Dementia Care – How to Interact When a Person’s Abilities Are Different Every Day

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By Polly LoganJune 22nd, 2021

Dementia Care – How to Interact When a Person’s Abilities Are Different Every Day

Strategies for Connecting With Where They Are In The Moment
By Polly Logan
Have you ever noticed that the abilities of a person living with dementia can change greatly over short periods of time?

When someone is living with dementia and their symptoms are quite variable, such as those living with vascular dementia, it can often be extremely challenging to know what exactly to expect on a day-to-day basis. Some days they may be doing very well, cognitively, and have no difficulty whatsoever recognizing you, while other days they may not recognize you at all.

When my grandmother was living with vascular dementia, some days I would introduce myself and she would snap, “Don’t be silly, of course I know who you are!” Other days, she would not have any idea who I was, or even exactly who she was.

When abilities are so incredibly variable, what are some tips for approaching an interaction?
Observe Before You Approach:
Image of a woman's eye who is observing somethingFirst, slowing down your initial approach can be very helpful. If possible, pause in the doorway or at least six feet away from them, in what is known as public space, and knock on the door or verbally say “Knock, knock!” Then, say “Well, hi!” or “Well, hey!” Rather than coming closer at this point, remain in the public space and observe them.

Watch their face carefully for any recognition of you, such as a smile or a light in their eyes. Observe their body language and verbal language, too. If they extend their arm to you, wave, try to get up to greet you, or invite you to come closer, then chances are they are having a good day and may be recognizing you.
When They Recognize You:
Image of young woman shaking an older man's hand and smiling at himIf they seem to be easily recognizing you, then you may certainly call them by the term you usually use to address them, such as Mom or Grandpa.

If this term seems to puzzle them, then it may be that they recognize you but not necessarily your relationship to them.

Rather than trying to correct them or help them remember your relationship, such as by saying “Mom, don’t you remember, I’m your daughter?” it may often be better to switch to addressing them by their first name.

Even if this feels strange to you, it is often more comforting for those living in the later states of dementia to be addressed by their familiar first name rather than an unfamiliar title.
When They Don’t Seem to Recognize You:
Image of an older man who looks confusedIf you do not observe any signs of recognition when you are paused in public space, then it is quite likely that they may not clearly remember you and your relationship with them that day.

Rather than trying to get them to remember these details, address them by their first name. You also will want to slow your approach down even more if they are not recognizing you. Hold your open hand, still, next to your face and say, “Hi Mary, it’s Meg.” Then, stretch out your hand in the handshake position and come closer, slowly.

If their face seems at least somewhat receptive and they stretch their hand out to you, then you may come closer and enter their personal space. However, if they seem to be very upset or clearly not interested in interacting at that time, it may be better to try the interaction at another moment.
Next Steps:
Image of a red scarf laid out in a heart shapeOnce you’ve connected and are interacting, then what?

When abilities can shift even from moment to moment, it can be at times tricky to know what to do and say during the visit. Planning ahead can make a big difference in having a positive interaction rather than one that feels frustrating.

Whenever possible, bring something for them to look at, taste, smell, listen to, or feel. Try such things as a book with beautiful photos, a soft scarf, fabric scented with an essential oil, a favorite recording of music, or a piece of fruit that you know they would enjoy.

Try different things, and see what types of items that seem to interest them the most. You certainly do not need to buy something new or expensive: objects you have in your home or even items that are already familiar to them may be used, as well.  If you play an instrument or sing, you might perform some music for them and even possibly encourage them to join in with singing or playing along.

The key is to bring something that doesn’t necessarily depend on them knowing or remembering family relationships or details. For instance, on a day that they are having trouble remembering names and faces, a stack of family photos may not hold their interest for long, and may leave you frustrated or upset.
When Bad Days Happen:
If they are having a day when they are feeling a bit down or upset, as we all do from time to time, use statements such as I’m so sorry or I really hate this for you or I’m sorry, that should not have happened.

Validate their feelings, and mirror their emotions when you respond so that they feel you have truly heard them. If they are not interested in looking at whatever you brought that day, try your best and go with their flow. Also, do not be afraid to keep the visit short.
Taking the approach slowly, using your observational skills, and bringing along objects can help to improve the chances of a positive interaction when someone is living with dementia.

Even if the individual doesn’t know exactly who you are in the moment, if they feel that they really like you in that moment, then the visit was a success!

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9 Comments on “Dementia Care – How to Interact When a Person’s Abilities Are Different Every Day”

  1. this is a wonderful article. Is there anyway I can print this so I can give it to our staff at our long term care facility? I tried to print if from here, but it does not print right

  2. My Mom is 100% deaf. She was just recently diagnosed with emphazema and is extremely weak. And no she doesn’t smoke. She is 90 yrs old and last smoked when she was 53 yrs old. She had taken 7 yrs lip reading when she was young. Some days she can read lips and some days she has challenges with lip reading. I do however use a dry erase board(s) for communicating with her. I am also the sole caregiver and have been doing this since 2016 and have nobody to step in and give me a break. I have inquired about services yet they are extremely expensive. Do you guys know of a service that is very reasonable? I’m in the Houston area. Thank you immensely, A. Laura McCarthy

  3. So helpful to know what to expect. ITs easy to think they really don’t have dementia on good days which gives false hope. Just going with their reality is helpful.

  4. This is a great article. Thank you for all the information and practical suggestions you provide to those of us working with individuals with some form of dementia.

  5. Very helpful and interesting. I would love to learn how to deescalate if you have become the focus of the anxiety – for example the person wants to call the police to have you removed from their home.

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