HOW TO TALK TO SOMEONE WITH DEMENTIA

When a person with dementia has a difficult time understanding or following a long conversation. Breaking the conversation into small segments, with a repeat of important information will be more effective than a long talk. Help the person with dementia stay focused by making great eye contact, holding the person’s hand, any additional focused connection. Be very attuned to facial expressions. When one word doesn’t seem to be understood, use a simpler word. Adding gestures can not only demonstrate words, but can also bring more focus to the speaker.

A person with dementia may lose their train of thought during a conversation. Helping the person with dementia with a word, or forgotten idea depends on the relationship. If the confused person feels that they are being controlled, this form of “help” may be viewed as an intrusion. If it can be done in a lighthearted way, it can guide the person back to their train of thought.

A person with dementia can be very distracted in a noisy environment. One of the first things Sara noticed about her husband was that he seemed rattled when out in a restaurant. She started requesting a table far from the kitchen, where the slightest clang of utensils, would make her husband turn to the sound. He frequently complained about the noise, even though it seemed very normal to everyone else. As time went on it became apparent that in order to even conduct the simplest of table conversation, they would need to go dining at off hours, when the restaurants were almost empty.

A person with dementia may begin to avoid crowded events, or become anxious in crowds. Not only dining out can become a problem, but going to a theater, sporting event, church service, or any event where there are large amounts of people, can be an opportunity for the confused person to become anxious. Very good pre-planning for any event becomes so important. If the caregiver doesn’t plan well, and is running late to an event, the confused person will take on the anxiety as well.

Virginia Garberding RN

Certified in Gerontology and Restorative Nursing

SENIOR WITH ALZHEIMER’S DEMENTIA CHANGES TRYING TO COMMUNICATE

Of all of the changes the family sees in their loved one with Alzheimer’s dementia, the most frightening is personality and behavioral changes.  When the senior with dementia acts childish, irrational, stubborn, suspicious, paranoid, or becomes physically combative, the caregiver can be frightened.  The caregiver can feel that the relationship is over, this person is now a stranger.

These behaviors are not only frightening for the caregiver but even more so for the person with dementia.  Preventing behaviors is always the goal, and so much easier that dealing with a full burst of anger.

Preventing bad behaviors:

  • be alert and aware to what is going on in the environment – if the last time Grandpa became angry were there too many people, too much talking, too much noise, just too much stimulation?
  • arguing with a person with dementia never works, the person just doesn’t have the reasoning skills any longer to engage in finding solutions – divert attention and head off any confrontations
  • respect and protect the elder’s dignity , there is a real reason why bathing is such a hard task for someone with dementia – being undressed is a huge loss of control
  • make every task as simple as possible – breakdown the task into one step at a time – even though this slows progress – slow and happy is much better than fast and unhappy
  • reassure, and reassure again and again – the elder is very afraid of being abandoned – even the most demanding elder is basically afraid of abandonment

The elder with dementia doesn’t mean to be difficult. Difficult behaviors are a means of communication by the elder. The elder knows that they are missing something everyone else understands. The changes the elder feels they are no longer able to communicate with words. So the elder will try to gain control over their environment through – behaviors.

Virginia Garberding RN

Certified in Gerontology and Restorative Nursing

ALZHEIMER’S DISEASE AND LASTING ABLILITIES – THE ABILITY TO SEE AND READ BODY LANGUAGE

Lois was just leaving the shower room of the nursing home, bundled up in her brown and blue bathrobe. She was talking to her caregiver about what a fine shower she had just enjoyed. Then she saw the family standing together in the hallway of the nursing home. “She is crying” Lois said pointing at one of the women. “And she is too,” Lois continued, “They all are crying.”

Because Lois has been affected by her Alzheimer’s disease, she no longer follows social conventions when speaking. If something occurs to her, she just says it. The mother of these young adults had just died, and Lois could clearly read their body language. As they stood there with arms around each other, supporting each other and crying, Lois could tell something was very wrong.

The ability to read a caregiver’s expression and body language remains long after the person can no longer speak to you. A look of anger or disgust is rarely missed by the confused person. That caregiver who is given to smiling, singing, whistling and always has a pleasant expression is the caregiver worth their weight in gold.  Because the confused elder, he or she is caring for, is in the moment and can be made happy by a happy caregiver.

This was a great reminder for all of us working in the Nursing community. Lois spoke for all of the residents who couldn’t that morning. All of the residents could read the body language of those family members. They could see the grief and recognize their pain. Because they can’t tell us what they see doesn’t mean they don’t see it and understand. The person with advanced Alzheimer’s disease just needs a Lois sometimes to remind us.

Virginia Garberding RN

Certified in Gerontology and Restorative Nursing

ALZHEIMER’S DISEASE – LOSS OF REASON AND BAD DECISIONS

We have all met or known people who appear to have little ability to take facts, and then think through what is practical and possible. Not a difference of opinion, but a real lack of the ability to think about a situation and come up with a logical conclusion. Not brain surgery, but everyday simple decisions we all make, the inability to reason.

I think of Myrtle, her husband Phil had Alzheimer’s disease and still very much wanted to “help.”  Phil had never been involved in the kitchen for the 45 years of their marriage. Now, since he was home all the time, he had evidently decided to get involved in what had always been Myrtle’s territory. His “help” was making Myrtle feel on guard all the time – guarding her kitchen.

Since Phil became involved, kitchen items Myrtle had had all their married life were disappearing at a frightening rate. Myrtle’s favorite spatula she had for 40 years was gone. She knew Phil, in his confusion was throwing things away; she had found enough things in the garbage to know that.

Phil really liked to run water and took every opportunity to get to the sink and run water. If Myrtle didn’t immediately clear the table after meals and rinse dishes, she could expect hamburger, pieces of fish, paper towel just about anything to be floating in the sink. Phil was fast! Once Phil got the water running, he would get easily distracted and leave the kitchen, only to have Myrtle later find water overflowing.

Phil was no longer able to reason that he would forget about the water, as he had in the past. He never thought, maybe it isn’t a good idea to leave running water. He no longer learned from past experiences.

Myrtle’s solution was to try as best she could to stay one step ahead of Phil. In the kitchen her policy was to simplify-simplify. Although she would like to make the traditional meals Phil so much enjoyed. It now was too hard for Myrtle to keep that up and still monitor Phil. Simpler meals, less ingredients and preparation time cut down on the time she needed to focus on being one step ahead.

Myrtle and Phil started eating out more often at their local café. This gave Phil the socialization he needed and the rest from meal preparation Myrtle needed. Many people have found that when their spouse is in the early stages of Alzheimer’s disease, going out to eat are a normal activity that can still be successfully enjoyed.

Myrtle thought about how she could make their life run more smoothly and put these changes into place because, thank the Lord, Myrtle could still reason.

Virginia Garberding, R.N.

Certified in Gerontology and Restorative Nursing

BEING AN EXTREME CAREGIVER MEANS BEING CONSERVATIVE AND LIBERAL

The Conservative Caregiver

Be conservative in your criticism and in the use of negative words. Words like “stop,” “don’t,” “that’s wrong,” “I already told you that,” and so on and on.

When you have Alzheimer’s disease or another dementia causing illness, your day is full of mistakes. You no longer remember how to go about doing a familiar task.  You may no longer recognize people or your environment causing you to make even more mistakes.

It is very hurtful to have attention drawn to your on-going mistakes. The caregiver who is very frugal and conservative with hurtful words or comments is giving a priceless gift to the elder they care for.

The Liberal Caregiver

Be liberal in your use of positive sounding words and compliments. Use positive words that encourage like: “good job,” “nice,” “looks good,” “I like that,” etc. Be liberal in your supportive words like “thank you,” “I appreciate your help,” etc. Be liberal in your complimentary words like “beautiful,” “pretty,” attractive,” “strong,” “cute,” etc.

Once you start thinking in terms of positive sounding words and you see how really powerful those words can be, being a conservative/liberal caregiver will just come naturally.

Virginia Garberding R.N.

Director of Education, The Wealshire, Lincolnshire, Illinois

Author: Please Get To Know Me – Aging with Dignity and Relevance

www.pleasegettoknowme.com

How to Use Cues to help the Confused Elder Understand What is Happening

Helping the confused elderly through cues.

Oxford Dictionary defines cue as” a signal to do something.”

The cue may be a smell, a touch, a sound, an item, or a visual symbol. Using a full complement of cues through out the day can help the confused elderly understand the environment, and what is happening at any given moment.

A familiar smell can tell the confused elder it is time to eat

A smell can be a cue that is time to eat, if the cue you smell is pot roast.  A smell can stimulate your appetite such as passing a bakery and smelling the cookies, may make you feel like having a cookie. A fragrance such as baby powder cues you that there is a baby around.  The smell of laundry soap cues you that you are wearing clean clothes.

Seeing a symbol works best as a cue, when the symbol looks the most like what it represents. So a picture of a lawnmower will be a better cue than a line drawing of the same mower. A picture of a banana will not be as good a cue for “do you want a banana” as holding out a real banana to the confused elder.

Helping the confused elderly through combining cues.

Putting a favorite hand lotion on the elder’s hands and massaging it in is using the cues of touch as well as smell.  Hearing running water, holding a bath towel and smelling their life long favorite soap, Dove can cue the elder that they are taking a bath.

Communicating with the confused elderly using cues is non-verbal communication. When the elders have lost their “words” and no longer understand what is being said to them. They can still understand what is going on around them, through your cues.

Cues are forms of communication – helping the confused elder do more for themselves, better understand the environment and know what is going on around them, is the reason for offering cues.

Virginia Garberding R.N.

Director of Education, The Wealshire, Lincolnshire, Illinois

Author: Please Get To Know Me – Aging with Dignity and Relevance

www.pleasegettoknowme.com

When the caregiver of the confused elderly want to know, “How can I help you understand more?”

Caregiver of confused elderly

Helping the confused elderly through cues.

Oxford Dictionary defines cue as” a signal to do something.”
The cue may be a smell, a touch, a sound, an item, or a visual symbol. Using a full complement of cues through out the day can help the confused elderly understand the environment, and what is happening at any given moment.

A smell can be a cue that is time to eat, if the cue you smell is pot roast. A smell can stimulate your appetite such as passing a bakery and smelling the cookies, may make you feel like having a cookie. A fragrance such as baby powder cues you that there is a baby around. The smell of laundry soap cues you that you are wearing clean clothes.

Seeing a symbol works best as a cue when the symbol looks the most like what it represents. So a picture of a lawnmower will be a better cue than a line drawing of the same mower. A picture of a banana will not be as good a cue for “do you want a banana” as holding out a real banana to the confused elder.

Helping the confused elderly through combining cues.

Putting a favorite hand lotion on the elder’s hands and massaging it in is using the cues of touch as well as smell. Hearing running water, holding a bath towel and smelling Dove soap can cue the elder that they are taking a bath.

 

Communicating with the confused elderly using cues, is non-verbal communication. When the elders have lost their “words” and no longer understand what is being said to them. They can still understand what is going on around them, through your cues.

Cues are forms of communication – helping the confused elder do more for themselves, better understand the environment and know what is going on around them, is the reason for offering cues.

Caregiver Tips: How the senior who has Alzheimer’s Disease forgets their words.

Word loss can be predicted for the senior with Alzheimer’s disease.


As a person goes through the stages of this disease they will lose the ability to talk. In the very beginning they have word finding problems, and they start substituting words, when they forget a word. In the mid-stage they may have just a few words and in the late stage many times they have only one word left and it is yes, or no.

Confused seniors no longer understand concept words.


As people with Alzheimer’s disease lose the words they say, they also are losing the ability to understand words. So when working with someone in the mid-stage who has few words saying to them “do you want to have lunch” won’t be understood. This is why Alzheimer’s specialist say to use concrete words and when ever possible show the item.

As a very young child grows they first can identify a banana by seeing a real banana. They then progress to being able to identify a picture of a real banana, then a drawing of a banana and finally they understand the word banana and can be asked if they want a banana without showing them the fruit itself.

Persons with Alzheimer’s disease lose their words and the meaning of the words in the same order they gained those words. So for the person who is losing these words, once again showing them an actual banana and saying do you want a banana will work much better than the word alone.

Help the senior understand by showing.


So when you talk to a person with Alzheimer’s disease, turn “do you want to have lunch” from a question into a statement “let’s have a sandwich” while you show the bread and lunch meat.

Anytime you turn a question into a statement and an idea into something concrete to be seen you will have greater success.

Caregiver Tips: The senior’s name is so important, when working with the senior with Alzheimer’s Disease.

Use the name the senior responds to.


Everyone’s name is important to them. Many people have a special significance to their name. They were named after someone in the family, by someone usually their mother. This is the word that people respond to even very late in the disease process.

I remember a woman who had lost all of her words, was total care in all activities of daily living. And as I walked past her in the hall, all I said was “Gracie”, and her head turned towards me. She was at the end of her life and died soon afterwards but till the end she still responded to her name.

Make sure you are using the name that the person still responds to. When caregivers call everyone “Grandma” that person may have long forgotten that they are a grandma. And so much worse, if the caregiver doesn’t really know them and they never were a grandma – how confusing would that be. I have seen elderly women only respond to their maiden name and when living in a nursing home, the home had to use both maiden and married names to identify them.

Everyone deserves the dignity of being called by the right name; take the time to find out that name.

Caregiver Tips: 8 Tips for communicating effectively with a senior with Alzheimer’s disease.

8 Steps to better communication with the confused senior:


• Talk slow – people need time to process and understand words. People with Alzheimer’s disease need even more time.
• Make sure you have the person’s attention, make eye contact. This means if the person is in a wheelchair, stoop down or sit down to talk to them at their level – eye level. Standing over someone and talking down to them can be intimidating, or it might make the person think you are speaking to someone else.
• Give one direction at a time. People with Alzheimer’s disease can’t remember several things at a time.
• Use concrete names. Say” please put the plate over here” – don’t say “put it over here” using “it” for plate. Use a person’s name instead of he or she and add the person’s relationship. Instead of “he is parking the car” say “Bob your brother, is parking the car.”
• Remember “please” and “thank yous”. People with Alzheimer’s disease retain courtesy late in the disease process. I have seen people with no language skills left, yet still able to walk. If they bump into you will say “sorry” or “excuse me”, even though they can say nothing else.
• Keep it simple. Don’t use a lot of words when few will do. It might be your way to talk a lot, and the sound of the human voice can be very soothing. But not if the words are expecting something from the person unable to understand and so cause frustration. But informative conversation about the family, the weather, food, anything that doesn’t include questions and require answers, will be positive.
• Don’t argue. In fact if there is a misunderstanding apologize before emotions escalate. If you don’t understand what the person wants or is trying to communicate simply say “I’m sorry, I don’t understand.”
• When things go wrong or mistakes are made, laugh it off. Not in a way where the person might think they are being laughed at – but rather in a way that says, we all make mistakes – this isn’t a big deal.

Let Go – Let God. Keep in mind the big picture see (Let Go Let God) the last chapter of my book Please Get To Know Me – Aging with Dignity and Relevance.