Use the Prompting Technique With Loved Ones With Dementia

About Juliet Holt Klinger

Senior Director of Dementia Care

Juliet is a passionate advocate for people living with dementia and their families. She is deeply committed to improving the cultural acceptance of those with cognitive differences. As our gerontologist and Senior Director of Dementia Care, Juliet develops person-centered care and programming for Brookdale’s dementia care communities. But if you ask her, Juliet says she continues to learn every day from the true experts, those living with dementia and their care partners. Juliet believes we need to move beyond the concept of caregiving, which implies a one-sided relationship, and embrace the idea of care partnering. Care partnering is about relationships built on cooperation—a two-way street promoting person-centered care and mutual feelings of purpose, where the person living with dementia also plays a strong role in shaping their care and daily routine. We are here to partner, learn and grow with our residents and families to make aging a better experience. After volunteering in nursing homes in high school, Juliet knew she wanted to work with older adults. While working on her bachelor’s degree in social work at the University of Iowa, she completed an Aging Studies Certificate program, before there were formal gerontology programs available. At Iowa, Juliet also had the chance to study with pioneers in the field of dementia care, an opportunity that shaped her passion for caring for those living with dementia. Trained as a gerontologist, with a master’s degree from the University of Northern Colorado, Juliet joined Brookdale in 2004. She is a seasoned senior living executive with more than 30 years of experience designing and executing innovative Alzheimer's and dementia care programs and living environments in both assisted living and skilled settings.

Caregiving at home for a person living with dementia evokes many emotions, and there’s no question that frustration is one of them. I know sometimes it may seem as if your loved one is refusing to perform simple actions in order to provoke you, but that is not the case. As a human being, feeling irritated in response to a challenging task is a normal reaction and not one to feel guilty about—for either of you. However, expressing this annoyance as the caregiver, even if only through body language, can make the situation worse. It is important when frustration arises that we resist the urge to take over and remember to do with and not for. This can go a long way to preserve abilities and a spirit of cooperation.

So, how can we support a person without completely taking over? I encourage you to use a technique known as prompting, which can truly help foster a more successful partnership. It can help you and your loved one communicate better and work together more smoothly. It also motivates the person living with dementia to remain involved in everything to their highest ability.

Prompting refers to giving a verbal, physical, or gesture cue to indicate what the person with dementia is expected to do next. This process taps into familiar movements that are stored in long-term memory, which often remain well into the disease’s progression.

Here are a few types of prompting:

Transition: Use transition prompts during every interaction with your loved one to alert him or her that something is happening. Make eye contact and use positive body language while making a simple statement that indicates what is coming next. An example would be saying, “Good morning, dear; you must be hungry” before accompanying your loved one to the kitchen table for breakfast.
Verbal: Verbal prompts consist of giving step-by-step directions. Again, use a cheerful manner and a helpful, respectful tone to say something such as “Use the spoon to stir your coffee.” Verbal prompts should be short and simple.
Gestures: Gesture prompting is pointing to an object or touching your loved one to indicate where you want them to take action. Perhaps both of you have gone outside to check the mailbox. You can point to it or touch his or her hand to suggest opening it.
Demonstration: Demonstration prompts involve showing or mimicking the action you’d like your loved one to accomplish. If you serve a glass of iced tea and wish to encourage them to drink it, bring an imaginary glass to your own lips as a signal.
Hand-over-hand: Here, you place your hand over that of your loved one to guide the desired action from beginning to end. After repeating it several times, let go to see if they can continue on their own.
Hand-under-hand: Providing more assistance than hand-over-hand, this technique consists of hooking your thumb under your loved one’s to take them through the physical action of the task, while you are the one actually doing it. It helps them maintain awareness and involvement in the action. It helps to start this prompt with a simple handshake and then swivel your hand around until you have accomplished the thumb grasp. This is the ideal physical prompt as it allows your loved one to have more control and you can affect both gross and fine motor movements.

People living with dementia can experience fluctuations in ability on a daily basis, and even from one time of day to the next. This is especially true for those living with Lewy Body dementia. If your loved one couldn’t do something this morning, it doesn’t mean they can’t this afternoon or ever again. Be careful to just use the amount of prompts and cues needed, rather than over-assisting, which can take away your loved one’s sense of control and eventually, even their abilities. The phrase “use it or lose it” is on target here – if we don’t encourage people with dementia to do things at their highest capacity, they may soon be unable to do it at all.