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Communication Skills

"The difference between the right word and the almost right word is the difference between the lightning and the lightning bug.". Mark Twain

The most important skill that a caregiver may need the most is effective communication with the care receiver!

Because Alzheimer's disease slowly erodes communication skills, an affected person's words and behavior may make little or no sense to you. Alzheimer's gradually strips the meaning from words, causing frustration, anger and frayed nerves of everyone involved.

The following are some specific suggestions of things to think about when communicating with an impaired person:

Importance of Communication
Communicating With Someone Who Has Alzheimer's
Your Approach Sets The Tone
Think Before You Speak
Doing Tasks Together
Having Trouble Being Understood
Things NOT To Do
When It Just Fails

When Doing A Task Together

Try to focus on familiar skills or tasks.

  • People with dementing illnesses gradually lose the ability to learn new tasks, but may be able to do familiar work, or hobby-related tasks or household chores even when very impaired.

Give choices, whenever possible.

  • For example, choosing whether to take a bath before or after dinner,
  • or choosing which of two shirts to wear, may help the person continue to feel some sense of control over life.

Allow plenty of time for the information to be absorbed.

  • People with dementia often need much more time to absorb simple statements or instructions

Allow a moment of silence before gently repeating an instruction. This requires a lot of patience on the part of caregivers.

Repeat instructions exactly the same way.

  • It may take a number of repetitions before the person responds.
  • If, after allowing plenty of time, it still is not understood, try using., different key words, or demonstrating what you want the person to do.

Break the task down into simple steps.

Most of our daily tasks are very complex activities; the concept of "getting dressed" or of "taking a bath" may be too overwhelming and abstract for a person with a dementing illness. Instead the person may be able to respond better to small, concrete steps - one part of the task at a time.

  • For example, the first step in getting dressed might be unbuttoning pajamas. The second step might be taking the right arm out of the sleeve, etc
  • Find out which steps the person is able to do and encourage those.
  • Gently help with steps that are more difficult.
  • Although this technique takes time and practice, doing tasks together can become much more successful and pleasant.

Modify the steps as the person becomes more impaired.

  • You may need to break the task into even smaller steps,
  • You may need to gently begin doing some of the steps that the person was able to do previously.
  • Again, this takes time and patience on the part of the caregiver but can be very rewarding for both the person with dementia and the caregiver.

Praise sincerely for success.

  • We all need to hear that we are doing a good job, and for people who are losing their abilities it may be particularly important.
  • Praise doesn't need to be long or "gushy" but may be a simple thank-you, or "You did a nice job.

Things NOT To Do

Don't argue with the person.

  • This always makes the Situation worse.
  • Furthermore it is important to remember that a person with dementia no longer has the ability to be rational or logical to the extent you do.

Don't order the person around.

  • Few of us like to be bossed around and the person with dementia is no exception.
  • Even when your words are not understood, your tone of voice will be

Don't tell the person what he or she can't do.

  • State directions positively, instead of negatively.
  • Instead of "you can't go outside now," try "Let's sit down here and look at these pictures."

Don't be condescending.

  • It is hard not to use a condescending tone of voice when you are speaking slowly and in short sentences.
  • However, a condescending tone is likely to provoke anger, even if the words are not understood.

Don't ask a lot of direct questions that rely on a good memory.

  • Often our attempts at being sociable involve asking people about themselves.
  • Remember that people with dementia have memory loss and may feel humiliated or angry if you ask questions they can no longer answer.

Try rephrasing.

  • For example, instead of "Who is this in the picture?", say "This must be your daughter."
  • This approach allows the person to reply gracefully and noncommittally if he or she is not sure.

Don't talk about people in front of them.

  • It is easy to fall into the habit of talking about people in front of them, when they can no longer communicate well.
  • It is impossible to know how much someone with dementia understands, and this may vary from moment to moment.



Having Trouble Being Understood

Be sure you are allowing enough time.

  • It may seem to you that you have waited a long time, but people with brain impairments often need a great deal of time to process information.

Try demonstrating visually what you are saying.

  • Though not always possible, this technique of doing and saying at the same time is often a very effective way of communicating.

Use Visual aids ?

  • Hold up the sweater when you are saying, "It's time to put on your sweater."
  • Point to the spoon when you are encouraging the person to eat.

Think about the complexity of what you are saying.

  • Can you say it more simply?
  • Is it too many words or too abstract for the person to understand?
  • Can you be more concrete?
  • Saying, "Why don't you sit in this chair?", while touching the chair, may be much more effective than "It's time for breakfast."

Try a hug and a change of subject.

If you are both getting frustrated, it may be a good idea to drop it affectionately for the moment and try again later.

  • Sometimes a hug and change of subject can make you both feel better. Other times you may need to leave the room and calm do

Having Trouble Understanding

Listen actively and carefully, to what the person is trying to say.

  • If you do not understand, apologize and ask the person to repeat it.
  • Let him or her know when you do understand by repeating it or rephrasing it.
  • Try to focus on a word or phrase that makes sense.
  • Repeat that back to the person and try to help him or her clarify what is being said.
  • Respond to the emotional tone of the statement.

You may not understand what is being said, but you may recognize that it is being said angrily or sadly.

  • Saying, "You sound very angry," at least acknowledges the feelings, even if you cannot decipher the words.

Try to stay calm and be patient.

  • Remember the person is not doing this on purpose and is probably even more frustrated than you.
  • Your calmness and patience will help create a caring atmosphere that will encourage the person to keep trying.

Ask family members about possible meanings for words, names, or phrases you do not understand.

  • Sometimes people with dementia talk in a kind of code that may make sense to people who have known them for a long time.
  • A name called over and over may be a close friend or relative from the past whose memory is reassuring.
  • "Let's go down the street to my house," may be a very logical way of referring to a long corridor and room, when the names for these places have disappeared from memory.
  • Language from childhood, Such as names for bathroom habits or pet names for things, may reappear in tile person's vocabulary.
    • While it is helpful to use their words (e.g., "pee" or "tinkle"), it is important to continue to treat them as adults, not children

When Communication Fails

Try distracting the person.

  • Sometimes simply diverting the person's attention to other activities - going for a walk, changing the subject, offering a snack, turning on the television ? may be enough to diffuse an angry or anxious mood.
  • Try again later.

Ignore a verbal outburst if you can't think of any positive response.

  • it is much better to ignore angry or agitated statements than to become angry yourself.
  • You might also try apologizing and letting the subject drop, or changing the emotional tone of the conversation. (e.g., making a positive, cheerful comment instead of an angry reply.)

Try other forms of communicating.

  • There are lots of ways of  communicating that don't involve words.
  • Familiar songs, gentle touching or massage, favorite foods, walking together can often demonstrate concern and affection more effectively than words.
  • These modes of communicating can also help soothe a troubled person and take the edge off difficult comments.