Since communication is vital to quality of life, we who care for those with Alzheimer’s or other diseases that make understanding language difficult need to learn unique methods of coping with the challenge. It’s not easy. When your wife thinks you are her brother, when your dad thinks his best friend is robbing him, when your 75-year-old mom insists that her baby is in danger - it will be your challenge to try to find words or actions that will calm your loved one and redirect his or her thinking.
Conversely, when your loved one is trying to tell you that he or she wants coffee but is saying the word "bread," you will be faced with the challenge of trying to understand what is desired. For example, I vividly recall a time when my uncle insisted that I fix his magazines. I straightened the pile of magazines on his bedside table, thinking this was what he wanted. However, he grew more and more agitated as he repeated - with increasing volume - fix my magazines After much stress on both sides, with me pointing to or touching nearly everything on that side of his room, I picked up his razor. "Yes!" he said. "My magazines!" His razor was broken and he wanted me to get it fixed. Can you imagine his stress? It’s heartbreaking.
We’ve established that communicating with someone who has dementia is not easy. Still, there are steps we can take to help smooth the way. Here are a few suggestions:
- Say your name. Even if you are speaking to your husband, he may not remember who you are. If, upon entering his room, you say, "Hi Hon. It’s Mary," he may be less confused.
- Enunciate well. Speak clearly and slowly enough so that the damaged brain of the person with AD has a better chance to pick up on words that he or she may remember. Don’t exaggerate to the point where your speech isn’t natural, just speak clearly.
- Maintain eye contact and try to just focus on the person. People with dementia can become easily agitated, so staying calm, maintaining eye contact and even gently touching his or her arm while speaking may help the person concentrate. It also reassures the person that you are trying to communicate a thought to them or understand what they are saying.
- Use simple words and short sentences. If you are giving directions or advice, take it step by step. You can say, "Let’s walk over here." Then say, "Let’s put this book on the table."
- An elder with dementia is not a baby and shouldn’t be addressed in phrases that are disrespectful of his or her adult status.
- Don’t talk about the person with a third party as if he or she were not there. If you must communicate to a third party about the person, try to do so in another setting. There are times, of course, when this isn’t possible, such as in some situations when two people must provide a care procedure. However, for the most part, we should try not to talk about them as if they aren’t there. We need to be cognizant of the fact that we don’t know how much someone with dementia will understand, so assume that he or she knows what is being said.
- If the person is trying to tell you something, try not to hurry him or her. Criticizing, correcting or ignoring the person because of impatience just makes the situation worse.
- Visual cues can help. Pictures of people or objects, or gestures suggesting that they sit down on a chair or walk through a door can be more effective than words.
- Don’t argue. Your loved one’s world is as real to him or her as yours is to you. Don’t argue about right and wrong. Just accept what is being said and ask your loved one to tell you about the problem. Arguing will just upset the person bringing on anger and agitation. If necessary, try to distract the person from obsessive thoughts.
- Stay calm. Keep your voice kind and at a friendly pitch, keep your body language smooth and welcoming, keep your touch soft and non-threatening. If you cannot maintain this kind of calm demeanor, try to leave the room for a moment to take some deep breaths and adjust your attitude, or if your stress is severe, ask someone else to take over when possible.
- Watch your loved one’s body language for cues that pain is present. If the person can’t verbally communicate pain, it’s up to the caregiver to watch for signs that the person is experiencing physical distress.
To practice, try to place yourself in the position of someone who can’t communicate the most basic needs or understand what the caregiver is saying. A good exercise may be to view a film in a foreign language, without subtitles, and pretend that it’s vital that you understand what is being said and that you make these people understand what you need. If you can suspend reality for just a short time and watch this film as if you life depended on unscrambling the "code" that is being spoken, you may have a better feel for how frustrating it is to have dementia. An exercise like this isn’t perfect, but it’s a start. Anything we do to try to understand what our loved ones are experiencing will be helpful.
Mayo Clinic Staff. Alzheimer’s: Tips for effective communication. Retrieved from http://www.mayoclinic.com/health/alzheimers/AZ00004/?utm_source=newsletter&utm_medium=email&utm_campaign=alzheimers-caregiving&pubDate=06/13/2013
Carol Bradley Bursack is a veteran family caregiver who spent more than two decades caring for a total of seven elders. She is a newspaper columnist and the author of Minding Our Elders: Caregivers Share Their Personal Stories. Bradley Bursack is also a contributor to several books on caregiving and dementia, and is passionate about preserving the dignity of elders. Her website is www.mindingourelders.com. Follow Carol on Twitter @mindingourelder and on Facebook at Minding Our Elders.