War of the Words

Among the many struggles of caring for someone with Alzheimer’s is communication.  It can be extremely frustrating, for both parties.  The first concern that caregivers and family members bring up during a consultation or support group is usually a problem with communication.  This can range from hyper-repetitive questions, usage of incorrect words and even cursing or offensive language.  There are so many variables as to what causes this, but it basically comes down to the fact that the brain of the person with dementia has been damaged by the disease and has made it difficult for them to communicate as they once did.

Here are some effective tips for communicating with someone with Alzheimer’s or other dementia:

  • Speak clearly  Introduce yourself. Speak in a clear, straightforward manner.
  • Show respect  Avoid secondary baby talk and diminutive phrases, such as “good girl.” Don’t assume that your loved one can’t understand you, and don’t talk about your loved one as if he or she weren’t there.
  • Stay present  Maintain eye contact, and stay near your loved one so that he or she will know that you’re listening and trying to understand.
  • Avoid distractions  Communication may be difficult — if not impossible — against a background of competing sights and sounds.
  • Keep it simple  Use short sentences and plain words. As the disease progresses, yes-no questions may work best, and only one question at a time is best. Break down requests into single steps.
  • Don’t interrupt  It may take longer than you expect for your loved one to process and respond. Avoid criticizing, hurrying and correcting.
  • Use visual cues  Sometimes gestures or other visual cues promote better understanding than words alone. Rather than simply asking if your loved one needs to use the toilet, for example, take him or her to the toilet and point to it.
  • Don’t argue  Your loved one’s reasoning and judgment will decline over time. To spare anger and agitation, don’t argue with your loved one.
  • Stay calm  Even when you’re frustrated, keep your voice gentle. Your nonverbal cues, including the tone of your voice, can send a clearer message than what you actually say.

As is touched on above, communication is much more than the words we use. Body language can send powerful messages.  Thus, maintaining a positive presence will be much more effective than words in many cases; especially in the later stages when the person may not be verbal any longer.  A smile and a gentle touch are still recognizable as reassuring and kind.  The Alzheimer’s Foundation of America has compiled helpful suggestions for caregivers and family members to enhance their interactions with their loved one overall:

  •  Remember that the individual with dementia might be feeling confused, anxious, irritable and depressed, and suffering from low self-esteem.
  • Be aware of body language. Individuals with dementia are very receptive to body language. They are often able to detect if a person’s body language depicts happiness, anger or other emotions, and then mimic the cues they see. If a frustrated caregiver, for example, gives off a certain negative energy, the individual with the disease might mirror back the emotion and respond with an equal amount of anger or impatience.
  • Make certain that the person with dementia has the best chance of seeing and hearing you. This involves checking that the person is wearing glasses and hearing aids, if necessary, and that talking occurs in a quiet environment.
  • Approach the individual from the front. An unexpected touch or drawing near from behind may startle and upset the person.
  • Before asking the individual to do something, address the person by name to get his attention. While you are speaking, maintain eye contact to help him focus.
  • Ask only one question at a time and allow time for an answer. If he does not seem to understand, repeat the question using the same wording. If this does not work, after a few minutes, rephrase it.
  • Allow the individual adequate time to respond in conversation or when performing an activity. Rushing will increase confusion.
  • If the individual repeatedly asks a question, keep in mind that he cannot remember the response you have just given him. Instead of answering the question after a second or third repetition, reassure the individual in some way-everything is fine, you will be with him, you will help him.
  • Avoid statements that sound negative. For example, instead of “Don’t go outside,” say, “Stay inside.”
  • Use humor whenever possible, though not at the individual’s expense.
  • Break down all tasks into simple steps. Tell the individual one step at a time what to do. Giving too many directions at once or too quickly will increase confusion. If the individual gets upset and becomes uncooperative, stop and try again later.
  • Keep on talking, even when a person may no longer be verbal. Chat about things that mattered to the person and mention names of family and friends. Even if communication is one-sided, it can loudly show that you care.

Maintaining communication is such an important part of care giving and caring.  Beyond exchanging information, communication provides a way to connect to others. Everyone wants to be heard, to be understood, to matter.  Just because a person may lose the ability to verbalize their feelings and needs, doesn’t mean these feelings and needs go away.  Instead of battling over words or questions, find an alternative way of communicating that makes it easier for the person you are caring for.

Download our FREE booklet, Alzheimer’s Communication Strategies, to learn more ways to communicate and interact with those you care for.