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Communication Skills

"The difference between the right word and the almost right word is the difference between the lightning and the lightning bug.". Mark Twain

The most important skill that a caregiver may need the most is effective communication with the care receiver!

Because Alzheimer's disease slowly erodes communication skills, an affected person's words and behavior may make little or no sense to you. Alzheimer's gradually strips the meaning from words, causing frustration, anger and frayed nerves of everyone involved.

The following are some specific suggestions of things to think about when communicating with an impaired person:

Importance of Communication
Communicating With Someone Who Has Alzheimer's
Your Approach Sets The Tone
Think Before You Speak
Doing Tasks Together
Having Trouble Being Understood
Things NOT To Do
When It Just Fails

Importance of Good Communication

How the person with Alzheimer's, or any dementing illness, lets you know what they need, or how they generally get their message across, will change. As the dementia progresses, the person may communicate their needs increasingly through their behaviour. Communicating with a person with a dementing illness, such as Alzheimer's disease, can be a terribly difficult task.

Often in early stages of a dementing illness, people have trouble finding the words to express their thoughts, or may be unable to remember the meaning of simple words or phrases; but these problems are usually minor inconveniences or frustrations. The later stages may be much more difficult with language skills quite impaired, resulting in nonsensical, garbled statements, and great difficulty in understanding.

When people cannot comprehend what is being said, or cannot find the words to express their own thoughts, it can be painful, frustrating, and embarrassing for everyone.

LOOK for meaning.... Ask yourself "What is he/she trying to tell me?"
Understanding what the person is trying to say may prevent some difficult behaviours from developing.

Your Approach - You Set the Tone

Think, about how you are presenting yourself.

  • Are you tense?
  • Frowning?
  • Are you being bossy or controlling?

People with dementia are often extremely aware of non-verbal signals such as facial expression, body tension, and mood. If you are angry or tense, they are likely to become angry, anxious, or annoyed.

  • Try a calm, gentle, matter-of-fact approach.
  • You set the mood for the interaction.
  • Your relaxed manner may be contagious.

Use a non-demanding approach

  • try humor cajoling, cheerfulness.
  • Humor or gentle teasing often helps caregivers through difficult moments.
  • Convincing someone to get out of bed or go to the bathroom is usually easier if you can make a game or joke of it.
  • Ordering or demanding may be much less successful with some people.

Try using touch to help convey your message.

  • Sometimes touch can show that you care, even when your words don't, or when they are not understood.
  • Some people shy away from being touched, but most find a gentle touch reassuring.

Begin your conversation socially.

  • Winning the person's trust first can often make a task much simpler.
  • One way of doing this is to spend some time chatting before approaching the task at hand.
  • For example, you might spend ten minutes talking about weather or family members, or some reassuring topic, to help get the person in a relaxed frame of mind.
  • Again, you are creating a pleasant mood




Communicating With Someone Who Has Alzheimer’s

Learning about Alzheimer's, how it progresses and how it is managed is critical to understanding how best to interact and communicate with a person who has Alzheimer's disease. In the process you will learn many tips and strategies for coping with the cognitive and behavioral symptoms of the disease. These symptoms will change as the disease progresses, and you may need to continually adapt strategies in accordance with your loved one's level of function and symptomatic behaviors.

One successful approach to reducing inappropriate behaviors is to communicate within the affected person's frame of reference. Consider how your loved one sees the world and interact with respect for that "reality." It can also be helpful to engage the person in reminiscing about happier times by sharing memories and old photos; interactions that are focused on past times that the person might be able to recall may be less stressful than trying to communicate about current or recent events, which may not be accessible to the person.

In later stages of Alzheimer's, aggressive or agitated behaviors may become common and may make it increasingly difficult to care for a loved one at home. Though generally viewed as symptoms of the disease itself, some experts believe that such behaviors may in part be reactions to the actions of people around them. For example, talking too loudly or too fast or contradicting the afflicted person's perceived reality might cause agitation. A growing body of research is showing how certain techniques for communicating and interacting with a person who has Alzheimer's can help reduce disruptive behaviors.

If your loved one is agitated or disruptive, examine how your own actions may be influencing that person's behavior. Try to determine if something you have done (or have not done) might be triggering an agitated response and change that behavior in subsequent situations. Certain social situations, such as a holiday reunion of family with noise, kids, pets, etc., may trigger agitation. In such instances, it may be helpful to remove the person to a quiet area away from large groups of people until they calm down.

Take Time To Think Before Speaking

Talk to the person in a place that is free from distractions,

  • Such as equipment noise, television, or other conversations.
  • People with dementia often have very little ability to screen out distractions.

Begin conversations with orienting information.

  • Identify yourself, if necessary, and call the person by name.
  • After creating a relaxed atmosphere, explain what it is you propose to do.
  • Look directly at the person and make sure you have his or her attention before you begin to speak.
  • If you cannot get the person's attention, wait a few minutes and try again.

Move slowly.

  • Gently touch an arm or hand to gain attention, while saying the person's name several times.
  • Be careful not to startle him or her.
  • It is important to be at eye level with the person, especially when talking to people who are very impaired or to those who are hard of hearing.

Speak slowly and say individual words clearly.

  • This is particularly important for people with hearing problems or those who are in the later stages of dementia.

Use short, simple sentences.

  • People with dementia may not be able to remember more than a few words at a time.
  • Pause between sentences and allow plenty of time for the information to be understood.
  • Ask simple questions that require a choice of a yes/no answer, rather than open ended questions.
    • For example, instead if saying, "What would you like to wear today?"you might say, "Do you want to wear this green dress or this red one?" or "Is this the dress you would like to wear today?"

Use very concrete terms and familiar words. As people become more impaired they lose the ability to understand abstract concepts.

  • You may need to say "Here is Your soup at this table," instead of "It's time for lunch."
  • They may also revert to words from childhood or earlier in Life, "Do you need to go to the bathroom?" may not be understood as easily as "Do you have to pee?"
  • Talk in a warm, easy-going, pleasant manner

Try to use a tone of voice that You would like people to use with you.

  • Keep the pitch of your voice low.Sometimes when people don't immediately understand us, we have a tendency to shout.
  • This will simply upset the person with dementia, and will make communication more difficult.