DEMENTIA - Communication Tips
This is how I Feel!!
Communication Tips directly from Individuals with Early Memory Loss
* Speak with a smile, so I know that you care
* If you are tense, remember I feel your tension too
* A smile takes away tension and helps put me at ease
* Use language I understand – keep it simple, no jargon or slang
* Slow down your speech
* Keep it short and to the point, one idea at a time
* Be clear and concise
* Let me take the time to think through what you said to me
* Remember it takes time to think through the meaning of words
* Let me set the pace of the conversation
* Let me be the leader in the conversation – give me charge of the conversation
* Make sure you have my attention
* Pause once you say your thoughts
* Pause so I can say my thoughts
* Give me time to find the words and to say my thoughts
* Take turns during a conversation
* Let me finish what I am trying to say, it takes a little longer & sometimes it takes a lot longer
* Take the time to help me get my thoughts out, ask me questions to help find the words
* Please repeat information if I ask
* Make sure I hear you, ask if I understand what you have said
* Tone of voice – adjust it up or down. Louder is NOT always better
* Ask me if I can hear you
* Face me when you talk, eye contact helps to get my complete attention
* Rephrase information if I’m having trouble understanding
* Please, don’t interrupt me
* Please be patient.
Tips for Communicating with a Person with Alzheimer’s Disease or Other Memory Loss Problems
Families and other care partners often discover communication problems as Alzheimer’s disease progresses. As with anything else in life, people learn new ways to compensate for those losses.
Initially, it may not seem like the person with Alzheimer’s disease is experiencing communication difficulties. Common things, like daily routines, may be remembered enough to talk about until the middle phase of the illness. In some instances, the ability to chat or make small talk will diminish, or may be all that a person can do
Changes in the brain make selecting appropriate words, matching objects to their use, or following the simplest of instructions difficult. Changes in language ability can cause withdrawal from social situations because the person becomes self-conscious of those losses. This can be a frustrating time for families because the medical information they get does not always address these common changes in communication.
Some caregivers create new patterns of communication easily. Other families need more practice. Remember, we still need communication as the bond that holds us together. We just need to change the way we mix the cement!
When a person with Alzheimer’s disease is having difficulty expressing themselves and understanding others they may:
* Have difficulty finding the right words
* Use familiar words repeatedly
* Invent new words to describe familiar objects
* Frequently lose their train of thought
* Experience difficulty organizing words logically
* Revert to speaking in a native language
* Curse or use offensive words
* Speak less often
* Rely on nonverbal gestures
When having a conversation…
* Do not startle by approaching from behind. Begin conversations by identifying yourself, calling the person by name and orienting them to the situation. Stand in front or in the direct line of vision of the person Alzheimer’s. Touch an arm or shoulder gently to get or keep attention. Show your interest by sustaining eye contact throughout the conversation.
* Avoid questions whenever possible. Not knowing the answers embarrasses the person. It may be helpful to cue the person with the necessary information such as supplying a name or a place. When you do use questions, ask one question at a time and use only those that call for a yes or no answer whenever possible. Do not offer choices that make decisions difficult, or that are not acceptable to you.
* Tone of voice and facial expressions (non-verbal communications) are just as important as the actual words you use when communicating with a person with dementia. Use a normal tone of
voice in a calm manner. Do not express excitement with your voice.
* Speak slowly and simply. Do not expect a quick response. Present only one idea at a time. Use short sentences, giving simple messages and use direct statements to initiate actions, “Let’s get dressed now.” Give the person time to process the information. Discuss only concrete actions and objects because the person cannot relate to abstract concepts and avoid using pronouns and identify people by their names.
* If it is necessary to repeat statements, use the same words. Do not rephrase sentences or use different words. You may wish to ask the person to repeat what you have said. This may help the person understand. Be prepared to repeat yourself time and again until your loved one understands what you are saying.
* Use gestures and visual cues or aides to clarify your message. Try using more than one of the senses to communicate, such as touching as well as talking. Do not use gestures which threaten the person.
* Be aware of your own behavior. Try to remain calm and gentle, and avoid showing signs of frustration and anger. Persons with dementia often mirror the behavior they see modeled. If they show anger or hostility toward you, try not to take it personally. Don’t argue. If the person says something you don’t agree with, let it be.
* Encourage the person to continue to express thoughts even if he or she is having difficulty. Encourage non-verbal communication as well. Be careful not to interrupt.
* Communicate with the person as much as possible, although a constant stream of conversation is neither helpful nor necessary.
Be patient and supportive. Let the individual know that you’re listening and trying to understand what is being said.
Avoid criticizing, correcting, and arguing. Avoid using negative statements and quizzing (i.e., “You know who that is, don’t you?”)
Don’t talk about the person as if he or she wasn’t there.
Have patience, flexibility, and understanding. Give the person time, let them think about and describe what is wanted.
Validate the emotions the person feels. The person you care for may express frustration over communication problems. Let her know that you understand and will be there to help.
Don’t place unreasonable demands on the person. Don’t expect them to perform lost skills. Instead encourage activities that the residents can still perform and enjoy, (i.e. Walking, listening to music, looking at photos etc.) Do not assume that the person can understand and act on messages, either written or verbal. You will need to observe him/her to know. Try to be aware of the changing abilities and inabilities of the individual.
Be aware that the person with Alzheimer’s has lost the ability to keep track of time. This may cause anxiety and frustration. A person may feel deserted when only a few minutes have elapsed. Reassure as much as possible.
Remember that for those with dementia their world can be confusing and frightening.
Coping Strategies to Respond to Lost Abilities:
* Use song lyrics or prayer verses to communicate since these are easier to remember and understand.
* Reminiscence about the previous good times to give your loved on something to talk about that he/she will remember.
* Use touch and music to substitute when conversation is too difficult to carry.
* Understand that the person with Alzheimer’s may say one word and mean another. Listen and try to find the meaning in what is being said. You may have to guess at the correct meaning. Try to clarify your guess with the person. You could be wrong. Focus on feelings, not facts. Tone of voice and actions may help you understand how the individual is really feeling. Limit distractions. Find a place that is quiet.
* Use objects to help the person understand what you are telling them (i.e. Bring their jacket if you are suggesting that you take a walk).
* Simplify complex tasks by breaking them into manageable steps. Encourage the person to take one step at a time, and talk through each step (i.e. Brushing teeth involves many steps, take one at a time).
* Help the person get adequate exercise.
* Write things down. Sometimes a visual aide is helpful.
* In many cases you will have to work around the behavior because you will not be able to change it.
Other Communication Tips to Keep in Mind:
* If the person starts to walk away while you are talking, don’t try to stop them right away. Move along with them and keep talking. If you are met with resistance, it may be best to stop and try
* Avoid situations which bring about frustration and anger. Try to anticipate problems and prevent them from happening.
* Encourage persons to participate in activities which are adult and provide pleasure to them. Be aware though, that they may have short attention spans. Find out what activities they have enjoyed in the past and may continue to be rewarding.
* Remember that the person may have lost the ability to judge between safe and unsafe conditions. Evaluate each situation and do not let the person be in a potentially dangerous position.
When Avoiding a Direct Answer is Necessary:
What can the adult child or spouse do when the person with dementia asks, “Where are my parents?” (When their parents are deceased), “Why can’t I go home?” (Perhaps meaning a childhood home), “Where are my car keys?” (When they no longer drive). There is no perfect response but there is a creative communication technique that can work well when any of these questions arise. It is called “therapeutic fibbing.” If we dissect the term, Webster tells us that therapeutic means, “having or exhibiting healing powers” and fibbing is describes as, “an insignificant lie.” Believe it or not, these contradictory terms promote a very effective communications tool when encountering persons with dementia.
Learn to Live in THEIR world!
Validate their feelings always!
Always ask yourself “Does this REALLY matter?”
Fact Sheets from the Alzheimer’s Association
Dementia Training Manual - Sarah Jones SCSU
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