
  • Approach them from the front. Make sure they are aware you are there and can see you and what you are doing. Greet them with a welcoming smile and let them get comfortable before administering treatments or therapy.
  • Stay calm. When a patient gets agitated or even aggressive, it can be difficult to stay calm yourself. However, raising your voice or approaching the patient may only upset them more. Instead, keep a calm, even voice, and keep a distance from the patient. If needed, slowly leave the room.
  • Don’t correct them. As a caregiver, it’s in your nature to want to correct a patient when they are confused, but with dementia patients this could cause them to become agitated. Instead, meet them were they are. “Go into their world,” Howland said. “Don’t force them into yours.”
  • Walk away, and try again later. If a dementia patient is becoming overly agitated, ask yourself if it’s completely necessary to their health that they receive that treatment at that exact time. If it can wait, simply walk away and try again later.