Dementia & communication: open, closed, leading questions

Asking questions to people who are suffering from dementia requires a certain expertise. People with a form of dementia, such as Alzheimer’s, are forgetful. Questions can be threatening if one can no longer think of an answer. It helps if the conversation partner consciously chooses an open, closed or suggestive question. In this way, the healthy conversation partner influences the feeling of safety of the person with dementia, regardless of whether this is Alzheimer’s, vascular dementia or Parkinson’s. A skill that is also for non-professionals!

  • Types of questions
  • When do you ask which type of questions to people with dementia?
  • Conclusion

 

Types of questions

Human language has different types of questions: open questions, closed questions, leading questions, rhetorical questions and perhaps more. In a conversation with people with dementia, the first three types of questions are especially important.

Open questions

Open questions are questions to which all possible answers can be given. For example, if someone asks you, What do you like to eat?, he can give you countless answers, as long as it is something edible. “Apple sauce,” he might reply. Or: ‘Simmer steaks’. Or: ‘Nasi goreng’. Just make it up. All those answers are legitimate and correct.

Closed questions

Closed questions are questions to which only a limited number of answers are conceivable. These are answers such as: Yes or No or I don’t know. Or nuances of these answers. For example, an answer like: Maybe not or I think so. An example of this type of question is: Is it Saturday today? Or: Is that girl’s name Manon? Or, sticking with food questions: Do you like dessert after dinner? “Yes, I like dessert after dinner.” “No, I don’t like dessert after dinner.” Or: ‘Sometimes’.

Suggestive questions

Suggestive questions are questions in which the answer to the question is already reflected in the question itself. The tone and choice of words suggest the expected answer. You certainly don’t need applesauce anymore? Or: You used to always go to France on holiday, right? The person asked this question only has to say: Yes, we always went to France on holiday. Although this answer is also conceivable: No, not to France, but to Germany. Or: Child, I really don’t know anymore! Or, “Oh, we went everywhere.” That may indeed be the case, but for people with dementia this can also be a way of not showing that they no longer know.

When do you ask which type of questions to people with dementia?

The answer to this question is not very simple to formulate. Forgetfulness is increasing in people with dementia. And then again: someone’s memory due to Alzheimer’s, for example, can function much better one day than the next. And finally: one person is not the same as the other! But general guidelines can be given. And when to switch from one type of question to another is a matter of careful observation.

When the open questions?

The open questions are in principle the most difficult. It is therefore best to use this if someone is still at the beginning of the dementia process. These people still have quite a lot of memories because the damage to the brain is not yet that serious. So they have quite a few answers ready. They are also still reasonably able to choose from the number of possible answers.

When the closed questions?

The closed questions are more useful if the dementia is in an advanced stage. These people with Alzheimer’s (one of the many diseases that cause dementia) have fewer memories and are often less able to choose. In this phase of the diseases that cause brain damage, people are often more insecure.
They are also more sensitive to what an interlocutor expects from them in response. They may be afraid of giving the wrong answer. What they feel is wrong: the unexpected answer. In general, the person with dementia feels that it is a good answer: the socially desirable answer. That is, the answer that the person asking the question expects from them.

When the leading questions?

They find the suggestive questions useful for people with these types of syndromes, if their dementia is already well advanced. Many memories have already been wiped from their minds. Questions should preferably be safe. Based on the tone of the question and the choice of words of their conversation partner, people with dementia can sense and give the suggested answer.
This makes it necessary for the person asking the question to already know the answer to the question.
You always drink coffee, don’t you?, when you serve someone coffee every day. Or: You had a farm, right?, if you know that the person in question has been a farmer all his life .
However, contact via leading questions may ultimately become too difficult if a person’s dementia is very advanced. For example, he or she suffers from aphasia and has a greatly reduced level of consciousness. Contact is then almost exclusively possible via special techniques.

Conclusion

At the beginning of the dementia process you can still ask open questions. Gradually it becomes necessary to switch to closed questions. Finally, you still have the leading questions at your disposal. When you need to switch from one type of question to another type of question depends on the stage of dementia a person is in. By carefully observing how someone with vascular, frontotemporal or another disease that causes dementia responds to questions, you can recognize when the time is ripe for a switch to a different type of questions.

read more

  • Communicating with people with dementia via the CRDL
  • Reminiscing/retrieving memories in dementia: methodology
  • Reminiscing/reminiscing in dementia: reasons
  • Reminiscence in dementia: stimulate all senses
  • Elderly people with dementia: making contact to communicate
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