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Beyond Words: Nonverbal Cues and Dementia

As word skills decline, caregivers must rely more on what’s unspoken to communicate with their loved ones.

Female caregiver holding senior man's hands.

A major change that occurs as dementia progresses is the loss of ability to communicate meaning easily. People who are cognitively healthy are able to use words to communicate meaning. But as people who have dementia lose verbal and complex thinking abilities, it becomes more difficult for them to bring across their thoughts and feelings. If you are a caregiver to a loved one who has dementia, you know that this can be a challenging—yet not insurmountable—adjustment. After all, not all communication relies on words.

“People who are caring for someone who is living with dementia have to get very good at picking up on nonverbal communication,” Dr. Soo Borson, co-lead of the BOLD Center of Excellence on Early Detection of Dementia, told Guideposts.org. “They have to be able to use it well and they have to be able to read well the underlying emotional state of the person in order to be able to respond to what’s driving what’s being said or how the person is acting.”

As dementia advances from mild to moderate stages, reading your loved one’s nonverbal signals becomes ever more important, said Borson, who is also professor of Clinical Family Medicine at the USC Keck School of Medicine, and professor emerita of Psychiatry and Behavioral Sciences at the University of Washington School of Medicine. “Just as a caregiver takes over paying the bills and running the bathwater and doing all the other things that caregivers progressively need to learn how to do when they are being a primary caregiver for someone with dementia, they also become the primary interpreter of that person’s state of mind—both for themselves to understand how best to respond and for others who are not likely to know.”

Although picking up on nonverbal communication comes naturally to almost everyone, Borson said, it helps greatly to develop more effective communication skills via resources like caregiver training programs. She said that it behooves caregivers of loved ones who have dementia to keep in mind the following points:

  • “Human beings are wired to understand communication using body language, facial expression and changes in tone of voice, for example. Few people are wired in such a way that they can’t do that. The rest of us are wired with different amounts of gift in that area. Some are really much better than others, but human beings in general are good enough if they know that that’s what they need to do. They don’t have to stop and think, ‘I wonder what’s being communicated here.’”
  • “A problem in earlier stage dementia is difficulty keeping up with conversation, especially a fast-paced or abstract conversation. You can tell if someone is agitated, for instance, by looking at them. Agitation is an emotional and motor state. So, fidgeting, looking distressed, having a facial expression of distress, seeming to withdraw socially, pulling back. It’s no different from how you would pick up the same kinds of clues using nonverbal communication with anybody—for example, your spouse who is cognitively healthy. How do you tell if somebody’s embarrassed? They may blush, they stop talking, they turn away.”
  • “What caregivers have more difficulty learning is mastery of their own emotional responses to the emotional responses of people with dementia. Emotions are contagious, so another aspect of understanding what is being communicated nonverbally by somebody who has dementia is how it makes you feel—how you are feeling. You’re not just empathizing with what the other person is feeling. You’re also reacting out of your own current situation. So, it’s important to learn how to modulate your own emotional reactions, to be aware of them and also to temper their expression.”
  • “Caregiver training programs often teach how to manage your own emotional reactions to what’s happening. They mainly provide enough education to set the stage about the dementia—what’s going on, what is present? And they teach caregivers how to deal with altered behaviors. In surveys, that is what caregivers mostly ask for: ‘How do I handle this behavior? How do I handle it if he gets up and walks away from a conversation, what do I do if he refuses to go to the doctor, etc.?’ Almost all caregiver programs teach how to manage behavior changes, and the good ones also rely on helping caregivers understand that they need to be experts at reading nonverbal communication, and how to bone up on those skills. We all have them to a degree, but it takes time. It takes calming yourself down so that you can observe, without interference, your own emotional responses. These are very high-level caregiving skills that the best caregivers, whether they are paid to do the job or are family members, are really good at.”

To find out about caregiver training programs in your area, go to the Alzheimer’s Association or the Eldercare Locator for information on Area Agencies on Aging. Many organizations offer good classes on dementia caregiving and caregiver self-care, including Family Caregiver Alliance, which has the Savvy Caregiver program and Dementia Friends USA.

The Alzheimer’s Association also provides tips for better communication with a loved one who has dementia.

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