Pronouns.

Today we are talking about pronouns.

What do pronouns have to do with dementia?

Let me tell you a story.

I went out with a friend last night. We were talking about two guys we used to work with. Let’s call them Ben and Brad.

She told me that one of them did something not-so-ethical a few years ago. As the story progressed, I realized it was actually quite a few not-so-ethical things. He managed to commit several transgressions against his family, his friends, and his workplace. And I was not impressed.

However, I didn’t know who to be unimpressed with.

We had been talking about Ben and Brad. Perhaps at the beginning of this story my friend had clearly stated which man she was referring to. And I had forgotten. Or not heard in the first place–we were at a noisy restaurant.

Or maybe she didn’t clearly state which person she was speaking of but assumed I’d know.

Anyway, I found myself–three minutes into this story–hoping she’d use his name rather than he/him/his. And, as the story went on, I hesitated to ask because I was embarrassed I didn’t know. I felt dumb for listening and reacting throughout the story when I wasn’t even certain who we were talking about.

Please tell me something similar has happened to you. Tell me that you’ve been in the midst of listening to a story and had some uncertainty about who the story was about because…pronouns. I’m not the only one this has happened to, am I?

Think about this in reference to individuals who are living with short term memory loss. When we use pronouns, we assume the person we are talking to can remember throughout the conversation who “he” or “she” refers to. For those with short term memory loss, this may be a big ask.

What is the purpose of pronouns?

You might be better off asking someone with an advanced degree in language, but I’ll give it a shot.

Pronouns avoid repetition. Instead of repeating a noun, we use pronouns to refer back to it. For example, instead of saying “John went to John’s car because John forgot John’s keys,” we say “John went to his car because he forgot his keys.”

However, pronouns can sometimes create confusion if it’s not clear what or whom they are referring to. For example, in the sentence “Alex told Jordan that they were late,” it’s unclear whether “they” refers to Alex, Jordan, or someone else.

Processing pronouns requires cognitive function to link the pronoun back to the correct noun. This can be taxing for someone with dementia, who may already be struggling with cognitive overload.

And it can lead to misunderstanding.

I remember a situation where a woman with dementia was upset with her family because they told her that her daughter would be coming in the evening. When the daughter didn’t show up, the woman asked where she was.

The family told her that she wasn’t coming….she had never planned to come and no one had mentioned that she was coming. The woman accused her family of lying to her.

“But this morning at breakfast you said she’d be here tonight!” the woman said.

The family realized that they’d had a long conversation over breakfast about a woman who was coming to drop off some quilting supplies. They weren’t sure exactly what time she would be over with her quilting supplies, but they knew she would be there after 5pm and before 8pm. They talked about who would be home when she arrived, and whether or not she would stay long.

She. Her. She. She.

Before this conversation, the woman had been talking to a family member about how her daughter had a new job. She must have thought that the following conversation also referred to her daughter.

This mix-up highlights a common issue for individuals with dementia: the difficulty in tracking conversations that involve pronouns. 

Keeping this in mind–how can we improve communication and minimize misunderstandings?

Whenever possible, use the person’s name instead of pronouns. For example, say “Bill went to the store” instead of “He went to the store.” Reinforce who you are talking about by repeating their name throughout the conversation.

In addition, consider your use of “there” and “here.”

Instead of saying “Go in there,” say “Go in the bathroom.” Instead of saying, “Maya is coming here,” say “Maya is coming over to your house.”

And “it.”

Trying saying, “Please give me the brush,” rather than “Please give it to me.”

While we are talking about communication, it’s not a bad idea to go over some more general tips as well:

–Repeating important details can help reinforce understanding. For example, “We are going to the park at 3 PM. Yes, we will leave for the park at 3.”

–Avoid complex sentences and jargon. Use language that is easy to understand.

–Use yes/no questions or questions with limited choices. For example, “Would you like tea or coffee?” instead of “What would you like to drink?”

–Speaking at a slower pace and enunciating your words can help the person process what you are saying.

–Allow the person extra time to process information and respond. Avoid rushing them.

–If possible, use pictures, gestures, or written notes to support your verbal communication. Visual aids can help clarify your message.

–Sudden changes in topic or context can be confusing. Providing clear transitions and context helps.

–Speaking too quickly can make it hard for the person to process information. Slowing down and pausing between sentences can help.

–Frame statements positively. For example, instead of saying “Don’t forget your coat,” say “Remember to bring your coat.”

— Break down complex tasks into smaller, manageable steps. For example, instead of saying “Get ready for bed,” say “First, brush your teeth. Then, put on your pajamas.”

–Try to have conversations in a quiet, calm environment to reduce background noise and distractions.

–Show that you are listening and engaged by maintaining eye contact and using encouraging body language.

–Periodically ask if the person understands what you are saying. For example, “Does that make sense?”

Communication is fundamental for humans, and its importance is magnified when it comes to individuals with dementia. Effective communication can significantly enhance the quality of life for those living with dementia. Small changes in our communication strategies can decrease anxiety and maximize connection.

And people with dementia deserve that.