Talking to Someone Whose Memory Is Going
Most of what goes wrong in these conversations comes from correcting, quizzing and asking open questions. What to do instead, and why it works.
You have just been asked, for the fourth time in an hour, when the appointment is. Or told about a visit that did not happen. Or asked where your mother is, and your mother died in 1994.
What you do in the next ten seconds determines how the rest of the afternoon goes, and almost everybody gets it wrong at first, because the instinctive responses are the unhelpful ones.
The three habits that cause the most distress
Correcting. “No, we did that yesterday.” “You already asked me.” Each correction is a small notice of failure. The information does not stick, so the correction achieves nothing, but the feeling of having been caught out remains long after the fact is gone. That is the cruel arithmetic of it: the facts fade, the feelings do not.
Quizzing. “Do you remember who this is?” “What did you have for lunch?” Usually asked out of a well-meaning wish to keep somebody’s mind active, it functions as a test that can only be failed. If you want to prompt a memory, supply it instead: “That is Michael, in the garden at the old house.”
Open questions. “What would you like to do today?” is a harder question than it sounds, because it requires generating options, holding them in mind and comparing them. Two concrete choices are far kinder: “Shall we sit in the garden, or would you rather have a cup of tea inside?”
One rule underneath all three: respond to the feeling rather than the fact. Somebody asking where their mother is usually wants safety, comfort or home. Answering the question defeats you. Answering the feeling generally works.
What to do when what they say is not true
This is the situation families dread, and there is a workable middle path between lying and correcting.
Start by asking what is underneath it. “You are missing her” is a truthful response to a question about a mother who died decades ago, and it opens a conversation rather than delivering a bereavement afresh. Follow with an invitation: “Tell me about her.” People whose recent memory has gone frequently retain long-term memory in detail, and this hands them something they can still do well.
Where somebody is agitated and pressing, do not argue and do not construct an elaborate fiction you will have to maintain. Reassure and redirect: “You are safe here, I am with you. Come and sit down, the kettle has just boiled.”
Families ask whether this is dishonest. It is worth being clear about what the alternative involves. Repeatedly informing somebody that a parent has died, in a way they cannot retain, is not honesty in any sense that helps them. It inflicts the loss again with nothing gained. Kindness and truthfulness pull apart here, and kindness has the better claim.
You are not managing a conversation about facts. You are trying to leave somebody feeling safe, which is the only part of the exchange they will still have in ten minutes.
Practical things that make talking easier
Approach from the front, and say who you are. Not as a test, as information. “It’s Sarah, Mom.” Arriving in someone’s peripheral vision is startling; being asked to identify a face under pressure is worse.
One thing at a time. Short sentences, one idea in each, then wait. The pause feels excruciating and is usually the most useful thing you do. Processing has slowed, not stopped, and people who are given six or seven seconds frequently answer perfectly well.
Cut the background noise. Television off, radio off. Following a voice against competing sound is disproportionately hard, and much apparent confusion is simply that.
Say the noun. “Your cup is on the table,” not “it is over there.” Pronouns and vague locations require the listener to hold context they may not have.
Keep your face and voice easy. Emotional tone is read accurately long after the words have stopped being followed reliably. A tense voice produces a tense response even when the sentence was reassuring.
Do not overrule what they can still do. Finishing every sentence for somebody is efficient and diminishing. Wait.
When the conversation goes wrong anyway
It will. Somebody becomes agitated, accusatory, or upset about something you cannot resolve.
Stop trying to fix the content. Lower your voice rather than raising it. Change the setting, because moving to another room or outside often resets the whole thing. Where possible, use activity instead of conversation: folding washing, drying dishes, looking at photographs. Doing something together with hands busy removes the pressure to perform verbally and frequently ends better than the conversation would have.
If accusations are involved, particularly the common one about stolen money or possessions, do not defend yourself at length. It reads as argument and escalates. “That is upsetting. Let us have a look together” is nearly always better than the truth stated firmly.
Late afternoon is harder for many people, and if these episodes cluster then, that pattern has a name and some practical answers. See sundowning and why late afternoon is harder.
What this costs the person doing it
Nothing about this is natural and all of it is tiring. You will correct out of habit, snap when you are tired, and feel appalling about it afterwards. That is a normal account of caring for somebody with a failing memory, not a personal failure.
Two things help. Say the difficult things out loud to somebody who understands, whether a support group or a friend in the same position, because the isolation does more damage than the work. And take actual breaks, not the kind where you are still on call. Caregiver burnout sets out what to watch for in yourself.
Where a familiar visitor comes regularly, the whole thing is easier: they are not carrying the family history into the room, and they can be endlessly patient in a way that is far harder for a daughter. Our companionship service is built around exactly this, and what tends to change first covers the earlier stage.
