“It’s Not What You Say—It’s How You Say It”

How our reactions shape the experience of those living with dementia.

In the last blog we explored how dementia and Alzheimer’s are not the same as memory loss. If you missed it, here is the link [Link]. Today we will look at what happens when we, as a care partner, react to the person living with brain changes.

Let’s use the same scenario as before; dementia or Alzheimer’s in the task of brushing their teeth. In the sequencing below the person missed the step of getting the cap off the toothpaste and is now brushing their teeth without toothpaste.

Sequencing of Brushing Teeth with Dementia (or Alzheimer’s):

• Step one reach for the toothbrush
• Step two reach for the toothpaste
• Step three put the toothpaste on the toothbrush (went through the motion)
• Step four remove the cap on the toothpaste (this step was passed over)
• Step five wet the toothbrush
• Step six brush teeth (brushing teeth without toothpaste)

If you are the primary care support for someone with dementia, what would your reaction be?  What would you say to them given that they missed the step of taking the cap off and not getting toothpaste on their toothbrush? What would your facial expression look like and express to them?

Here is what a typical reaction from a care partner sounds like and might look like.

“What are you doing? You don’t have any toothpaste on your toothbrush. Here let me help you.”

Look at the picture and reread the statement. The reaction of “what are you doing”, shows your surprise and disappointment.  Adding in you don’t have any toothpaste on the brush makes a person feel less than adequate or belittled. Saying “Here, let me help you” can make someone feel like a child. As a care partner your intension is to be caring and helpful. Folks living with dementia have a difficult time seeing the reaction from the care partner’s point of view. All they know is that you as the care partner are upset and they (the person living with dementia) have done something wrong. Who likes being wrong? Not me. Dementia or no dementia no one really likes to be wrong.

Here is a better reaction from a care partner:

“Oo (name). No toothpaste, huh? Try this (take cap off toothpaste offer it to the person).”

Shifting your language from being about the person’s mistake to being about the task takes the blame out of the interaction. By saying no toothpaste and looking/sounding curious doesn’t make the person living with dementia feel less than adequate or belittled. People living with dementia react to how you treat them.

Next time you are interacting with someone living with dementia, try being curious. Offer your help as an option instead of a necessity.

“People will forget what you said. People will forget what you did. But people will never forget how you made them feel.” Maya Angelou