The last two months I’ve talked about a lecture that I attended, “Understanding the Person with Dementia: How to Communicate Effectively.” It was presented by Susan Stone who is with the Alzheimer’s Family Day Center (AFDC) in Fairfax, Virginia and does outreach and education. Communicating with a person with Alzheimer’s disease (AD) is a challenge which takes patience and understanding. This is a continuation of her lecture and the final in the series of three articles.

To communicate with a person with Alzheimer’s disease (AD), we need to understand their world. There is no point in arguing or correcting. The patient’s reality is not your reality so join the individual where he is. Simply acknowledge the statement and emotion behind it even though you know that it’s incorrect. Avoid asking questions that they cannot answer. Allow them to reminisce.

Make positive statements. Try going through the day without saying “no.” Difficult? Avoid pronouns like it, he, she. And use very simple explanations. Details often overwhelm them and can cause increased anxiety.

Here are some strategies to consider.

  • Offer guided choices. They are losing their right to make choices so say something like “chocolate or vanilla” and they will likely remember the last word.  The speaker humorously added that if there are only two choices and you want the chocolate one, offer the chocolate one first followed by vanilla since they will probably choose vanilla.
  • Write it down and use labels. During the late stages, labels won’t help, but during earlier stages of AD, they will help.
  • Validate emotions rather than facts.
  • Avoid overstimulation.
  • Model appropriate behavior.
  • Fill in lost words, although this depends on the person.
  • Turn your questions into answers.
  • Use events to measure time.

Listening is extremely important. Learn to read body language to figure out what the person is trying to communicate. Is it pain, frustration, fear, pleasure, boredom? Survey the environment as well to see what’s going on. Focus on the person and listen. One AD patient said,

I have taken time to put words together and I may be unable to repeat it.

Another AD patient said, I’m doing the best I can. They may overhear you talking about them so be careful. The ability to understand what is being said outlasts the ability to speak effectively.

The understanding the person has might come from body language and tone of voice more than from the words that you use. Use humor gently and never at the expense of the individual. But humor is everywhere; just keep looking for it.

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Last month I talked about a lecture that I attended, “Understanding the Person with Dementia: How to Communicate Effectively.” It was presented by Susan Stone who is with the Alzheimer’s Family Day Center (AFDC) in Fairfax, Virginia and does outreach and education. Communicating with a person with Alzheimer’s disease (AD) is a challenge which takes patience and understanding. This is a continuation of her lecture.

As we age, we all experience age-related brain changes, but for Alzheimer’s disease (AD) patients, the changes may be a lot more pronounced. They include:

  • Impaired hearing – especially higher frequencies
  • Lessened ability to determine the location of sound
  • Decreased vision
  • Slower thought processing
  • Slower in adjusting to light changes. (She suggested going into their bedroom earlier and opening the blinds).

Along with age-related brain changes, there are definite communication changes in dementia. They include the following:

  • Word finding problems (initially nouns and pronouns)
  • Frontal lobe damage
  • Word salads (stringing a lot of words together that don’t make sense)
  • Perseveration (repeating words over and over)
  • Mis-naming (but getting close) (An example she gave was someone trying to say Dairy Queen and used the word “king”).
  • Returning to original language (first to learn and last to lose)
  • Loss of ability to recognize and understand words

When approaching a person with dementia, use the person’s name and casually introduce yourself. Approach the person from the front and make sure you have eye contact. Touching the person also helps them to maintain attention. There’s less human touch as a person gets older so touching is important.

Finally, here are tips for initiating conversation.

  1. Speak slowly and clearly. Use e-x-p-a-n-d-e-d speech, but by all means treat them with dignity and not as though they are a child.
  2. Pause at the end of thoughts to give them time to process.
  3. State one request at a time.
  4. Always explain what you are going to do.
  5. Use lots of hand gestures.
  6. Watch the person closely for their reaction. Anxiety leads to anxiousness to regression.

Next month I will continue with more tips.

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Alzheimer’s Family Day Center

Alz_FamDayCareLocated in Fairfax, Virginia, the Alzheimer’s Family Day Center (AFDC) is the only adult day health center in the Washington, DC metro area for adults with Alzheimer’s disease in the mid to late stages of Alzheimer’s and other related dementia. For those in the early stages, the Social Club meets for a half-day once a week. Founded in 1984 by visionary Dr. Lin Noyes Simon, AFDC just celebrated its 25th anniversary. As a founding director of the first and only dementia-specific day-care center in Northern Virginia, Dr. Simon turned a concept of care into a viable nonprofit business that increases the quality of life for people with dementia and their families.

Alzheimer's Family Day Center

Alzheimer's Family Day Center

Part of the mission of this organization is education. They offer training programs for caregivers and they practice and improve the skills and techniques in their programs. They also offer classes for caregivers on many aspects including medical, legal, financial, community resources, how to build coping skills.

The Alzheimer’s Family Day Center is a full care facility providing breakfast, lunch, and two snacks each day. Additionally medical services and transportation are provided. They can accommodate up to 34 participants with a 1:4 staff ratio. Fees cover 40% of their budget; fund raising and grants cover the rest. Scholarships are provided for those that cannot afford the fees. Level II care for the middle stages of Alzheimer’s and runs from $730 to $1533 per month, depending on the number of days the client attends. Level III care for late stage dementia ranges from $830 to $1743 per month.

On the day I visited, the group was actively engaged in a game. One aide was seated right outside of the restrooms ready to assist while another sat right outside of the game room also ready to assist. Another staff member was cleaning the bright dining room. It’s a very pleasant facility with an upbeat staff.

Nancy Dezan, Executive Director, said day care is not for everyone. People think that their loved ones won’t like it, but once they attend, they think it’s the greatest thing since sliced bread. She asked me why I thought my family never sent my father to day care. Well, they tried it, but my mother (as my father’s primary caretaker) felt it was so much work to prepare him to go out. Furthermore, they had to be ready when their transportation arrived. Nancy said this was a typical answer for many families.

To see how you can help, visit the AFDC Web site.

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