Alzheimer's Disease: Communication Strategies

With the loss of cognitive abilities associated with Alzheimer's disease often comes a loss in residents' abilities to communicate. This loss involves both difficulties in the residents understanding others and in making themselves understood. Hearing and visual impairments associated with aging may also make communication a challenge. The following article outlines some of the strategies used at Illinois Council facilities to effectively communicate with these residents. As each resident is an individual, caregivers must be flexible in communication, adapting their strategies to reflect the residents' changing cognitive levels and abilities.

Challenges with Communication

Persons with Alzheimer's disease face a variety of communication challenges. They may have difficulties in finding the right word during conversations sometimes substituting a word that sounds similar to a word that they cannot remember, such as saying "wrong" for "ring" or "music thing" for "piano." They may try to describe the object that they cannot name or create a new word to describe this object. When their vocabulary becomes severely limited, they may use keywords over and over, even if they are meaningless to others.

Having- limited attention spans, they may find it difficult to follow long conversations. Being able to focus only on one thought at a time, multiple step instructions may lead to confusion. Even activities that most people take for granted, such as tying a shoelace or watering a plant, become difficult be-cause of the many small steps involved.

Short term memory problems can lead to residents losing their train of thought or repeating thoughts over and over. They may quickly forget what they did understand in the beginning of a conversation. Background distractions such as television noise or nearby conversations can compete for attention and impair conversation.

Residents with dementia may try to cover up their communication problems. They may become frustrated or angry when they cannot formulate the words to answer a question. They may say that they understand something, when in fact they don't. These communication challenges and their resulting frustrations may precipitate many of the common problem behaviors found with persons with dementia.

Communication: Focusing on Abilities

While recognizing the residents' communication challenges, caregivers are also capitalizing on residents' communication abilities. These residents still have many ways that they can express themselves and understand what people are saying. Nursing home staff are challenged to be creative and adapt their communication strategies to meet the residents’ unique needs

Residents have many opportunities for making their thoughts understood. While they may have difficulties with using language, they often have abilities in utilizing facial expressions, making gestures, or pointing to an object. Their daily behaviors are also a form of communication, expressing their emotional states. Caregivers must become creative listeners, looking at both the residents' verbal and non-verbal communications.

Residents with dementia also have many tools at their disposal for understanding others. They compensate for their language-based difficulties by becoming very sensitive and adept to non-verbal communication, including gestures, tone of voice, and touch. They become more intuitive, able to read a person's emotional status and discern easily if a person is uncomfortable around them. Many retain the ability to respond to more simplified language and one step instructions.

Communication Strategies: Helping the Resident Understand You

Through trial and error, Illinois Council facilities have discovered many successful strategies for communicating with residents who have Alzheimer's disease.

In initiating conversations with residents, caregivers begin by making eye contact getting the residents' attention before saying anything. They then identify themselves and call the residents by name. For instance, one could say "Good morning, Mr. Jones. I am your nurse assistant, Mary." They make sure to never question or test the residents. Questions such as 'Who am I, Mr. Jones?" or "Do you remember me?" cause nothing but frustration and anxiety to a resident with limited cognitive abilities. This advice should be shared with family members, who often feel a need to quiz their loved ones.

Caregivers make sure to speak slowly and distinctly to residents in a low pitched voice, maintaining an open, calm, and friendly manner. Because many residents can only process one thought at a time, they remember to use only short and simple sentences.

Tasks are broken down into clear and simple steps For instance, In helping a resident put on a shirt, a staff person could say, "Put your arm in the sleeve," "Button up," and "Tuck in your shirt tail." Staff also are aware of what words are familiar to the residents and use these words often, including those in the residents' native languages.

Open-ended questions, such as "What would you like to eat?", are avoided whenever possible. Caregivers try to make their questions specific, offering a yes/no question or a choice between items such as "Would you like to have some chicken?" or "Do you want chicken or beef?"

If a resident doesn't understand a question repeat it exactly, only later changing the wording if the resident is still confused. As many residents need more time than the average person to process the question, it is important to be patient, giving them the extra time they need.

Residents with dementia need to be spoken to in an environment with as few distractions as possible. Caregivers make sure to turn off radios and close room doors. To further improve resident attention, they speak to residents face to face, kneeling down to the floor for residents in wheelchairs.

Facial expressions, gestures and touch are used to their fullest potential to facilitate understanding. To make a message clear to the resident, a caregiver may want to demonstrate the desired behavior, such as "brushing" a finger across one's teeth when asking a resident to brush her teeth. It may also be helpful to hold up a picture or show the resident an object.

Expressions are avoided that may be taken too literally by the resident. For instance, using the phrase "Why don't you hop into bed?" may lead the resident to do just that.

A smile or a hug speaks volumes to a person with dementia, communicating that they are cared about and appreciated. The entire communication experience should be made as positive as possible. Make sore to talk in positive terms, limiting the use of the word "don't and avoiding harsh orders. Instead of saying "Don't put on that dirty shirt," one might say, "Would you like to put on this pink shirt over here?"

It is imperative that residents with dementia be spoken to in a respectful and adult-like manner. Staff strive to never talk down to a resident or use condescending language. Even with their limited cognitive abilities, these residents are still able to tell if they are being treated like children.

Caregivers make sure never to speak about residents in front of them as though they are not there. Even if residents cannot understand what is being said, they will feel disrespected. Residents particularly become confused and upset if staff talk around them in a foreign language.

Communication Strategies: Helping the Residents Communicate

There are many ways that Illinois Council facilities help residents to communicate their thoughts and needs. Realizing that self-expression is vital to resident well-being, nursing home staff have taken the extra time and the energy needed to help residents communicate. By talking with residents and showing interest in their feelings, staff convey to residents a feeling of concern and respect.

Make sure to be calm, supportive, and attentive. Every effort should be made to show interest in what the resident is saying. One must try not to interrupt residents with dementia when they are attempting to communicate an idea, as this may cause them to lose their train of thought. Eye contact and touch are excellent ways to let residents know that their thoughts are being heard. To keep a resident on a subject, caregivers can ask relevant questions or summarize what has already been said.

Sometimes it may be difficult to under-stand what the resident is saying. Caregivers find it helpful to supply a word that the resident may be struggling for. They may encourage residents to use other forms of communication, such as pointing to an object, making a gesture, or giving a description.

Through experience staff have become adept at reading the residents' vocal tone or body movements to understand what the resident is feeling. While caregivers may be able to guess what a resident is trying to say, they remember to ask if these guesses are indeed correct. Through all of these efforts ,questions must be phrased in such a way that they do not damage the residents' self-esteem.

Caregivers try to never contradict or argue with the resident with dementia as this may lead to a catastrophic reaction. If residents say "I'm waiting for my mother to take me home," telling them that their mothers have passed away will only upset them. As residents with dementia often "live in the moment," they may react to this statement as though they are hearing it for the first time.

Caregivers look at the emotional meanings and subtext behind the residents' statements. Residents waiting for their mothers most likely feel lonely, insecure, and fearful. One can help alleviate these negative feelings with a statement such as "Don't worry I'm here to take care of you." Another suggestion is to distract the resident and offer a "therapeutic fib." The caregiver might say "Your mother will be here in a little while. Why don't you join us for some coffee and cake." Involved in another activity, residents often will forget about their anxiety.

By being creative and flexible, caregivers at Illinois Council facilities have found many ways to maximize the communication abilities of residents with Alzheimer's disease. These strategies have increased residents' autonomy, reduced feelings of frustration, and promoted the residents' continued involvement in life.