On a spring morning, the thermometer shows -1.5 degrees. The sky is blue, the sun is shining. “How nice, today I’ll put on my dress and sandals when we go shopping,” says Erna, the 78-year-old mother of a client who is living with dementia. Stefanie Froitzheim from the Dementia Service Center of AOK Rheinland/Hamburg is familiar with such situations from the daily lives of relatives and caregivers. In conversation, she offers tips for communication in conflict situations with people with dementia.
Understanding people with dementia
“Often we react with incomprehension or anger to the behavior of people with dementia,” says Froitzheim. A typical reaction to the mother walking around in a summer dress would be the reproach: “That’s nonsense, it’s freezing, you’re putting on your winter coat before we go out!”
Relatives experience almost daily that such appeals achieve the exact opposite of what they are meant to. The person with dementia may respond with indignation—feeling treated like a child—or withdraw, explains the AOK expert.
Accusations do not help
To prevent such inevitable conflicts from arising in the first place, Froitzheim recommends acknowledging that people with dementia live in their own world. With the progression of the disease, this world has less and less to do with the reality of “healthy” people. For the 78-year-old mother, sunshine means warm air. The knowledge that the ground can still be frozen on a March morning has been lost to the disease.
In another example, a husband complains that his wife with dementia ignores the recent federal election. “She always used to be interested in politics,” he laments at the counseling center. His reproach: “How can she be so disinterested?” The advice not to take his wife’s behavior personally eventually helps him.
Playing along eases tension
“We live in a hectic world,” says Froitzheim. But people with dementia have their own rhythm, their own perception. In conflict, these two worlds collide. It is important to understand that the disease is individual—just like each person. The key is to observe, take reactions seriously, and redirect if necessary. A turned-on radio, for example, can become a pleasant conversation partner for a person with dementia. They may talk to the voice from the device—or believe burglars are in the house because they don’t recognize the moderator’s voice.
Depending on the situation, people with dementia may experience joy, fear, or sadness. The reactions of relatives or caregivers should be appropriate. “Play along,” recommends the AOK expert. This also helps defuse conflict situations. If someone needs ten minutes instead of two to brush their teeth or comb their hair, it is not helpful to remind them of the time pressure. Sometimes patience is required.
Enabling participation for people with dementia
Another rule in dealing with people affected is to encourage and support them. The expert recalls a lady who once loved cooking but sat apathetically in her armchair during a visit. “We remembered she was a quick potato peeler,” Froitzheim says. But her husband had banned her from the kitchen: “Because she couldn’t do it anymore,” he explained.
Yet with her familiar potato peeler—not a new, unfamiliar one—she managed to peel potatoes. “Movements practiced over a long time can often still be carried out,” Froitzheim explains, since the brain can access these routines even in a diseased state. Short-term memory, however, is usually affected first.
The key lies in the message behind the task: People with dementia feel entrusted with a role, which conveys the positive experience, “I belong, and I am needed.” The outcome does not matter. “If the potatoes are poorly peeled or shrink into small cubes, then so be it,” says Froitzheim.
Changing the way we ask questions
According to the AOK expert, adjusting the way we ask questions can also help avoid conflict. “If someone enjoys a roll with quark and jam in the morning, I ask whether they would like exactly that,” Froitzheim explains. Instead of setting the table abundantly and overwhelming the person, a closed question helps: “Would you like a roll with quark and jam?”
Redirecting can also be useful in conflict situations. For example, a man with dementia sits at the table and asks for his brother’s place to be set—though his brother has long since passed away. Instead of pointing this out, it helps to redirect the situation: “Oh, we still need to get the cake, will you come with me?” After walking to the kitchen and back, the worry about the missing brother may already be forgotten.
Emotional world of people with dementia
To understand the emotional world of people with dementia, relatives should look for underlying causes. Restlessness can, for example, be caused by pain or the need to urinate. Shadows can repeatedly trigger fear. An apparently harmless bottle may cast a shadow on the wall that is perceived as a monster.
By the way, the 78-year-old mother was allowed to wear her summer dress for shopping. The relative simply brought the winter coat along. For the shoes, he suggested sturdy footwear since they had to walk a bit to the supermarket. Playing along and redirecting were, in this case, the double key to preventing the conflict from arising in the first place.
