Improve Communication in Dementia With the Three Time Principles

In my last post, I reviewed the 4Rs: Reassure, Reconsider, Redirect, and Relax. In this post, I will review a method to improve communication: the Three Time Principles.

Improve Communication With Your Loved One

The final broad strategy for managing problems in dementia is to communicate with your loved one as effectively as possible. Because they may be experiencing changes in their memory, attention, language, and vision, communication is more difficult. This difficulty alone will often cause frustration and create behavior problems. Practicing good communication skills can foster positive behaviors and reduce challenging ones.

We suggest the three time principles:

1. Take Your Time. When communicating with your loved one, allow sufficient time for unhurried interactions. It is always helpful to begin by making eye contact to ensure they are paying attention. Gentle physical touch, like a hand on their shoulder, may help to focus their attention. Reducing any distractions in the environment can also be useful. It is important always to use a soothing voice, pleasant expression, and comforting body language.

2. One Thing at a Time. As your loved one’s dementia progresses, you may find it helpful to slow down your speech and speak deliberately and clearly. Because their understanding of language may be impaired, use your tone of voice, facial expression, and hand and arm gestures to help them know what you are trying to say. As it becomes more difficult for them to follow complicated, multi-step commands, it will be important to break tasks down into simple, one-step commands when asking them to do something.

For example, instead of asking your loved one to “get undressed, get into the shower, and wash your hair,” it may be better to say each of these steps separately, adding the next request only after the prior one has been successfully completed. Begin with “get undressed” or maybe just “take off your shirt,” and, after that step has been completed, proceed with the next step. Similarly, favorite hobbies that require multiple steps (such as cooking or gardening) are often given up as dementia takes hold but may possibly be resumed (with a bit of supervision) if they are broken down into individual steps.

3. Offer Timely Praise. Avoid criticizing your loved one’s behavior and give praise generously. Offering praise and appreciation can protect against problem behavior. Find something genuine to praise, as exaggerated praise might seem insulting. There is almost always something to praise, even if it is just their effort in trying an activity. Remember, your loved one may feel insecure and uncertain, and giving sincere praise can help them feel valued and included. Fostering positive feelings helps prevent negative ones that can underlie behavior problems.

Illustrating the Three Time Principles

I asked my husband to wash his hands, set the table, fill the glasses with water, and then come help me in the kitchen. When I checked on him 20 minutes later, he was watching TV. I could tell he washed his hands, but nothing else was done. So, I asked him again to set the table, fill the glasses, and then come help me. Fifteen minutes later, the table was half-set, the water wasn’t in the glasses, and he was agitated and storming around the dining room, periodically stopping to pound on the table. What should I do?

As dementia progresses, it can be difficult for your loved one to follow multi-step commands. They may only remember one of the several things you asked them to do. This failure may cause them to feel embarrassed, frustrated, or annoyed, resulting in behavior problems such as anger and agitation. It is important to break larger tasks into small, one-step commands.

You might ask your loved one to wash their hands, set the table, fill the glasses, and help you in the kitchen. Give them help with each step if they need it. Remember that steps like “set the table” can be broken down into smaller steps. Clear, one-step commands can reduce frustration and problem behavior.

© Andrew E. Budson, MD, 2022, all rights reserved.