“Get into their world.” That’s the best way to build communication with Alzheimer’s patients or anyone living with dementia, according to Kandice Westhoff, Director of Health Services for Breeze Park, a Lutheran Senior Services (LSS) Life Plan Community in Weldon Spring, Missouri. “They really respond to one-on-one interaction.”
Communicating with someone who is living with Alzheimer’s or dementia requires patience, care, and understanding. As a person advances through the stages of early to late-stage Alzheimer’s or dementia, their ability to communicate will change. To help their loved ones and caregivers avoid frustration, it is important to understand the stages of Alzheimer’s progression, and how to most effectively build communication with an Alzheimer’s patient.
Changes in Individuals with Alzheimer’s
Each person’s experience with Alzheimer’s or dementia will vary, but generally some changes you can expect to see include:
- Difficulty finding the right words
- Using familiar words repeatedly
- Describing familiar objects instead of naming them
- Easily losing train of thought
- Difficulty organizing words logically
- Reverting to speaking a native language
- Speaking less often and relying on gestures
- Safety hazards like forgetting to turn off the stove
- Wandering off or becoming lost and disoriented
- Showing poor financial judgment
- Mismanaging medications
- Eating poorly or not taking care of oneself
- Becoming increasingly isolated
Communication Through Disease Progression
Alzheimer’s progression varies, but typically falls into three stages: Early, Middle, and Late. Following are some tips that help promote effective communication with Alzheimer’s patients through each stage.
Early Stage
The early stage of Alzheimer’s is characterized by the milder symptoms of the disease. One may be able to meaningfully participate in a conversation or engage in social activities. Common signs of the disease include repeating stories, having difficulty finding the right word, or becoming overwhelmed by excessive stimulation. The disease affects each person differently. However, the most important things you can do to foster communication with Alzheimer’s patients in this stage are to ask, listen, and be a friend. Tips for successful communication with Alzheimer’s patients in the early stage include:
- Speak directly to the person. Don’t exclude them from conversations or speak to their companion instead.
- Give the person time to respond.
- Don’t interrupt unless help is requested.
- Listen to the person express their thoughts, feelings, and needs.
- Ask what the person is comfortable doing, and if they want or need help.
- Discuss their preferred method of communication – face-to-face, email, phone calls, etc.
- It’s OK to laugh together. Sometimes humor lightens the mood and makes communication easier.
- Make time to check in. Your honesty, friendship, and support are important.
Middle Stage
Typically, the middle stage of Alzheimer’s, in which moderate symptoms are present, is the longest stage. The disease will progress over many years and communication will become more difficult. Continuing to give the person space to express themselves and being a friend remain important to facilitate communication with Alzheimer’s patients in this stage. Redirection instead of correction works best.
It’s important to meet the person where they are, as they may believe they are at a different point in their life. For example, they may think they are living in their childhood or early adulthood. Westoff advises embracing where a person is today and to not contradict them. Removing the person from whatever is upsetting them and distracting them with a different activity is better than trying to reason with them.
“The hardest thing for family members is that they want to correct their loved one,” said Westhoff. “They have to remember that we just need to play along and do whatever you have to do to keep them happy.”
Feeling useful is important and some people enjoy having simple, routine tasks to perform. “We have a resident who is happiest when she is busy. She sweeps the floor and sets the table for meals. If one of us leaves the floor, she’ll tell us ‘I’ll cover you!’”
Tips for communication with an Alzheimer’s patient in this stage include:
- Engage the person in one-on-one conversations in a space that is quiet with minimal distractions. Too many sounds can make focusing difficult.
- Speak slowly and clearly.
- Maintain eye contact. This expresses that you care about what they are communicating.
- Be patient. Give them time to respond and encourage them to explain their thoughts.
- Don’t overwhelm them. Ask one question at a time.
- “Yes or No” questions are preferred. Ask, “Would you like some water?” instead of “What would you like to drink?”
- Avoid arguing.
- Don’t criticize or correct. Listen and repeat what was said to clarify.
- Demonstrate a task using visual cues and give clear, step-by-step instructions.
- Don’t take it personally. If they get angry or agitated, remember that it is the illness and not about you personally.
- Seeing a loved one change can be hard. Take care of yourself and allow yourself a “time out” if you become frustrated.
Late Stage
The final stage of Alzheimer’s, referred to as the late stage, may last from several weeks to years. As the disease advances, communication with Alzheimer’s patients may rely on nonverbal communication. In this stage, the person will require continuous care.
It is especially important to have consistent caregivers for people in this stage, as some do not communicate verbally. “We get to know their behavior and are able to read nonverbal cues like ‘bathroom,’ ‘pain,’ and so on,” said Westhoff.
Some tips for successful communication with Alzheimer’s patients in this stage include:
- For each interaction, approach the person from the front and identify yourself.
- Get creative with nonverbal communication. Use hand gestures as well as touch, sights, sounds, smells, and tastes.
- Look beyond words. Sometimes the emotion behind a word or sound is more important the specific word being used.
- Respect the person’s dignity. Do not speak about the person as if they are not present or talk down to them.
- Just be there. It’s OK if you don’t know what to say. Just being a friend matters most.
Alzheimer’s Communication Tips for Caregivers
Westhoff advises finding out as much as possible about the person’s life story from before their memory condition. What did they love to do? What was important to them? “Every person is different so you have to get to know their history so you can find certain little avenues that work for that person,” she said. For example, a resident who loves going out to eat can be persuaded to get dressed or be distracted from something that is upsetting by saying, “We’re going out to eat later. Let’s go decide what to wear. We should get cleaned up!”
How a caregiver phrases questions and directions can make a big difference. For example:
- Say, “Let’s try this way,” and gently redirect instead of pointing out mistakes.
- Say, “Please do this,” instead of “Don’t do that!”
- Say, “Thank you for helping,” and mean it, even if the results are not perfect.
- Ask “yes or no” questions instead of open-ended questions. “Are you hungry” instead of “How do you feel?”
- Too many options can be overwhelming, so limit them. For example, say, “Would you like fish or chicken for dinner” instead of “What do you want for dinner?”
- If they don’t understand something the first time, repeat using different words.
- Avoid saying “Don’t you remember?” or “I already told you.”
How Memory Care Helps Those with Alzheimer’s or Dementia
As Alzheimer’s or dementia progresses into the mid to late stage, a person living with the disease will require increasing levels of care. Lutheran Senior Services Life Plan Communities offer Memory Care in controlled-access, purposeful environments created with the special needs of the residents in mind. LSS is the first organization in the region to implement Tovertafel, an innovative interactive technology proven to promote movement and stimulation for people living with dementia.
Meaning “magic table” in Dutch, Tovertafel uses light projections onto a table to create an immersive and interactive experience where participants play games that engage their skills in a fun way.
Using Tovertafel can break through restless and tense behavior, as well as increase positive emotions in people living with dementia. Games are created for a range of cognitive abilities, respond to even the slightest movement, and can be played individually or in a group. Playing together has been shown to promote social bonding between those living with dementia, care professionals, fellow residents, and family members.
“They really like it,” said Westhoff. Her residents especially enjoyed a game that made musical notes. “One lady was waving and laughing and said it sounded like she was playing music!”
Each day within Memory Care is planned with activities and programming tailored to keep residents engaged physically, mentally, and spiritually. This includes daily routines and opportunities to participate in normal daily tasks. Residents also receive assistance with activities of daily living such as dressing, bathing, and toileting.
In addition to controlled-access communal living rooms, dining rooms, and activity rooms, many Memory Care areas include secured outdoor patios, porches, and gardens for residents. By providing the opportunity to be with other residents and staff members, residents are more socialized and avoid being isolated as compared to living alone at home.
Find an LSS Memory Care Center for Your Loved One
Developing good communication with Alzheimer’s patients comes down to seeing the person and not the diagnosis. Throughout the stages of the disease, patience, listening, and being a good friend are the most important ways to foster good communication with an Alzheimer’s patient.
For each person and their family, the decision to investigate memory care comes at different times. The move is a big change for both the resident and family members. Working with the senior living community staff can make the transition easier. Staff have gone through this transition before and can provide resources and support!
LSS has communities throughout Missouri and Illinois offering high quality memory care. Find out more at https://www.lssliving.org/contact/