How to Talk to Someone Who is Unaware That They May Be Experiencing Symptoms of Dementia

7 Strategies for Having A Better Conversation

By Valerie Feurich, Positive Approach to Care (PAC) Team Member

Have you noticed changes in a person recently, but they themselves are not aware or don’t acknowledge these possible symptoms of dementia?

Are you concerned, but aren’t sure how to start this conversation? This type of talk can be tough, but there are a few things you can try to make it go a little smoother.

1. Get curious about what they do recognize

Does your person know that others are concerned? Can they tell you what others may have said to them? You’ll want to try to see whether they have the ability to hold on to things like that. Why? Because what you’re seeing may be dementia, or it could be that something else is going on.

Dementia is not a sign of normal aging, as is often mistakenly assumed, but a symptom of a changing brain. While an inability to form new memories can be a symptom, many other things can mimic a dementia. So how do you best find out what they do recognize? Read more in the next step.

2. Lead with curiosity, and not with judgment

Do you like to be judged or have others make faulty assumptions about you? Chances are, you answered no. When talking to the person who you suspect might be showing signs of a dementia, don’t make bold statements or assumptions that will do nothing but get them to put their guard up (likely eliminating any chance of having a productive conversation).

Instead, gently lead into the topic through a series of simple questions. After the person answers, you may want to reflect back the last few words that they just spoke. This will not only make them feel heard, but can help keep the conversation going.

As an example, the conversation may sound something like this:

• Teepa: “How about other people, besides your daughter? Any differences you’re noticing in what other people are saying? Anything that feels unfair, like they’re picking on you or saying things that aren’t true?”
• Valerie: “Well, I did get an overdue notice recently. But that’s because they didn’t send me my phone bill. And if they don’t send me a bill, I can’t pay it.”
• Teepa: “Oh. So as far as you know, you never got the previous bill, you just got this one?”
• Valerie: “That’s right. They just sent me this late notice without sending the first one.”
• Teepa: “Yeah. So when you get mail, do you put it into a specific location or do you look at it right away? What do you do with mail when it comes in, in general?”
• Valerie: “Ah, I have a little cabinet by the stairs. When I come in, I usually set new mail on top of it.”
• Teepa: “You usually set it on the cabinet. Do you ever put it in the cabinet or do you always just set it on the cabinet?”
• Valerie: “I just set it on top.”
• Teepa: “And as far as you know you’ve never gotten that bill, but they said you did. Talk to me about what you‘re going to do.”
• Valerie: “Ahh, well, you know.”
• Teepa: “Did they say it was past due? Did they charge you extra?”
• Valerie: “Yeah, they’re charging me a $25 late fee, and I’m mad. They didn’t send it to me, so I’m going to call them.”
• Teepa: “Yeah. So you’re going to complain about that late fee because you don’t think you got the first bill. Is this the first time this has happened, or has this happened before?”
• Valerie: “Uhhh, well, a couple of months ago the electric bill also didn’t come in. The postal service has a new person in our area, and I think they just aren’t very good.”

Did you notice how Teepa uses questions to gently find out more about the unpaid bill and direct the conversation?

Can you pick out the areas where she reflected back what Valerie just said?

While this may feel a little awkward at first, practicing these and Teepa’s other communication techniques will likely make your future conversations more effective and help protect your relationship with the person you’re talking to.

3. Take small steps

Looking at the earlier conversation, what do you think would have happened if Teepa had started with “So Val, did you know that a lot of people think you have dementia?”

Chances are, their chat wouldn’t have been nearly as smooth. While, yes, the goal may be to help them recognize that something isn’t right, as a learner once said to Teepa, “Know the agenda, but don’t show the agenda.”

Go slow, take your time, and don’t rush this conversation. Most important of all, you’ll want to try to protect the relationship that you two share. And by approaching tough topics gently and by taking baby bites, you’re more likely to find a common ground to build on.

4. Make it clear you’re on their side

Being told that others are noticing changes and that you may be developing Alzheimers disease or another dementia type can be scary. If you were on the receiving end, how would that make you feel? Chances are, you’d experience a range of emotions. Would you feel a little less anxious knowing you have a friend and partner by your side? For many people, the answer would be yes.

As you’re talking to your person, try to show that you’re on their side through empathy and by recognizing their concerns. In addition, even if you don’t agree with something they may say, try to let go of being right and remain curious instead. To continue with the earlier example, see if you can pick the spots where Teepa reflects Valerie’s concern, showing she is on her side:

• Teepa: “Yeah. So, it sounds like there are a couple of things that are changing. Now, whether or not it’s you or it’s the phone company, did you have problems with late bills like that before? Do you ever remember getting notices that you didn’t pay something when you know you had?”
• Valerie: “I don’t think so.”
• Teepa: “I don’t think so either. So, it sounds like maybe something a little different is going on. And you know, you are getting into an age range where it’s nobody’s fault, we’re just getting older. There could be something happening with the meds that you take, when you get a little older they don’t act the same. Or it could be that what’s going on here may be that you have a health condition that isn’t being as well managed as we’d like it to be.”
• Valerie: “Yeah, I hope that’s not going on.”
• Teepa: “I hope it isn’t either. But, you know, the only way we’re going to figure it out is to look a little more carefully.”

And for bonus points, did you notice the three words Teepa uses twice to make her observation feel non-confrontational?

By sharing observations with a label like It sounds like…, it seems like…, or it looks like…, you can make your comments feel less like an attack and more like genuine curiosity.

5. Pause and take a step back if you need to

Sometimes, given the circumstances, it may be better to bring somebody else in to have this difficult conversation.

Do you and the person you’re concerned about have a lot of history together? If yes, did it involve fighting or other conflicts? If you answered yes to both of these questions, you may consider making sure you don’t risk harming your relationship through the help of a third party.

If possible, you may try to bring in somebody who understands dementia, as they’ll likely be able to find a common ground with the person you’re concerned about.

6. Ask for a favor

Another way to help you learn what may be really going on is to ask the person for a favor. Most people like to be helpful when they can, and by asking if they could help you out with something, you may be able to gather more information.

As an example, you could say something like: “Tell you what. Can you do me a huge favor? Could we look in the cabinet to see if there is any chance, maybe, in an off moment, you were cleaning up and you put things in the cabinet?”

In this case, asking for a favor may allow you to scope out some of the hidey-holes where your person may be putting things. Because the saying out of sight out of mind rings true. If it’s not there, without the visual, it’s very easy to forget.

You’ll want to ask permission and ask for a favor to try something, which is one of Teepa Snow’s Positive Action Starters. By doing this, you’re helping confirm that you’re on their side. You’re saying I hear you, and I believe what you believe.

Making your person realize that you’re not arguing with them is one the of most important elements you’ll want to keep in mind.

7. Be compassionate

Imagine how you’d feel if a skill you used to ace, you could no longer successfully complete?

How would you feel if you’ve never missed a bill in forty years, but suddenly someone else points out that you’re overdue on some of them?

Chances are, you’d go through a flurry of emotions. Chances are, you’d think I don’t remember getting that bill or I don’t think they ever sent that in the first place.

Realize that recognizing and acknowledging that some of your abilities are fading is something that is likely difficult to process. If you can, try to put yourself in their shoes. And remind yourself to be compassionate and patient.

We know this isn’t always easy, but we’re certain it is worth a try.

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Positive Approach to Care

Positive Approach to Care (PAC), founded by dementia care educator Teepa Snow, offers caregiver education through effective hands-on care skills and techniques.

Interested in learning more? Visit www.teepasnow.com/blog.