Alzheimer’s- Communication is Not Just Speaking
Communication refers to the ability to speak, understand speech, read, write, and gesture. It is how we make contact with each other. Nonverbal messages are given through silence, body movements, or facial expression. As much as 90 percent of our communication is nonverbal. Be aware that words can carry one message and the body another; people with Alzherimer’s disease (AD) seem to be especially sensitive to the tone or feeling of your communication and that is what they will react to. Communication problems get progressively worse over the course of the illness, until verbal communication becomes virtually impossible.
How to Be Understood
Tips for better communication—
- Keep good eye contact.
- Don’t interrupt or distract the person while he is talking.
- Avoid criticizing, correcting and arguing.
- Focus on the feelings, not the facts. Sometimes the emotions being expressed are more important than what is being said. Look for the feelings behind the words.
- Approach from the front and introduce yourself.
- Call the person by name. It helps orient the person and gets her attention.
- Use short, simple words and sentences. Talk slowly and clearly.
- Ask one question at a time. Give simple short explanations.
- Patiently wait for a response. A person may need extra time to process your request.
- Repeat information and questions. If the person doesn’t respond, wait a moment. Then ask again. Perhaps if you rephrase and use other words, the person will understand better.
- Avoid quizzing. Reminiscing can be healthy, but avoid asking, “Do you remember when…?” Stay away from saying things like, “You should know who that is…”
- Break down tasks and instructions into clear, simple steps. Give one step at a time,
- Avoid confusing expressions. If you ask the person to “Hop in!” He or she may take that as a literal instruction. Describe the action directly to prevent confusion. “Please come here. Your shower is ready.”
- Turn negatives into positives. Instead of saying, “Don’t go there,” try saying, “Lets go to the dining room.”
- Give visual cues. To help demonstrate the task, while asking him to do the task, point to or touch the item you want the person to use. Or, begin the task for the person.
Helping the Person Communicate in the Stages of Alzheimer’s Disease
The most important thing to remember is to treat the person with dignity and respect. Avoid talking down to the person or talking to others as if he or she is not there. At all times be aware of your tone of voice and body language. The person in your care may not understand your words, but he may nevertheless respond to the tone of your voice or your posture. There are many ways in which you can help a person in the early stage to continue to have the confidence to use his remaining verbal skills. You may ask if he wants you to suggest the word he cannot find or to remind him of what he was trying to say when he loses his trend of thought. If he is open to that kind of support, provide the missing word or connection without making an issue and let the conversation continue.
The Early Stage
In the early stages, people with Alzheimer’s disease may—
- Have difficulty finding the right word to say and lose train of thought
- Use familiar words repeatedly
- Have difficulty following conversations when there are many speakers
- Take long pauses between words. Since memory for recent events has declined, they may repeat themselves because they don’t remember that they already have said something.
Middle Stage
In the middle stages, people have trouble expressing their feelings and needs.
- Have trouble sticking to a subject or forget what they were intending to say.
- May talk around a word they cannot remember; they will say, “You know the thing you make calls on” if they cannot think of the word “telephone.”
- They may use phrases that sound like regular social dialogue, which really cover up an inability to say more complex things. “Hello how are you? You look real good.” May be repeated to each person they meet.
Late Stage
In the late stage, people with AD gradually lose their ability to speak. They may make sounds or moans or facial expressions that give you a clue as to how they are doing. If you think that the person is uncomfortable, try to change his position, offer a drink, play music, or do whatever you think may bring him some comfort. Watch the response to your efforts to see if you are on the right track. You can communicate your caring through gentle gestures and even singing an old favorite song.
- The need for contact is still felt by the person in your care. People with AD want to be able to communicate. They may be very frustrated by their inability to do so verbally. Their tone of voice may tell you what their words cannot. Try to learn to read their body language. You too can express yourself to them with body language. They may be able to understand a hug or a pat on the arm when they don’t understand affectionate words.
Taking Care of Yourself- Being the Interpreter
One of the biggest challenges to caregivers or family members is to remain patient while coping with the changes in communication. The challenge will increase as the disease progresses.
You may still be able to get the drift and the feeling. Respond to that as best you can. “That sounds important” may be a possible response and if the person is making an effort to express something, then it is important to her that you acknowledge it.
When the person is among strangers, it may be necessary for caregivers to explain to them what the ill person is saying and to convey what the others are saying to the ill person. You are acting as interpreter for both parties.
You are more likely to be able to figure out what the person in your care is trying to say, since you know this person better than they do. You may have to repeat what was said to the person in your care in simpler terms. Gently help the person in your care to communicate with the other person. This is especially important when visiting the doctor or in the hospital.
Memory Care- Salty Language
Sometimes people with AD use salty language, which they never would have used before they became ill. Don’t be offended. It is the disease speaking. Try to remind yourself that these embarrassing behaviors are symptoms of the illness.
Safety Tips- Hearing and Vision
Communication difficulties may appear more severe because the person may have hearing and vision loss as well as problems with judgment, impulse control, and planning. Make sure the person has proper glasses or a hearing aid.
Communication will be more difficult if the person has an uncorrected hearing loss. It is worth finding an audiologist who is able to test hearing of people with Alzheimer’s disease, and trying to have a hearing aid fitted. While some older people are uncomfortable with hearing aids, others benefit greatly.
Don’t assume that the reason the person in your care doesn’t recognize others is due to Alzheimer’s without having his vision checked. If the person in your care does not see well, perhaps new glasses will help. In any case, rather than risking startling the person, it is best to say who you are as you approach.