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.

Enhanced by Zemanta

According to the Alzheimer’s Association, there are seven stages of Alzheimer’s disease. In stage 5, there is moderately severe cognitive decline. This is the moderate or mid-stage Alzheimer’s disease. The Alzheimer’s Association says:

Major gaps in memory and deficits in cognitive function emerge. Some assistance with day-to-day activities becomes essential. At this stage, individuals may:

  • Be unable during a medical interview to recall such important details as their current address, their telephone number or the name of the college or high school from which they graduated

  • Become confused about where they are or about the date, day of the week or season

  • Have trouble with less challenging mental arithmetic; for example, counting backward from 40 by 4s or from 20 by 2s

  • Need help choosing proper clothing for the season or the occasion

  • Usually retain substantial knowledge about themselves and know their own name and the names of their spouse or children

  • Usually require no assistance with eating or using the toilet

Life becomes quite a challenge for the primary caretaker at this point. I was not the primary caregiver; my mom was, but my sister and her family lived in the same house so she was always available to assist. Mom never had a break, but each summer I would go to assist when my sister and her family went on vacation.

I do remember dad being frustrated with his situation at this point and he voiced his frustration. It is such a helpless situation. He definitely recognized me at this point and I remember the big smile he had to see me, although he wondered how I had gotten there.