Communicating with Participants with Alzheimer’s

How can I communicate better with my patient who has Alzheimer’s?

Learning about Alzheimer’s, how it progresses and how it is managed is critical to understanding how best to interact and communicate with a person who has Alzheimer’s disease. In the process you will learn many tips and strategies for coping with the cognitive and behavioral symptoms of the disease. These symptoms will change as the disease progresses, and you may need to continually adapt strategies in accordance with your loved one’s level of function and symptomatic behaviors.

One successful approach to reducing inappropriate behaviors is to communicate within the affected person’s frame of reference. Consider how your loved one sees the world and interact with respect for that “reality.” It can also be helpful to engage the person in reminiscing about happier times by sharing memories and old photos; interactions that are focused on past times that the person might be able to recall may be less stressful than trying to communicate about current or recent events, which may not be accessible to the person.

What are some tips for communicating better?

Here are some other tips that might be useful in interacting with a person with Alzheimer’s:

• Try to anticipate and address needs or concerns proactively.
• Listen and communicate patiently; try to reduce the frustrations the person may feel from not being able to communicate effectively.
• Use memory cues – verbal, visual, auditory – to help the person stay on track during conversations or day-to-day tasks. For example, place clothes prominently in plain sight, in the order in which they should be put on, or visually guide the person during dressing.
• During the early stages of the disease, write notes to the person to remind him/her to do routine tasks, and provide clear, written directions for accomplishing tasks.

What communication techniques work best?

A number of specific communication techniques have been shown to be effective in reducing problematic behaviors and improving day-to-day functioning of people with Alzheimer’s and other dementias:

• Reality therapy: Interact with the afflicted person within his or her own frame of reference for the world, even if it has little to do with reality.
• Validation therapy: Don’t correct or contradict the person’s view of reality; rather, encourage and validate it by really listening and asking questions.
• Redirection: Be creative in redirecting conversation without contradicting or denying the person’s statements. Use any opportunity possible to try to elicit fond memories or remind the person of tasks or appointments.
• Memory cueing: Use words and visuals to cue old or recent memories. For example, play videotapes of family events; place reminder notes in plain view; color code or number things in the order they should be done.

How do I deal with aggressive behavior?

In later stages of Alzheimer’s, aggressive or agitated behaviors may become common and may make it increasingly difficult to care for a loved one at home. Though generally viewed as symptoms of the disease itself, some experts believe that such behaviors may in part be reactions to the actions of people around them. For example, talking too loudly or too fast or contradicting the afflicted person’s perceived reality might cause agitation. A growing body of research is showing how certain techniques for communicating and interacting with a person who has Alzheimer’s can help reduce disruptive behaviors.

If your loved one is agitated or disruptive, examine how your own actions may be influencing that person’s behavior. Try to determine if something you have done (or have not done) might be triggering an agitated response and change that behavior in subsequent situations. Certain social situations, such as a holiday reunion of family with noise, kids, pets, etc., may trigger agitation. In such instances, it may be helpful to remove the person to a quiet area away from large groups of people until they calm down.

Source: Alzinfo.org

Alzheimer’s and dementia: Tips for better communication

Rethinking your listening and speaking strategies can help you communicate with a person who has dementia.

By Mayo Clinic Staff

Communicating with someone who has Alzheimer’s disease or a related dementia can be challenging.

A family member or friend with dementia may have difficulty understanding you, and you may have a hard time understanding what he or she is trying to communicate. There’s potential for misunderstanding, confusion or frustration in both directions — making communication even more difficult.

You’ll need patience, good listening skills and new strategies. Here’s help easing your frustration and improving your communication.

What to expect

A person with dementia may have difficulty remembering words or communicating clearly. You might notice patterns in conversations, including:

• Having trouble with finding the right word
• Substituting words
• Describing an object rather than naming it
• Repeating words, stories or questions
• Mixing unrelated ideas or phrases together
• Losing a train of thought
• Speaking less often
• Reverting to a first language

What you can do to help

To improve understanding in both directions:

• Be patient. Take time to listen and allow time for the person with dementia to talk without interruption.
• Learn to interpret. Try to understand what is being said based on the context. If the person is struggling to get an idea out, offer a guess.
• Be connected. Make eye contact while communicating and call the person by name. Hold hands while talking.
• Be aware of your nonverbal cues. Speak calmly. Keep your body language relaxed.
• Offer comfort. If a person with dementia is having trouble communicating, let him or her know it’s OK and provide gentle encouragement.
• Show respect. Avoid baby talk and diminutive phrases, such as “good girl.” Don’t talk about the person as if he or she weren’t there.
• Avoid distractions. Limit visual distractions and background noise, such as a TV or radio, that can make it difficult to hear, listen attentively or concentrate.
• Keep it simple. Use short sentences. As the disease progresses, ask questions that require a yes or no answer. Break down requests into single steps.
• Offer choices. Offer choices when making a request for something a person might resist. For example, if someone is reluctant to shower, you might say, “Would you like to take a shower before dinner or after dinner?”
• Use visual cues. Sometimes gestures or other visual cues promote better understanding than words alone. Rather than asking if the person needs to use the toilet, for example, take him or her to the toilet and point to it.
• Avoid criticizing, correcting and arguing. Don’t correct mistakes. Avoid arguing when the person says something you disagree with.
• Take breaks. If you’re frustrated, take a timeout.

The challenges of communication evolve as the disease progresses. You will likely find that nonverbal communication with your family member or friend — such as touch or the comforting sound of your voice — will become not only important but also meaningful.

Source: Mayo clinic

Communicating with those with Dementia

Stage-dependent Goals

Caregivers need to communicate differently with those with dementia at different stages of the disease. As the disease progresses, more skill is required to convey messages and establish mutual understanding. It is important to remain flexible and aware of how effective different techniques are in different situations. As dementia progresses from early to late stages, communication strategies, goals, and expectations need to change.

In the early stages, the goals of communication are to:

1. Maintain as near to normal communication and interactions as possible.
2. Keep the person socially engaged.

In some ways, these are relatively easy goals to achieve, because the main communication problem involves word finding.

In the middle stages, the goals of communication are to:

1. Maintain a shared pattern of communication through turn-taking and other social forms.
2. Maintain a two-way flow of communication.

In the late stages, the goal of communication is to maintain communication by emphasizing non-verbal techniques.

Communication Strategies

Research on the best ways to communicate with care recipients who have dementia have identified four strategies that are effective:

1. Show respect
2. Decrease environmental stress
3. Empathy and validation
4. Focused communication

These four strategies build on each other and are best used in combination.

Show respect

The first way to show respect is to address the care recipient by her/his preferred name.  The second way of showing respect is to use good manners such as saying “please” and “thank you.” The third way of showing respect is to invite the care recipient to participate in something rather than telling or demanding them to do it.  The fourth way of showing respect is to give priority to the care recipient’s agenda over yours. Attend first to what the care recipient wants or needs before you attend to what you want.

Decrease environmental stress

Those with dementia can react very negatively to stress. For a person with dementia, even a small amount of stress can produce what is known of as a catastrophic reaction (serious emotional reactions characterized by emotional outbursts, agitation, and sometimes physical aggression).

The best strategies for decreasing environmental stress include:

1. Reducing noise and distractions.
2. Maintaining consistent routines and rituals such as mealtime and bedtime.
3. Decreasing the “hustle, bustle, and rush” around the person.
4. Use calm voice tones and slow movements.
5. Giving the person with dementia time to comprehend and respond.

Empathy and validation

The goal of this strategy is to affirm the feelings behind the message that the person with dementia is sending rather than focusing on the content of the message. The task for the caregiver is to carefully observe the emotions, behaviors, and environment of the care recipient, and then reflect back what the caregiver believes is going on.

Strategies for showing empathy and validation include:

1. Rephrasing what you observe (e.g. “You look thirsty”).
2. Asking questions about who, what, when and how.
3. Mirroring the care recipient’s words back to acknowledge that you are listening.
4. Matching with words the emotional expressions that the care recipient displays (e.g. “You look worried”).
5. Reinforcing the behaviors using smiles and gentle touch.
6. Reminiscing about memories to distract the care recipient to reduce her/his distress.

Communication Don’ts

1. Avoid pointing out errors. There is generally no need or benefit to correcting errors made by the care recipient. Pointing out errors may cause distress and agitation.
2. Avoid arguing. Arguing won’t improve the care recipient’s ability to remember. It will only make the situation worse.
3. Never invalidate emotions. Affirming the care recipient’s feelings is important.
4. Don’t criticize, scold, or embarrass the care recipient.
5. No matter how busy you are, never rush the care recipient.
6. Never force the person to do something s/he doesn’t want to do.

Communication Do’s

1. Face the care recipient directly, maintain eye contact while communicating, and attract her/his attention before beginning.
2. Be at the care recipient’s eye level. If the person is standing, you should be standing, and if the person is sitting, you need to be sitting.
3. Orient the care recipient frequently. Provide frequent cues about who, what, when, where, and why.
4. Provide continuity by continuing on the same topic without changing focus too often. If the topic is going to change, provide orientation.
5. Try to help the care recipient find the words that s/he may be “stuck” on trying to remember.
6. Simplify your instructions to only one or two topics. Keep sentences short, simple and direct. Repeat nouns rather than using pronouns.
7. Try to ask easy questions. If there are choices, limit the number of choices to two if possible.
8. Use pleasant facial expressions and tone of voice, pictures, hand signals, and pantomime to convey your message.
9. Give the care recipient time to respond. Offer clues about how the person can answer the question if necessary.
10. Remember that good communication is a two-way exchange. If the care recipient is having difficulty holding up her/his part of the conversation, try to help her/him to participate.

Source: Communicating with those with Dementia – Alzheimer’s Research and Resource Foundation (ARARF)