What are the three golden rules of dementia?

When someone you love is diagnosed with dementia, you will have many questions. As a caregiver, you will want to know what the course of their disease may look like and how to prepare for its progression. One of the most important questions you are likely to have is how best to support a loved one as they adjust to life with dementia. These golden rules of dementia care can help as you support and care for someone with dementia.

Dementia progresses differently for each person, meaning everyone experiences different difficulties. However, for a person living with dementia, conversation and communication become more difficult over time, as it affects their ability to remember, think and speak.

Listen

The first step to being able to communicate effectively is to listen carefully. When having a conversation, it is helpful to make sure the person you are talking to can see and hear you clearly. If you can, choose a quiet, calm, well lit space and position yourself at their eye level.

Active listening can be non-verbal as well as verbal. Make regular eye contact and nod to show you are paying attention to what they are saying.

It can be tempting to interrupt – for example, to help someone find a word they are struggling for. However, it can take people with dementia longer to process information, so allow them plenty of time to respond and try not to jump in to ‘help’ them.

If someone is upset, give them time to share their feelings and try not to dismiss their worries. Sometimes the only thing you can do is listen and show that you are there. That’s why one of the golden rules of dementia care is simply to listen.

Don’t contradict

When a person says something that you know isn’t true, it’s natural to want to correct their belief – especially if you think it will make them feel better. However, false beliefs and delusions can feel very real to someone with dementia, especially as it progresses. They may become angry if you challenge them, which can lead to bad feeling and arguments, making it harder to care for them. 

If it feels appropriate, you could try to reframe a false belief in a different way. For example, if they think someone has stolen their wallet, instead of saying ‘Nobody has stolen your wallet’, you could say something like ‘Let’s see if we can find it in case it was misplaced.’

People living with dementia increasingly use intact memories from their past to make sense of the present. One of the golden rules of dementia care is to avoid contradicting these beliefs, as this disrupts their ability to make sense of the world around them.

In some situations, feelings can be more important than facts. For this reason, you may decide to ‘go along’ with what they are saying, even if it is wrong. Giving responses that will make a person with dementia feel good may not always be based on facts.

Ask yourself whether contradicting your loved one could add to their distress. For example, reminding someone of a bereavement – ‘Your brother died 10 years ago’ – may cause them fresh pain.

Distraction techniques – such as turning on a favourite TV show or some music – can be helpful, as they turn attention away from an upsetting feeling and towards an enjoyable activity.

Don’t ask direct questions

Dementia affects a person’s ability to recall factual information. That’s why one of the golden rules of dementia care is to avoid direct questions related to memory recall. For example, asking ‘Did you remember to take your medication?’ may cause someone to feel upset and frustrated if they do not know the answer.

When talking to a person living with dementia, it may be helpful to think of ways that you can lead the conversation. For example, instead of asking ‘How was your day?’, you could tell them about your own day and give them time to ask you any questions about what you have done. Then allow them to choose whether to share any information about their own day.

It is often possible to find ways to avoid asking direct questions. Ask yourself if there is a way to turn your question into a statement. For example, rather than saying ‘Do you remember when…’ start your sentence with ‘I remember when…’ This allows you to take the lead in the conversation and your loved one can join in if they feel able to.