A New Reality: Communicating as Dementia Progresses

The car was silent. Joe was driving his mother-in-law Caralyn to a medical appointment. Conversation had become more difficult as her dementia progressed. She had always been the chatty one, while Joe was quieter. Now, Joe wasn’t sure what to say but, knowing that Caralyn enjoyed talking, he took a creative and thoughtful approach—he asked for her advice.

One of the most challenging things about caring for someone with dementia is adjusting to their new reality. This can be particularly difficult for caregivers who have known the person for a long time.

When we are with someone we love who has been in our life for many years, it can be jarring to hear them say something wrong—or even seemingly absurd—about shared experiences. We often automatically want to—or even do—correct them. However, this is often not productive and can lead to arguments and distress.

Sadly, our ability to prevent or limit symptoms, such as memory loss and orientation to reality, is severely limited. The element we can control is how we respond.

Reality Therapy

The focus of this approach is to guide a person who has lost touch with reality back to reality. This method should support the person’s own views about the truthfulness of their situation and immediate surroundings. It is intended to improve cognitive function and involves repetition to orient the person to their reality. This can be useful when supporting someone who is at an early stage of dementia.

This therapeutic approach can be learned by caregivers and family members. It can take place at home and involves using familiar objects to stimulate memory and access to a window to help orient to place and time.

It is important to note that orienting to reality is not helpful in mid- or late-stage dementia. At that point, it can be detrimental and, in fact, cause agitation, further confusion, and even diminish the person’s sense of self and value.

Validation Therapy

This type of interactive cognitive therapy is focused on empathy and respect as demonstrated by caregivers and family members who listen to their loved one and acknowledge their views, emotions, and thoughts as valid. Caregivers can learn in-depth about this approach to ensure they can provide effective support.

It is valuable to keep in mind that someone with dementia may be trying to resolve issues from earlier in their life. As they work through these things, it is important not to correct them but instead accept their reality.

It can be helpful to combine validation therapy with reminiscence of happy times earlier in life, which can support a better quality of life.

Since validation therapy provides tools for communicating with someone with dementia, it can be useful to prevent a reaction that could otherwise escalate into challenging behavior. It is an approach that can be used by caregivers, family members, and health care professionals.

Ultimately, how caregivers respond to a loved one’s delusions or misperceptions is a personal choice. Regardless of how you deal with the new, invisible-to-you reality, endeavor to maintain a calm and caring approach.

Caralyn’s dementia had progressed to the point that she had difficulty speaking clearly and finding her words. However, it was apparent she appreciated it when Joe asked for her advice. She had difficulty articulating any ideas clearly, but he responded as though she were sharing insightful wisdom that would help him solve his problems. When they reached the doctor’s office, Caralyn got out of the car and seemed to be walking with a little more confidence—perhaps the result of feeling that she had something useful to offer her son-in-law. She could still support him as well.