Alzheimer’s disease diminishes a person’s ability to communicate. The strategies below can help both you and the person with dementia understand each other better.
Communication between those who are by all standards considered to be of normal health and lucidity is far more difficult than we may appreciate. Studies have shown that men and women use language differently, and also that women tend to be interrupted more—even by other women. It’s also interesting to note that it’s easier to apprehend the meaning of what someone who speaks your language as a second language than it is for two people who speak the same language. The reason is that when we assume a language barrier, we listen more intently, not assuming that we know exactly what the other person is saying before they finish speaking. It’s the assumption that we know exactly what someone who speaks the same language is saying without having to hear the entire sentence that makes communication problematic. Often we tune out as we think of a response, never really hearing what has been said, and more importantly, what was actually meant, which changes with context and inflection—misunderstanding and arguments ensue. As such, finishing one another’s sentences may not be as romantic as we are prone to think.
Good listening skills, patience, and empathy are the keys to effective communication. They are also the foundation required to communicate effectively with someone diagnosed with Alzheimer’s. There are also some practical considerations that will facilitate understanding and effective communication. These techniques change as Alzheimer’s progresses through its three basic stages: Early, middle, and late.
The most important state of mind to maintain throughout the three stages is one of professional detachment—even if it’s your loved ones. If you experience upset at not being recognized, during the advancement of the disease, don’t take it personally. You’re not being erased. The person suffering from Alzheimer’s is, and confronting them makes a difficult situation untenable and stressful for them. Also, trying to force recognition of any kind, whether it’s person or object, will not magically snap them back into reality. It just makes things worse for all involved. The trick is to care without personalizing the behavior.
Communication Changes With Alzheimer’s
Naturally, there is no rigidly defined progression or appearance of symptoms. With Alzheimer’s, the ability to communicate varies dependent on the person and how far along they are. However, there are identifying problems that you can expect to see as Alzheimer’s progresses*.
• Difficulty finding the right words
• Using familiar words repeatedly
• Describing familiar objects rather than calling them by name
• Easily losing a train of thought
• Difficulty organizing words logically
• Reverting to speaking a native language
• Speaking less often
• Relying on gestures more than speaking
Communication in the early stage
Initially, you may be inclined to write off early symptoms as the absent-mindedness that comes with age. In the early stages, also known as mild Alzheimer’s the afflicted person can engage in normal conversation and socialization. However, they may be inclined to repeat stories This is something many of advanced years do, and can be brought about by loneliness. As such, it’s easy to write off. However, along with repeated stories, the Alzheimer’s patient may also be overwhelmed by excessive stimulation or have difficulty finding the right word.
Tips for successful communication:
- Don’t make assumptions about a person’s ability to communicate because of an Alzheimer’s diagnosis. The disease affects each person differently
- Don’t exclude the person with the disease from conversation
- Speak directly to the person rather than to his or her caregiver or companion
- Take time to listen to the person express his or her thoughts, feelings and needs
- Give the person time to respond. Don’t interrupt unless help is requested
- Ask what the person is still comfortable doing and what he or she may need help with
- Discuss which method of communication is most comfortable. This could include face-to-face conversation, email or phone calls
- It’s OK to laugh. Sometimes humor lightens the mood and makes communication easier
- Don’t pull away; your honesty, friendship, and support are important to the person
Communication in the middle stage
Referred to as moderate Alzheimer’s in medical context, the middle stages are typically the longest and can last for years. As the disease progresses, the person will have greater difficulty communicating and will require more direct care.
Tips for successful communication in middle stages:
- Engage the person in one-on-one conversation in a quiet space with minimal distractions
- Speak slowly and clearly
- Maintain eye contact. It shows you care about what they are is saying
- Give the person plenty of time to respond so they can think about what to say
- Be patient and offer reassurance. It may encourage the person to explain their thoughts
- Don’t overwhelm, ask one question at a time
- Ask yes or no questions. For example, “Would you like some coffee?” rather than “What would you like to drink?”
- Avoid criticizing or correcting. Instead, listen and try to find the meaning in what the person says. Repeat what was said to clarify
- Avoid arguing. If the person says something you don’t agree with, let it go
- Offer clear, step-by-step instructions for tasks. Lengthy requests may be overwhelming
- Give visual cues. Demonstrate a task to encourage participation
- Written notes can be helpful when spoken words seem confusing
Communication in the late stage
The late stage of Alzheimer’s may last from several weeks to several years. As the disease advances, the person with Alzheimer’s may rely on nonverbal communication, such as facial expressions or vocal sounds. Around-the-clock care is usually required in this stage.
Tips for successful communication with severe Alzheimer’s:
- Approach the person from the front and identify yourself
- Encourage nonverbal communication. If you don’t understand what the person is trying to say, ask him or her to point or gesture
- Use touch, sights, sounds, smells and tastes as a form of communication with the person
- Consider the feelings behind words or sounds. Sometimes the emotions being expressed are more important than what’s being said
- Treat the person with dignity and respect. Avoid talking down to the person or as if he or she isn’t there
- It’s alright if you don’t know what to say; your presence and friendship are most important
When it’s all too much
If you were a transplant to Los Angeles, you may have been given the following advice in the course of learning how to live in L.A.: “Pick your battles. Some problems you just throw money at.” While it appears somewhat jaded, that’s good advice for life when it gets overwhelming. Fighting every fight is exhausting, and the stress of some problems can be alleviated by paying someone else to deal with it. If you find yourself overwhelmed dealing with a loved one suffering from Alzheimer’s in the middle to late stages, hiring a caregiver, even if part-time, can go a long way to help you deal with the stress of life compounded by being a full-time caregiver. If finances are a problem, there are programs and resources that can help. For more information and assistance, contact New Wave Home Care—we’re here to help.
*Bulleted lists are quoted from the Alzheimer’s Association website for sake of accuracy.