Communicating
The goal changes with this disease. It's no longer exchanging accurate information. It's exchanging safety, warmth, and dignity. Connect, don't correct.
Enter their reality. It's the kind thing
When she says she's waiting for her mother (gone thirty years), you have two options. Correct her, and she learns of her mother's death fresh, grieves for a moment, forgets the facts, and keeps the pain. Or step into her world: "You must miss her. Tell me about her." One of these is honest by the calendar. The other is honest to the person. Choose the person.
Clinicians call the gentle version of this validation, and the occasional protective untruth ("the car's in the shop") therapeutic fibbing. If it prevents real suffering the person cannot process, it isn't lying. It's translation. (Wrestling with this as a believer? Am I lying to them? takes the question to Scripture, both sides given their due.)
How to say almost anything
- Approach from the front, get to eye level, say their name, smile first. The body speaks before the mouth does.
- Short sentences. One idea each. "Lunch is ready" beats "Let's eat lunch now before your show starts because later we have to leave."
- Offer two choices, not open questions. "Soup or a sandwich?" beats "What do you want to eat?" An open field is overwhelming; a fork in the road is manageable.
- Wait. Then wait longer. Processing takes time now. Count to ten before repeating, and repeat with the same words, not new ones.
- Never quiz. "Do you remember me?" is a test they may fail in front of someone they love. Instead, hand them the answer: "Hi Mom, it's Sarah, your daughter." Gift, not exam.
- Talk to them, never about them while they're in the room. Comprehension outlasts expression. Assume they understand everything.
“A gentle answer turns away wrath, but a harsh word stirs up anger.”
Proverbs 15:1When words run out
In later stages, conversation becomes presence: sitting close, hand in hand, music from their twenties, a hairbrush, a photo album, the tone of your voice carrying everything your sentences used to. This is still communication. Some caregivers say it's when they finally stopped negotiating and started just being with, and that some of their best visits happened after words were gone.
She probably does, and that's part of the disease, not evidence against it. People with dementia can "showtime": rally every remaining resource into a short, polished performance for visitors and phone calls, then collapse into exhaustion and confusion after hanging up. Ten good minutes on a Sunday call and the daily reality of care are both true. If you want to see the real picture, come for a full afternoon (better yet, an overnight). The person doing daily care isn't exaggerating; they're the only one seeing the whole show.