Signs of dementia and communication strategies for financial professionals

(Excerpt from Making your workplace dementia friendly: Information for Financial Professionals (PDF) by the Alzheimer Society of B.C.)

It is not always immediately evident that a person has dementia. Everyone‘s dementia journey is unique, with different strengths, abilities and challenges along the disease trajectory. Some individuals will disclose that they have a diagnosis of dementia or that they are having memory problems; others will not. Every person with dementia is entitled to be treated with dignity and respect, regardless of the challenges they might be experiencing.

Signs that someone may be experiencing symptoms of dementia and strategies for responding in a supportive way include:

1. Problems with memory

As the disease progresses, a person with dementia may forget things more often, especially more recent experiences. For example, she may withdraw sums of money several times in one day, forget to pay a bill or call several times with the same trading suggestions regarding her stock portfolio. She may also have challenges recalling information from a previous meeting or appointment.

Communication strategies:

  • Do not argue. If the person does not remember receiving a bill it may be because she is no longer able to properly store that memory due to changes in her brain.
  • Unless her safety or security is at risk, try to adjust to the person’s reality because she may no longer be able to adjust to yours. Try responding to her feelings, not necessarily the stories she is sharing. For example, if she feels that you forgot to send the bill it is better to apologize to her and acknowledge that she feels frustrated (her reality) than to try to convince her that the bill was sent (your reality).

TIP: The person might want to put a limit on the amount of money or number of times that she can withdraw funds from her account in a given time period.

TIP: Some people may choose to set up a joint account with a trusted family member or friend who can help them manage their finances.

TIP: The person may want to consider setting up automatic payments for regular debits from her account.

TIP: The person may need assistance in creating a PIN that is easy for her to recall.

2. Difficulty with familiar tasks

Challenges in abstract or sequential thinking may cause a person with dementia to have trouble with tasks that were previously familiar to her. Completing paperwork necessary for managing investments or following the prompts provided by an ATM machine may be difficult.

Communication strategies:

  • If you are providing instructions, speak slowly in simple language and provide one message at a time. This gives more time to digest the information and complete a task.
  • Try demonstrating rather than providing directions verbally.
  • Be patient and supportive. Consider bringing the person to a teller where she can be helped by a person.
  • If possible, bring the person to a quieter space where it is easier to concentrate.

3. Inability to follow a conversation or find the right words

Everyone has trouble finding the right word sometimes, but a person with dementia may frequently forget simple words or substitute a less appropriate word for the one she really wants. This can make her sentences or accounts of events difficult to understand.

Communication strategies:

  • When possible and appropriate use closed-ended or “yes” or “no” questions, such as, “Would you like to make a withdrawal?” rather than “What can I do for you today?”
  • Ask the person’s permission to help her find the right word.
  • Repeat the question a different way, or try again later.
  • Don’t rush: this may mean booking a longer appointment or meeting.

4. Disorientation of time or place

It’s normal to briefly forget the day of the week or your destination. But a person with dementia may become lost in a familiar place and not know how she got there or how to get home. A newly renovated branch, for example, may be particularly confusing.

Communication strategies:

  • If you have concerns about the person’s ability to get home safely, ask her how she is planning to travel. With her permission, it might be necessary to wait with her until her transportation arrives.

IMPORTANT: If you notice that a person is pacing, standing still or looking around for a long period of time, they may be lost and disoriented, sometimes referred to as “wandering.” Wandering can be very dangerous and is an emergency. Ask the person if they need help, or if there is a family member you can call. If they refuse your help and you are still concerned, or if they cannot recall a family member’s information, stay close by and call 9-1-1 right away.

5. Poor judgment

A person with dementia may experience decreased judgment and her behaviour may change from what you’ve known in the past. For example, she may experience less social inhibition or make unwise financial decisions.

Communication strategies:

  • Make suggestions tactfully. For example, instead of saying, “Why do you want to withdraw that much? You will put your account into overdraft,” you may say something like, “I’ve just noticed that this transfer might overdraw your account. Can we transfer a lesser amount?”
  • Changes to certain parts of the brain can result in behaviour that is socially inappropriate such as swearing or inappropriate comments. Avoid drawing attention to the behaviour or criticizing it.

6. Problems with abstract thinking

A person with dementia may have challenges with tasks that require abstract thinking. This may make answering open-ended questions difficult. It may also be challenging to make sense of symbols or images.

Communication strategies:

  • Try to use straightforward language. Avoid metaphors, for example: “A bird in the hand is worth two in the bush,” or “Money doesn’t grow on trees.”
  • Stay positive and friendly, but avoid jokes or sarcasm, as these require abstract thinking skills.
  • Be compassionate and treat the person as normally as possible. For example, if the person is using her library card at an ATM, suggest that she try another card, as if it happens often.

7. Changes in mood or behaviour

Everyone experiences changes in mood. But a person with dementia can sometimes become suspicious, withdrawn or even more outgoing than before. Over time the person may become angry, more apathetic, fearful, or even paranoid. She may, for example, think that someone is stealing from her account or that you are doing something dishonest.

Communication strategies:

  • Adapt to the changes the person is experiencing. Like all of us, people with dementia will have good days and bad days. If the person is having a bad day it may be helpful to reschedule an appointment.
  • If you feel that the person may be angry or upset it can be helpful to acknowledge her feelings.
  • If you feel that the person may be experiencing abuse or neglect, it is important that you report this.

8. Other tips for communication

  • Remember to make eye contact. If you are making notes or using the computer, take a break and make sure to look at the person.
  • A person’s ability to understand body language is often maintained for a long time along the dementia journey. Take note of your body language and tone of voice. Keep positive and watch your gestures, facial expressions and posture.
  • If possible, sit beside the person rather than behind a desk to make her feel more comfortable.
  • It may be necessary to remind someone to put on their glasses or turn on their hearing aid, but do not assume that every person with dementia has a visual or hearing impairment.
  • Always speak to the person with dignity and respect.
  • Avoid using “elder-speak” or baby talk (for example, “sweetie” or “dear”).
  • Never speak about the person as if they are not there.

TIP: Over time it might become difficult for a person with dementia to maintain a consistent signature. Other forms of identity verification, such as keeping copies of photo identification in the person’s file, might be helpful.

TIP: At a certain point, you might want to ask the person if she has ever considered putting legal tools in place so that someone can help her with her finances. You might also ask if she has considered having a trusted family member, friend or representative attend important meetings with her; you might say, for example: “Sometimes this is all a lot to take in. Is there someone who you would like to come with you to meetings like this one?”

Additional resources

Last Updated: 08/25/2018