Communication Challenges

Needs of Persons with Alzheimer’s Disease (AD)

The primary goal for the caregiver is to find ways to meet these needs throughout the course of the disease.

  • To feel connected
  • To feel respected
  • To be appreciated
  • To feel loved
  • To be known
  • To be understood
  • To experience belonging
  • To share, give, love
  • To be helpful, useful
  • To feel safe

Feelings Associated with Alzheimer’s Disease and the Goal of Person-Centered Care

The person with Alzheimer’s disease shares all the same emotions and feelings as a person without cognitive impairment.  The goal of person-centered care is to move the person from the feelings listed below in the left-hand column to the ones listed in the right-hand column.  The shift may be only momentary, but person-centered care suggests that if we can link these moments together, then challenging behaviors will be reduced and the quality of life improved for the person with Alzheimer’s disease.

Loss Fulfillment
Loneliness Connectedness
Sadness Cheerfulness
Confusion Orientation
Worry / Anxiety Contentment
Frustration Peacefulness
Fear Security
Paranoia Trust
Anger Calm
Embarrassment Confidence

Key Elements of Communication

  • Communication:   Process by which information and feelings are exchanged among individuals through common symbols, signs, or behaviors.
  • Verbal communication:   Involves a complex feedback loop of organizing, sending, receiving, decoding, and responding to messages.  (We take complexity for granted.)
  • Non-verbal communication:   Consists of cues, gestures, and body language.  Only 7% of message is attributed to words used, the rest is through non-verbal messages we send.

Persons with dementia retain non-verbal communication skills long into the disease, much longer than verbal, so body language (of both the person with dementia and the caregiver) becomes very important and the primary mode of communication.

Non-Verbal Communication

As people with AD lose their cognitive abilities, they experience the world through their senses:

  • Touching (e.g., back rub, hand/foot rub, grooming activities, etc.)
  • Music (make sure it’s the kind of music they enjoy!)
  • Walks, sitting together, sharing meal
  • Use your voice to soothe (e.g., read to them, affirmations)
  • Create pleasant, reminiscent aromas (can use them as cues, e.g., bath oils for bathing, fresh coffee brewing at breakfast time)
  • Use multi-sensory cueing (e.g., ask them if they would like coffee while pouring it, so they can both see and smell it)
  • Pets
  • Muted decor, e.g., carpets, drapes, avoid busy patterns, minimize glare from windows/lights, even lighting
  • Spiritual connections (e.g., favorite prayers or Bible verses, hymns, rituals, incense, etc.)
  • Keep familiar, beloved items in visual field. Also remember familiar, beloved sounds, smells.
  • Use contrasting colors to items to be used (e.g., plate against place mat, colored toilet seat)
  • Ask for their help with a task
  • Limit distractions. Reduce clutter, confusion, noise (e.g., TV too loud, glare from lighting, too many people, spaces too big or small, mirrors)
  • Keep room temperature comfortable (AD persons generally run very cold)

 

“Do’s and Don’ts” for Communicating with the Memory Impaired

Do…

  • Listen
  • Use short, simple sentences and familiar words
  • Give directions, one step at a time
  • Be patient; expect repetition (e.g., the same question, over and over)
  • Help them fill in the blanks
  • Read their facial expressions and body language (even over words) and respond accordingly
  • Ask for their opinion
  • Watch your own body language; keep it calm, positive and reassuring (the person will tend to mirror your mood)
  • Give them praise, love, and lots of reassurance
  • Let them help, even if they don’t do the job “quite right” – fix it later
  • Respect and use their “best” time of day — for making decisions, plans, and doing activities
  • Stick to as consistent a routine as possible  (do the same things at the same time of day)
  • Keep your sense of humor and laugh with them
  • Keep the environment as calm and unchanging as possible, without too many distractions (e.g., TV, radio, etc. at the same time)
  • Let the person make as many decisions as they still can (unless that decision jeopardizes their own safety or someone else’s safety)

 

Don’t…

  • Correct or argue (even when you know they are wrong!)
  • Expect perfection
  • Speak for them
  • Do things for them that they can still do for themselves
  • Use long, logical explanations
  • Remind a person that they forget (e.g., “Don’t you remember we talked about this yesterday?”…)
  • Talk down to a person or treat them like a child
  • Talk about a person in his or her presence as if they are not there (e.g., “Yesterday he couldn’t remember our address.”…)
  • Ask questions of the person that requires remembering facts
  • Try to explain or prepare too far in advance
  • Rush or hurry them
  • Give too many choices
  • Try to teach the person new things
  • Take negative comments they might make personally; it’s the disease talking (e.g., “You’re stealing from me!”)
  • Give the person orders, demands (e.g., “Don’t do that!”)
  • Refuse help from others!

11 Golden Rules for Communicating with the Memory Impaired

  1. A smile is worth a thousand words. (People with dementia will mimic our mood and body language more than our words.)
  2. Respond not so much to what they are saying but the way they are saying it (their emotions).
  3. The goal of care-giving is to promote positive emotions.
  4. It’s okay to tell “therapeutic fibs” to promote positive emotions.
  5. Build on what’s left, not on what’s lost.
  6. Helping does not mean taking over.
  7. You can’t change their behavior or reaction, so change yours.
  8. They can’t resist, if you don’t insist.
  9. They can’t remember your reassurances; keep repeating them.
  10. Don’t try to bring the person with dementia into your reality; it’s a losing battle. Instead, be with them in their reality.
  11. Let go of power struggles; people with Alzheimer’s disease are always right! (Once Alzheimer’s is diagnosed, the person is excused 100% of the time.)