Tailoring your communication to people with dementia can forge a more robust relationship with patients and improve health outcomes.

Working with people with dementia can be challenging. It requires core professional skills ranging from patience and empathy through to sensitivity and a dedication to the provision of quality care.

Whether you work on the hospital ward, in the emergency department, in the community setting, in aged care or in general practice, soaring rates of dementia mean more nurses and allied health professionals than ever before are coming into contact with patients living with the debilitating disease.

Claire O’Connor, a research occupational therapist with Frontier, the frontotemporal dementia research group at Neuroscience Research Australia (NeuRA), says it’s imperative health professionals improve their skills when it comes to communicating with people with dementia.

“Dementia really impacts on a person’s ability to understand and interact with their world. This includes their ability to communicate with people and express themselves with people but also in their ability to understand situations around them as well,” she says.

“Essentially we think of dementia as really caused by irreversible changes to the brain, so they can’t change what’s happening to them, so it’s really important for us to learn how to interact with the person on their level so they can feel supported and understood in whatever situation they’re in.”

Ms O’Connor says not knowing how to best communicate with and manage patients with dementia can lead to increasing confusion and can escalate patients to experiencing agitation.

“People can become even more difficult to manage and that can have carry-on effects or rippling effects into other patients and the experience of staff, and is a really important issue.

“Really, changing the way we interact with people with dementia doesn’t only improve the experience of the person with dementia but it will have a carry-on effect and improve the experience of staff as well, as they’ll be having better interactions with their patients.”

People with dementia respond best to a person-centred rather than a task-orientated approach.

Health professionals should speak in a matter of fact way using short and simple sentences while taking time for the person to understand the message you’re conveying or the question you’re asking.

“People often over or under-estimate the cognitive abilities of the person with dementia,” Ms O’Connor says.

“So maybe speaking in a way that’s too basic and offending the person or just speaking in an over-complicated manner and just adding to that confusion that the person is already experiencing, and then rushing through tasks, and even just talking too much can be very overwhelming for someone with dementia.”

A busy, bright and fast-paced environment, such as the emergency department, can also affect people with dementia.

“An environment like that can be very over-stimulating for people and then they’re just not able to process that information that’s coming in,” Ms O’Connor says.

“Add to that, they’re already confused because they’re in a new environment and are not really understanding what’s happening to them.”

One example of a situation escalating is when a nurse went to take a blood sample from a female patient with dementia.

Ms O’Connor says the patient had some communication difficulties and was unsure about the situation she was in, and became anxious.

“When the nurse entered the room, she didn’t really take time to recognise what state or mood the patient was in, which is something really important when someone has dementia,” she says.

“The nurse went ahead and tried to apply the tourniquet and the patient did become a bit agitated and visibly upset.

“Instead of backing off a little bit, and providing more clear and calm explanations at this point, the nurse just persevered - picking up the needle and attempting to continue straight into the blood collection.

“At this point, there was quite a big altercation with the person yelling and tossing up her arms and becoming very upset.”


Ms O’Connor says the nurse should have taken a bit more time, read the patient’s situation at the beginning, and changed their approach.

“If you just persevere with the task, it’s going to escalate into a situation that is only going to become even more difficult to manage,” she says.

“Often people just need a little bit of reassurance with things explained in a really clear, simple and calm way and they may need this reassurance and explanation given multiple times throughout the appointment.

“It really can improve the experience of everyone involved.”


Four tips for talking to patients with dementia

There’s no one-size-fits-all approach when working with people with dementia.

Ms O’Connor says nurses and allied health professionals should read each person’s state and mood separately and respond appropriately to their individual state or situation, and their capabilities.

She advises health practitioners to:

Slow down - Take some more time to provide explanations for patients in a clear and calm manner.

Use distraction - If a person with dementia is upset or anxious, distract them with a cup of tea or a small walk. “It can break the cycle of whatever it is they’re upset about or they might forget what they’re upset about, and then you might be able to move forward again,” she says.

Provide reassurance - If the person with dementia keeps repeating the same question, they may be expressing a need or seeking reassurance. “Often the best way to address it is just to calmly keep answering the person and allaying their worries.”

Stay calm - Remaining calm is important when working with someone with dementia. While the patient may not understand what health practitioners are saying, they can still read your body language and understand the tone in your voice. “If you can just have a calm sense about you when communicating with people with dementia and working around them, that can really often help to allay any worries they have.”