Communication and Alzheimer's Disease

How to Better Communicate with Those Suffering From Alzheimer's Disease

As a person with Alzheimer’s disease (sometimes mistakenly called altimer’s disease) progresses through his or her illness, communication with the outside world becomes increasingly difficult. Once the brain begins to process information incorrectly, misunderstandings and misinterpretations become more common. This can be frustrating and upsetting for both the sufferer and others.

Yet communication of our needs and emotions is vital as a means of obtaining what we need and of preserving a sense of who we are. Those suffering from dementia of the Alzheimer’s type need to be encouraged to communicate in whatever way works for them.

It is frequently cited that up to 90% of communication can be non-verbal, consisting not of words but of gestures, facial expressions and touch. Non-verbal communication becomes particularly important as a person begins to lose their language skills.

Not all Alzheimer sufferers are affected in the same way.

Some of the changes which may occur include the following:
*  Increased difficulty in finding a word.
This can lead to a similar word (though not necessarily a synonym) being used as a substitute.
*  As time goes on, they may confuse the generations, mistaking their son for their husband for instance.  While distressing, this is a common characteristic in Alzheimer’s.
*  Speech may be fluent but incomprehensible
*  Normal social conventions may be ignored and sufferers may interrupt or ignore a speaker or walk off in the middle of a ‘conversation’.
*  Comprehension and understanding decreases
*  There is increased difficulty in eg taking a phone message or conveying information
*  There may be inappropriate expressions of emotion.
*  Frustration of any kind may result in an outburst of anger and/or aggression.

Despite these problems which will become more pronounced as the disease progresses, there are some general strategies which can make the process of communication easier.

1  Ensure you have the person’s attention before speaking. Make eye contact and try to find an area where background activity is not distracting or too loud.
2  Speak clearly. Be calm and still, giving them your full attention.
3  Watch their body language.
4  Watch your own body language. Keep facial expressions soft and interested and avoid agitated movements.
5  Don’t stand over, or too close to, the person. Respect their personal space. Try to get below their eye level as this will give them some sense of being in control.
6  Keep to one idea at a time. Dementia sufferers are unable to cope with complex or convoluted sentences so keep sentences short and simple.
7  Give the person time to digest what you’ve said. Those with Alzheimer’s can take longer to process data and respond.
8  Give cues and gentle reminders to aid understanding. Use names to assist as in ‘your neighbour Mary’.
9  Supplement words with non-verbal cues such as hand gestures and facial expressions.
10  Ensure the tone of the voice does not show condescension or impatience.

Listening Skills
*  Listen carefully and encourage interaction by showing interest via non-verbal clues such as nodding, smiling and/or gentle touching if appropriate.
*  Rather than finishing a person’s sentence (perhaps wrongly) ask them if they can explain in a different way. Listen and watch for clues.
*  Acknowledge their feelings. Don’t always try to cheer them up immediately. Sit quietly with them, hold their hand if appropriate and listen if they want to talk.
*  If they’re having trouble finding a word, they may substitute a word which perhaps sounds similar. So, while the language may seem to be garbled and incomprehensible it is sometimes possible to make a guess at what the sufferer is trying to communicate if it is realised that some words may be substitutions.

Things to avoid:
*  Arguing – this will only exacerbate any problems. Rather than contradicting something you know isn’t true, try to find ways around the problem.  At the very least, be non-committal.
*  Avoid giving commands or orders.
*  Give positive comments as to what they can do rather than what they can’t do
*   Watch your tone of voice. Raising your voice and speaking sharply will give the wrong cues even if the subject matter is innocuous.
*  Always ask one question at a time. Endeavour to help the person maintain his/her self-esteem by not asking direct questions which they may not be able to answer. Frustration can lead to irritation or even aggression.
*  Avoid giving too many choices. Making such a decision can be very confusing for a person with dementia.
*  If a person doesn’t understand what you’re saying, try to rephrase the comment in a different way.
*  Humour is almost always appropriate and a great de-fuser of potentially uncomfortable situations.
*  Never, ever, ever, make a person with Alzheimer’s feel foolish in front of others.
*  Avoid asking questions that rely on a good memory.
*  Do not talk about the person in front of them as if they were not there. Having a sense of being included in social groups protects a sufferer from feeling excluded and isolated.

Although there may seem a lot of ‘don’t’ in the above paragraph, much of the advice is really commonsense if there is a little knowledge of how Alzheimer’s disease affects people.

Those with Alzheimer’s are facing great difficulties in their daily lives. These difficulties can be exacerbated by other problems such as pain, discomfort, medications, failing eye-sight and hearing loss.

As the disease follows its course, communication will become increasingly difficult. Non-verbal communication will become even more important.  Where appropriate, a hug, holding hands or gentle touching or stroking can bring much comfort to sufferers.