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By practicing these tips when talking to an Alzheimer's patient, you will find the person is more cooperative and less frustrated. It is important to assume that the dementia patient understands everything that you say. Remember: do not talk about the person as if he/she is non-existent, nor make comments about behaviors.
To gain person's attention:
- Look eye to eye
- Call person by name (First name usually will bring response)
To deliver message:
- Use simple adult words
- Speak slowly and clearly
- Do not shout - Lower pitch of voice
- Give one message at a time
Listen for response:
- Allow time for response
- Repeat the question, using the same words
- Help person put words together
- Validate the meaning of the response
- Watch body language
Ask answerable questions:
- Limit choices - Too many can be confusing
- Do not offer choices if there are none
- Ask uncomplicated questions, one at a time
Use non-confronting, non-controlling statements:
- Agree first and then limit your response
- Do not argue, but instead attempt to change the subject
- Identify feelings rather than argue facts
- Ignore repetitive statements if they are not emotionally charged
- Ask for cooperation and help
Reassure and calm:
- Use body language (gestures) to explain statements
- Ask the person to repeat the information you have given
- Write a simple note
- Tell the person that everything is going according to plan
- Use events rather than the clock to measure time
- "Before lunch" or "After lunch" are more reassuring to a person with dementia than words such as "In an hour."
Problems in communicating with a dementia patient often arise because of our own expectations of the patient. Frequently, a person who is very close to the patient feels that the patient is misbehaving on purpose, when in fact this is not the case!
The environment and the use of nonverbal communication (BODY LANGUAGE) are very important in communicating. If the environment is hectic and active, it can cause the person to behave in a manner exactly opposite of what is desired. Communication can become impossible in this atmosphere. Be alert to any changes in the patient's environment. If the person seems to be disturbed, move him\her to a quieter environment. Also, be especially aware of the emotional climate in the room. Many Alzheimer's patients are aware of the emotional climate and will respond accordingly.
Body language is a very important tool when working with a dementia patient. Do not approach the person quickly from behind. Instead, approach calmly from the side at an angle or from the front, saying his/her name. Make certain that your body is saying what your voice and words are saying. Do not move too quickly and do not appear too hurried.
Touch the person or use some sort of visual aid. Use simple sentences. Say, "Time for a bath," instead of, "Hello, how are you? It's time for your bath now."
If the person does not respond after a while, repeat the question and use gestures if appropriate. Be aware that if you say things like "Stop that!" and "Not now!" in a sharp tone of voice, the person probably will respond in a similar manner. Therefore, try to moderate your tones and words.
It is important to try to determine what the person is trying to communicate. If the patient is restless: trying doors or punching air, for example, this would not be a good time to try to communicate with the patient.
Watch the person's eyes. They can tell a great deal about whether the patient is exhibiting fear, pain, or anger. If the patient does not want to talk to you, he/she will avoid eye contact, fold his/her arms and/or fidget. When the patient wishes to communicate he/she will often smile, appear to be relaxed, lean closer to you, and/or touch you. When the patient rambles and seems to be making no sense, try to listen to "key" words. Often the patient is trying to blurt out a few words which reveal the true message he/she is attempting to communicate.
Sensations from the skin are apparently represented by a large area of the brain and therefore stand more chance of "getting through" to someone with Alzheimer's disease. Lack of touching is often interpreted by the patient as personal and social rejection, and by using this means of communication you are helping to reduce his/her feelings of confusion and insecurity as well as increasing understanding between you.
Individuals suffering from a dementia have difficulty understanding what you and others tell them. Often questions and instructions no longer have any meaning, and as a result the caregiver or family member frequently misinterprets the actions as uncooperative or inattentive behavior.
People with memory loss may quickly forget what was once understood. When given a careful explanation, the patient will probably forget the first part of the explanation prior to your reaching the end of your explanation.
Sometimes a dementia patient cannot communicate a whole thought, but can express a few words of the thought. Some of them may understand you, but are unable to say the correct words to answer. As the dementia increases, some patients may repeat a phrase or a series of rhyming words which appear to have no meaning. Example: "who-who, who-who." It may seem as if the person has nothing to say because of his/her incoherent and nonsensical sounds. However, it is possible that some of these sounds have meaning to the person.
Techniques that may help in improving verbal communication:
Talk to the person in a non-distracting place. A dementia patient can not concentrate or sort things out when there are environmental distractions such as other conversations, equipment noises, or people walking by.
Start conversations (particularly at night) with orienting information. Identify yourself and call the patient by his/her preferred name (probably a first name, Grandma/Grandpa usually has no meaning, whereas the first name will usually bring recognition).
Use short words and short, simple sentences.
Speak slowly and say individual words clearly.
Even though short words and simple sentences are being used do not talk down to the patient. Speak in an adult manner as you would to a co-worker or friend. A dementia patient can sense when he/she is being treated as a child. Treat the patient with dignity and respect.
Use a low tone (pitch) of your voice. A raised pitch is a signal that one is upset. A person with a hearing impairment is able to hear a lower pitch more readily.
Speak to the dementia patient in a warm, easy-going, and pleasant manner. Use non-verbal clues, including facial expressions, tone of voice, or touch to show your feelings of affection. Smiling, taking the patient's hand, or touching the patient's arm, can vividly communicate that you are interested and really care.
Take your time when giving instructions. Allow plenty of time for the information to be absorbed. Wait for a response or a answer. It is important to give the patient plenty of time to respond, because the response may be slower than seems natural to you. If you take the time to wait, often the action will reward the wait. Waiting means silence which many of us are uncomfortable with, but remember that what seems like unproductive silence, is actually hard working concentration for the person with dementia.
Give clear and simple instructions. If you repeat an instruction, repeat it exactly. If the patient does not seem to understand, try other ways of saying it. It can also be helpful to get some feedback from the person, for this will let you know whether he/she really understands.
Ask the person to do one thing at a time. He/she is probably incapable of remembering a series of instructions, nor capable of making sense out of your request. Daily living activities involve several tasks such as getting dressed, taking a bath, or sitting down in a chair or wheelchair. Break each activity down into a number of small steps. This is called task-breakdown. By proceeding in this manner a patient is able to accomplish one task or activity at a time, starting at whatever point she/he is able. It is important that the breakdown of steps be adapted to each person's ability.
An example of a task-breakdown activity: Helping Mr. Jones walk from his bed to a chair on the other side of the room.
- With a calm, quiet voice tell Mr. Jones what you wish him to do. "I would like you to stand up. Together we will walk to the chair by the window."
- As he approaches the chair, give a simple direction. "Please turn around." This will enable him to be in the correct position before attempting to sit down.
- Remind Mr. Jones to place his hands on the arms of the chair in order to support himself as he sits down.
- Once Mr. Jones is seated, ask him to lift up his feet. Then a foot stool or ottoman can be placed under them.
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These tips and ideas have been compiled from information provided by Lin Noyes, Founding Director of the Alzheimer's Family Day Center in Fairfax, Virginia and from newsletters from throughout the country.
In the National Capital Area chapter service territory, for more information about
Communicating with the Dementia Patient, please contact the Chapter's telephone Helpline at 703-359-4440 or toll-free 1-800-272-3900. Outside the National Capital Area, please contact your local Chapter.
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© 1997 - 2005 Alzheimer's Association, National Capital Area. All rights reserved.
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