Tag Archives: dementia

Aging, caregiving

Use Silence for More Authentic + Vulnerable Conversations

I visited a hospice patient last week who is slowly detaching from this life. I know from my end-of-life doula training that this is normal. As they get closer to death, people often turn inward, eating less, talking less, seeming less engaged with the world outside themselves. I see this happening with Margaret.

When I arrived at her apartment, she was sitting at the table, staring down a plate of scrambled eggs. Her head hung. There was a fork in one hand, but that hand rested on the table and the fork dangled a bit precariously.

“Mom doesn’t want to eat,” Margaret’s daughter told me. I have assured the daughter on previous visits that it’s normal for people to lose their appetites and that if Margaret doesn’t want to eat, it’s ok. But the daughter would really like her mother to eat.

I asked Margaret if she was hungry.

“No,” she said quietly, not making eye contact. “I’m having . . . a bad day,” she said slowly, still not making eye contact.

“Do you want to talk about it?” I asked.

“No,” she said. Despite having said she wasn’t hungry, she started tentatively eating the eggs. While she ate, we sat in silence. Each bite seemed to take her full concentration and I didn’t want to break it. When she finished eating, I helped her to her recliner, where she dozed. My entire visit passed in near silence. It was peaceful and when I left, Margaret’s daughter commented that her mother was less agitated than she had been earlier.

I’ve always loved silence, but for most of my life, I tried to avoid it unless I was alone. Unless the person next to me was a stranger or we were watching a movie, I felt compelled to fill the silence with conversation. Unless I was alone, silence felt awkward to me. I think many of us are socialized this way.

At work, I’ve championed silence. In the writing center I direct, I teach tutors to allow silence in their sessions to give their clients time and space to reflect. I set a timer for ten seconds and we sit silently for the full ten seconds. It’s hard. We are not used to ten full seconds of silence.  

When I teach, I allow at least ten full seconds of silence to pass after I ask a question. My students sometimes comment on how uncomfortable the silences in my classes are. But more often, students thank me for providing the silences, saying those moments are productive for them.

Since my husband’s stroke, I’ve been allowing more silence into my conversations. My husband needed the processing time, and I’m finding that it’s not just folks who’ve had strokes who benefit from that time.

Being with someone in silence is a great way to hold space. Filling the silence with insignificant chatter does not invite authenticity or vulnerability.

If you’re not used to being silent with someone else, it may take practice before it feels configurable to you. That’s ok. I’ve been practicing for years and still succumb to the pressure to fill the silence sometimes.

If you want to get more comfortable with silence, here are some strategies to try:

  1. Practice counting seconds in your head after someone speaks and before you speak. Notice how many seconds (if any) typically pass in silence between you and the other person. Aim to extend it by one second. It may take many days or weeks of practicing this before you’re ready to extend it by another second, but that will eventually happen. Then add another second. You will notice your conversations stretching out, like a cat settling into a sunny spot. You will feel calmer. You will be listening better, thinking less about what you’ll say next.
  2. When the silence begins, take a deep breath. Use the breath to buy yourself a few seconds, but also to ground yourself in the present moment. I do this when I’m teaching. After I ask a question of the class, I take a deep breath and let it out slowly. Then I start counting in my head to ten. I don’t allow myself to speak until I’ve gotten to ten.
  3. Remember that silence is communication. It communicates patience, leisureliness, respect, attentiveness. It can de-escalate tension. In fact, silence has been key in helping me cope with tension and conflict without getting defensive. Recently, when I’ve been in situations that could escalate into an argument, I’ve taken a deep breath and made myself count to ten before responding. Interestingly, my responses in these situations tend to take the form of questions rather than defensive statements. I ask for more information instead of telling the other person they are wrong.

Others may not like the silence and that’s ok. They may not be used to it. They may be like the students in my classes who complain that the silence is awkward. Perhaps it is. But for me, allowing space for authenticity and vulnerability is more important than avoiding awkwardness.

Aging, caregiving

How to Have a Conversation with Someone Who Has Dementia

3 Comments

I’ve recently spent time with two elderly people who have dementia. Shawn is in the early stage, still able to live alone and take care of himself, although he is forgetful enough that he isn’t able to manage his finances and other personal business reliably. Susan is no longer able to live alone, forgetting to eat and bathe if someone doesn’t remind her.

When I was a kid, one of my grandfathers had dementia, although at the time, we called it “senility.” He often confused me with my mother or my mother with one of her siblings. He typically knew we were his relatives, but he had a hard time pinning down which one. It didn’t bother me at all because whether he knew who I was or not, he was genial and told good stories and sometimes gave me a dollar for ice cream (which was enough back then). I hadn’t known him before his dementia, so for me there was no loss and he just seemed like a happy—if confused—old man.

As I got older, I began to understand the losses people with dementia experience. Susan and Shawn have both expressed how frustrating it is for them to not remember things. They both often lose track of a conversation and will say something like, “What were we talking about?” or “Why was I telling you that?”

Susan recently described one of her childhood homes to me and then asked why she was telling me about it. “I asked you where you grew up,” I reminded her. She blinked at me blankly, clearly having no memory of me asking her that. “Oh,” she said, looking embarrassed.

In the past, I might have been tempted at that moment to either give her a more detailed recap of our conversation or to try to comfort her with a vague statement like, “I forget things, too” or “It’s ok, it wasn’t an important question.” But neither response would have been helpful.

The more detailed recap would likely not have helped her recall the conversation, which didn’t make its way into her short-term memory, and the details I provided might have just confused her more. The vague statements may have come across as condescending or patronizing or, worst of all, lies.

What I do now is remind myself that the purpose of the conversation we were having wasn’t to have a conversation; it was to connect. The information exchanged is irrelevant. Her remembering the conversation would matter if the information was important, but it isn’t. The connection is what matters, and so the way I make her feel is where I put my focus. If I make her feel like she is being patronized or lied to or placated, our connection will not be nourished.

So when she looked embarrassed that she forgot the conversation we were having, I put my hand on hers, made eye contact, and said, “Do you want to tell me more about where you grew up?”  

My intent was to make her feel valued and interesting, and I think it worked. She told me several more stories about her childhood. When she said she hated being so forgetful, instead of brushing her concern aside, I used an active listening strategy to acknowledge her worry, saying, “It sounds like you are really frustrated with your memory. Do you want to talk about that?”

She did. She only said a few sentences about it, but when she was done, she thanked me. I think pretending someone’s dementia isn’t real can make the person with it feel unseen and that me giving her an opportunity to talk about it made her feel seen. That’s connection.

I take a different approach with Shawn. He is more likely to repeat stories or misunderstand or misremember events. He gets very agitated about the things he misunderstands. He recently became convinced that he has to collect the serial numbers of all his appliances or they’ll be repossessed.

When he told me he couldn’t find the serial number on his hot water heater, I kept myself from saying, “Nobody wants the serial number on your hot water heater!” Instead I asked a simple question: “Who needs the number?” He thought it was the bank. I considered explaining that a bank wouldn’t be interested in his hot water heater’s serial number, but anticipated that could lead to an argument, with Shawn trying to convince me that the bank did want it and me trying to convince him that the bank didn’t want it. An argument wouldn’t do either of us any good.

In this situation, my purpose was to calm his worries. I wasn’t sure how he got the idea that the bank wanted this list of numbers. With Shawn, I try to ask very simple direct questions and I couldn’t come up with a simple direct way to find out what his worry stemmed from, so I asked a different simple direct question: “Would you like me to talk to your daughter about this?” He said yes and let it go.

With both Susan and Shawn, I try to ask questions that do not rely on short term memory, like “How was your day?” or “What did you have for breakfast?” Instead, I ask more open-ended questions that prompt them to share whatever is on their mind. “What’s on your mind today?” is my favorite. I also like, “What are you thinking about?”