Communicating with Alzheimer's

Communicating With the Person With Alzheimer's

Never stop communicating. As Alzheimer's disease progresses it slowly erodes the ability to communicate verbally. One of the classic symptoms of Alzheimer's is the difficulty of 'finding the right word' during conversation. Another is the impairment in structuring a logically sequenced sentence. These impairments are frustrating, as you can imagine, and likely have seen, but don't stop trying. Even more frustrating for the person with Alzheimer's than the difficulty he is experiencing making his thoughts known to you is the thought that you have given up trying, or don't want to communicate with him.

Be Sincere. Like children, people with Alzheimer's have a way of knowing intuitively whether or not someone is being honest with them. They will often demand honesty from you, verbally or otherwise, and this can easily be interpreted by caregivers and family members as agitation. This honesty does not require that you always be completely truthful and factual. This honesty is emotional sincerity, communicating in the moment.

Bernice was enjoying looking through her book of Fifties Sears Fashions, showing Holly the dresses she had ordered, and even the ones she had designed. (Bernice did work for Sears in the sixties giving sewing seminars to women all over the country.) Suddenly, she looked at Holly, and with a real concern said, "I haven't seen my mother today!" Holly simply said, "I'm sure she's alright." Bernice went back to her catalog, a potential mini-crisis averted."

This happened about the time that Bernice was entering the later stages of Alzheimer's, and does not so much illustrate sincerity as it does judgment. Total honesty would require Holly to tell Bernice that her mother was dead. No matter how she said it, "Your mother died a long time ago, Bernice," or "Your mother is dead, Bernice, you know that," would have upset Bernice and caused her to repeat a mourning process that she suffered many years ago. Unnecessarily. And the whole process would be repeated the next time she asked about her mother.

Maintain Eye Contact. It is also important to make and maintain eye contact when talking with anyone who has Alzheimer's disease. It shows that you are paying attention and makes it easier for him to understand what you are saying, or at least what you are meaning. The lack of this very intimate connection indicates to him that you are not truly interested in him as a person, not interested in what he is saying to you. Eye contact also assures him that you are being truthful.

Keep a Sense of Humor. Laughter may not always be the best medicine, as the adage suggests, but it is a very effective one, and the side effects are all good. A person retains her sense of humor after dementia has robbed her of many memories and other cognitive abilities. The limbic system is responsible for emotional memories, and this part of the brain remains relatively functional when other cognitive abilities are impaired by Alzheimer's. Be careful never to make a person with dementia the butt of a practical joke, and keep the level of humor appropriate to their stage. Political humor, for example, will not work well, but humorous mime likely will.

Use Touch to Reinforce Communication. This can be as simple as holding ones hand or lightly touching the forehead with a comforting gesture. It might be a backrub or involve lightly massaging the hands or feet. There is not a lot of clinical research about the effects of massage and touch on people with Alzheimer's disease and other forms of dementia, but practitioners report many benefits. The following is from Massage and Alzheimer's Disease: What would Maslow say?, an article by Ann Catlin, LMT, NCTMB, OTR:

As a licensed massage therapist and Compassionate Touch practitioner, I have witnessed the transformation that can occur when intentional touch is offered, enhancing quality of life of individuals living with Alzheimer's disease.
For example:

• The woman, withdrawn and thought to be non-verbal, who looked me in the eye and said "thank you" following a hand massage.
• The gentleman whose agitation was calmed with a simple back rub allowing the nurse's assistant to help him get dressed without the usual struggle.
• The activities director who said to me, "She has been here for several months, but when I gave her a hand massage, I felt like I really got to know her for the first time!"

So what is at the heart of these seemingly magical moments? There is clearly something profound happening that goes well beyond simple touch. We can explore the relationship between human needs and well-being to gain a greater understanding of how deep our touch truly goes.

Add scented oil or lotion to a massage and get the additional benefit of aromatherapy.

Avoid or Eliminate Background Noise and other Distractions

Don't Be Argumentative

Stay in the Moment. As simple as this sounds, it may be the most difficult of the suggestions on this page, and maybe the most important to remember and practice. It is frustrating to someone who is asked about something in the past if they have no memory of the event. To ask that person about his plans for tomorrow when he has lost the concept of future is likewise frustrating. As Alzheimer's disease progresses, a person lives more and more in the present, and it is here that you will effectively communicate with him or with her.

A situation that we commonly see when we visit in Alzheimer's communities is the well-meaning family member who comes to visit and tries to get a conversation going with a question like, "So what did you have for lunch, dad?" Very often, dad doesn't remember what he had for lunch, or even that he had lunch. To make matters worse, son or daughter will likely pursue the matter, sure that with enough prompting, dad will eventually recall what it was that he ate a few hours before, and the visit can continue normally. He probably won't, but he might pretend that he does.

There are probably many reasons for this pattern. "What did you have for lunch?", "Did you have any visitors this week?", " Did you get the flowers that Jeff sent you yesterday?", and, "Did you enjoy the movie last night?" are questions that we are comfortable with. They are common conversation starters, questions we might ask anyone to "break the ice" or as conversational transitions.

Equally non-productive are conversations that require a person with Alzheimer's disease to project into the future: "Are you going to watch the movie tonight?", or.... The inability to plan and to think about future events is a symptom that is common in the mid-stages of progressive cognitive disorders. Unfortunately, looking forward conversationally to events that we are planning is another pattern that we are all comfortable with.

Eliminating the future and the recent past as topics of conversation and as places to "be" with our loved one should not leave us with nothing to do, nothing to say. There is the present. This is where and when the person with a cognitive disorder spends most of his time, the place and time in which experts recommend you communicate from. Learn to be with your loved on in the now, and appropriate conversation will follow. a place that many of us are not totally at ease with. The best way to get there is by engaging in something that is both interesting and meaningful. Bring an activity that your loved one will find interesting. Doing puts us firmly in the now.

Nancy Pearce, in her book, Inside Alzheimer's, demonstrates what it is to be in the present and connect with someone with dementia. A social worker who has worked with people with dementia for more than 20 years, Nancy has filled her book with her personal experiences that illustrate how she successfully communicates with those affected by Alzheimer's disease.

Use reminiscence to reinforce a sense of identity and self-worth. This may seem to contradict the previous point, but reminiscing takes place in the present. The feelings and emotions that are conjured by remembering things past are being re-experienced now, as is the communication that is guiding and responding to the reminiscences. Read more about reminiscing and reminiscence therapy....