By Jeannine Forrest, Ph.D., R.N.
The word dementia indicates a progressive decline in various areas of brain functioning. These functions include, but are not limited to language, memory, judgement, insight, and planning. There are many different types of dementia, and dementia of the Alzheimer’s type is the most prevalent in the U.S. Like a slow moving ice-berg, changes in brain functioning take place in a persistent manner. For meaningful communication to take place, it is essential that you become willing to be flexible and learn new strategies over time. These strategies are not intuitive.
There are two communication styles methods to keep in mind:
- Communication with words, tone of voice and body language.
We are used to basic communications using words, tone of voice and body language. However, as dementia progresses an individual will experience difficulty with understanding and using words. In figuring out the message the person with dementia is trying to convey pay more attention to their tone of voice, facial expressions, and posture. Similarly, become more aware of your own tone of voice and non-verbal behaviors. People with dementia are excellent at absorbing positive and negative emotions conveyed with tone of voice and behavior. If you are stressed, angry or resentful, the person with dementia will readily absorb this negative energy and their demeanor will often mirror your behavior. This phenomenon underscores the importance of caring for oneself when you are a caregiver so that you maintain your energy, health and positive attitude.
- Communication with the five senses.
As the person moves from early through final stages, their communication changes from words and language to the use of senses – hearing, touching, smelling, seeing, tasting. Spend time listening to favored music, kneading, baking and enjoying home-made bread, providing hand massages with scented lotion are all sensory techniques that may be helpful in communicating.
With these two methods in mind, the following list of Do’s and Don’ts will provide more guidance:
- Eliminate or reduce back ground noise.
- Identify or introduce yourself first.
- Face the person at same level.
- Talk more slowly – allowing information to be received
- If the person asks the same questions repeatedly – respond as if it were the first time. The part of the brain that normally records or remembers what someone is saying no longer works properly – the person with dementia cannot control this – think of a loose lightbulb.
- Use distraction to change the conversation
- Allow time for the person to answer a question
- Provide a guess if word finding becomes difficult
- Use dementia-sensitive or dignified language:
o Say person WITH dementia instead of demented
o Say napkin instead of bib
o Say brief instead of diaper
- Time travel – enjoy reliving past memories and stories that are shared
- Focus on remaining abilities
- Encourage rest periods throughout the day. As the brain becomes fatigued, the person is more prone to problems with communication, overstimulation and irritability. Short naps after breakfast and before dinner will help to counter these concerns.
- Stay calm and apologize if the person becomes irritated or upset. In many circumstances, you cannot “fix” the problem. Just say, “I am so sorry you feel this way’
- Show empathy and compassion
- Appreciate the lessons that dementia can bring: patience, learning to live in the moment
- Keep your sense of humor whenever possible
- Find moments of joy
- Quiz or try to “test” someone’s memory. This creates anxiety, frustration and embarrassment.
- Think that the person is lazy. The ability to start or plan an activity becomes compromised over time.
- Speak over or for the person with dementia
- Ask abstract questions. Instead, give two choices at a time. Instead of saying what would you like to do today? (too vague) Ask: “Would you like to listen to music or walk outside?”
- Criticize or try to correct (think - what is more important, for you to be right or for the person to be happy?)
- Argue, try to rationalize or convince. Areas responsible for self-awareness and insight become compromised over time. You will never win.
o Evanston Public Library – 3rd Saturday each month.
Jeannine Forrest, Ph.D., R.N.
Dr. Forrest has over 30 years of serving people affected by Alzheimer’s and other dementias, and their families. In addition to offering at-home care services, she has also extensive experience working with nursing home, home maker and hospice administrators and their staff in the areas of training and education.
Her commitment to providing clarity to an often confusing and overwhelming disease, enables families and their care partners to gain a better understanding of what it means to navigate cognitive, physical and the emotional changes that occur throughout this journey.