การสนทนากับผู้สูงอายุที่มีภาวะสมองเสื่อม

Communicating with Elderly People with Dementia
As the aging population continues to grow, health-related problems in the elderly are becoming increasingly common. One of the most significant concerns is memory decline. Short-term memory in older adults tends to deteriorate gradually. Communication with the elderly, aside from the generational gap, is further complicated by emotional changes. These factors can make conversation challenging—especially with those who have dementia or are in the early stages of cognitive decline.

People with dementia experience impaired responses, attention, focus, and memory. This often affects their behavior, personality, and ability to care for themselves. Therefore, continuous mental stimulation, alongside adequate rest, is key to preventing the worsening of dementia symptoms. Conversation is one such form of mental stimulation—it helps keep the brain active and supports cognitive functioning.


Dementia in Traditional Chinese Medicine (TCM)
In Traditional Chinese Medicine, dementia is associated with the condition known as "Shi Dai" (痴呆), which refers to cognitive decline and emotional dullness. One of the main contributing factors to this condition is emotional imbalance.

TCM pathogenesis suggests that:
“Emotional disturbances—such as unresolved anger, excessive fear or shock, chronic overthinking and worry—can damage the flow of Qi and blood. This results in phlegm and blood stasis obstructing the brain’s orifices, eventually leading to dementia.”
(情志损伤，气郁血滞 ，瘀阻清窍，久必酿成神情痴呆之患)
When elderly individuals are isolated or spend extended time alone without meaningful interaction, their emotions may remain unexpressed. This can result in reduced speech, increased worry, and potentially anxiety.

Communication Techniques for Elderly People with Dementia
1. Get Their Attention First
Before starting a conversation, call their name and wait until they make eye contact or turn toward you.
Give them enough time to respond—especially in more advanced cases. Be patient.
2. Speak Clearly and Gently
Use a calm, soft tone with appropriate volume.
Keep sentences short and simple.
Avoid speaking to them in a childlike manner or talking about them as if they aren’t present.
3. Let Them Finish
If the elderly person is speaking at length, let them finish their thoughts.
If they go off-topic, gently bring their attention back by calling their name again.
Summarize or reflect key points to show you are listening.
4. Minimize Distractions
Turn off the TV, radio, or other background noise.
Elderly individuals may be hypersensitive to environmental stimuli, which can disrupt concentration.
5. Repeat and Summarize
Repetition is crucial, especially when it involves important matters like medication.
For example, review which pills to take and at what time.
6. Simplify Daily Routines
Make activities easier by organizing and simplifying steps.
For instance, place medications in the same spot daily and pre-sort them in easy-to-use containers.
7. Limit Choices
Offer 2–3 options instead of many. This helps prevent confusion while allowing them to feel autonomous.
Avoid forcing them to perform actions they are uncomfortable with (e.g., hugging, kissing), especially if they only do these with specific people.

Why Communication Matters
Talking with elderly individuals—especially those with dementia—is a powerful way to stimulate brain activity. It helps them feel valued, loved, and connected. Social interaction promotes emotional well-being and cognitive function. Family members and caregivers should engage in regular, meaningful conversations, tailored to the elderly person’s level of responsiveness.


References
Hilltop Dementia Training Manual: A Caregiving Tool for Families & Professionals (Revised 2015)
陈湘君主编，《中医内科学》，第二版，上海科学技术出版社，2013.6

---------------------------------
Article by:

林嘉诚 中医师
TCM. Dr. Thiti Nilrungratana (Lin Jia Cheng)
Huachiew TCM Clinic
Neurological Rehabilitation and Stroke Center