Beyond Words: How to Communicate with Alzheimer’s Clients & Patients

Alzheimer’s disease gradually diminishes a person’s ability to verbally communicate. It is common knowledge that people with dementia have difficulty expressing needs, thoughts, and emotions, and similarly struggle to understand others. A simple trip to the doctor may trigger anxiety because of unfamiliar surroundings and confusing dialogue. Equipping yourself with knowledge of the appropriate communication methods will help make things like a visit to the doctor successful for the patient, the physician, and the caregiver.

To generate the most positive results, there are six key things to remember when interacting with an Alzheimer’s patient:

Anticipate Triggers

As the disease progresses, oftentimes the person with Alzheimer’s cannot use words to express how he or she feels, and instead communicates feelings through behavior. Successfully dealing with problem behaviors in persons with Alzheimer’s disease begins by first identifying the cause or trigger of the behavior. Questions to think about include:

·      What happened just before the behavior started?

·      Where did the behavior happen?

·      What happened right after the behavior?

It is important to react calmly and reassuringly to avoid triggering the behavior again.

Read Emotions and Body Language

A person with Alzheimer’s may become agitated if they cannot decipher what is being said or can’t find the right words to tell you what he or she wants. Agitated actions are a result of inner emotions. Focus on the feelings, not the facts. Sometimes the emotions being expressed are more important than what is being said.

Monitor Your Response

Getting anxious or upset in response to a problem behavior can increase the level of stress or agitation in a person with Alzheimer’s. Again, respond to the emotion being communicated by the behavior and not to the behavior itself. Try to remain flexible, patient, and relaxed. Remember, the person is responding to your tone of voice and body language more than the content of what you are saying.

In conducting a conversation, these practices are suggested:

·      Learn to create a ‘kind voice’… slower speech, lower pitch, and smiling.

·      Talk slowly and clearly. Use short, simple words and sentences.

·      Avoid using logic and reason.

·      Ask one question at a time.  If the case is advanced, stick to Yes or No questions.

·      When giving instructions, break down what you are asking into one simple step at a time.

·      Patiently wait for a response as extra time may be required to process your request.

·      Be careful not to interrupt.

·      Avoid criticizing, correcting, and arguing.

·      Let the person know you are listening and trying to understand what is being said.

Consider the Environment

An unfamiliar environment or unrecognizable caregivers can trigger troubling behaviors for those with Alzheimer’s disease. Persons may act nervous and upset – picking at clothes, wringing hands, crying, and making accusations or using repetitive speech. Repetition is thought to convey how the person is seeking security and familiarity. Do not try to reason or correct; rather, determine what is troubling the person and try to understand his or her reality. A calm listener can have a calming effect on the behavior.

Likewise, an over-stimulating environment is a cause of stress in Alzheimer’s patients. Too many people, too much noise, garish colors in the environment, shadowy rooms, or excessive clutter can also lead to agitation, hallucinations, or aggressive behavior. Stay calm and at an arm’s length if safety is a concern. Provide reassurance and encourage the person to go with you to another place where it is well lit, quiet, and calming. Always try to remain visible to the person with Alzheimer’s and be careful not to approach from a path that isn’t in full view so as to avoid any surprises.

Check on the Caregiver

For a person with Alzheimer’s disease, engaging with a stressed-out or agitated caregiver could trigger distressed behavior. The caregiver reacts to the stress that comes from caring for the patient; the patient responds to the negative emotions they sense in the caregiver. Many care companies are happy to provide resources to caregivers, such as tips to avoid burn-out and additional communication techniques. If the caregiver learns to recognize signs of stress in themselves, they will be able to take control of it before it affects the Alzheimer’s patient and those around them.

Additionally, Geriatric Case Managers are available to offer support to families, advise and assist in decision-making, and manage a care plan geared to improve a person’s quality of life. Besides older adults and their families, geriatric care management services are appropriate for:

·      A physician who recommends in-home assistance or monitoring;

·      A company whose employee is missing work because of caregiving responsibilities;

·      An attorney or trust officer who is managing the estate of an older adult.

Respite care is particularly effective in decreasing caregiver stress and calming the Alzheimer’s patient. Suggesting respite care for caregivers is a positive way attend to the needs of all involved, allowing the caregiver some rest from the continuous stress of a difficult situation while simultaneously providing peace, activity, and reassurance to the care recipient via the trained private-duty aide.

Reflect on the Episode

After the event has concluded, think through how you handled the situation and if anything could or should be done differently. What worked? What didn’t? These cues can help improve communication in the future, ultimately succeeding in better understanding the patient and being understood by them.

Despite the unpreventable decline of communicative abilities in a person with Alzheimer’s, there are ways to maneuver around the obstacles. Through observation and awareness you will find that something is always being expressed, even when someone is unable to describe their feelings. If we are able to move beyond words we will find that it is possible to learn from the patient and make ourselves understood without heavy reliance on speech.

Barth Holohan, MSW, MBA, is the founder and president of Continuum, one of the area’s leading home care providers, a company dedicated to allowing people to remain independent at every stage of life. An expert on elder care and the home care industry, Holohan was awarded the 2007 SSM Health Care Stewardship Award and the Distinguished Alumni Award from Washington University’s Brown School of Social Work in 2009. Visit Continuum at  www.ContinuumCare.com for more information and a variety of care resources.