“When you’ve met one person with Alzheimer’s, you’ve met one person with Alzheimer’s,” said the Alzheimer’s educator at a workshop on Effective Communication Strategies.
Think about all the ways we communicate. It’s not just through words. It’s body language, gestures, tone, emojis and more. There are many ways to communicate and when an old way no longer works, we have to learn a new way. That’s our job.
Our friend or family member with Alzheimer’s is communicating with us the best she or he can, and it’s our job to figure out how to connect. The first thing we try may not work, but stay calm, be patient, rethink and try again.
Consider what we do when trying to understand or connect with a baby, a beloved pet or a foreigner who doesn’t speak our language. Don’t despair when a loved one with Alzheimer’s seems confused by something that use to be commonplace for him. Find another way.
The connection is worth it. A simple smile or a giggle from a loved one is worth the effort. If the choice is between giving up when the old way doesn’t work and losing that human connection or trying new strategies to maintain some type of connection — that seems like an easy choice.
Yes, I get it. It’s sad. It’s frustrating. It can be energy-zapping and heart breaking, but that smile . . . that smile for even a moment or the quick squeeze of a hand can be everything.
Knowing the person is key. Such knowledge can help inform which techniques work best.
Anytime I was home visiting and my father was going to bed, he’d kiss the top of my head and tell me he was glad to have me home. And when I was young and tagging along as he fed the cattle, he’d sing, “The Crawdad Song” or “You Are My Sunshine.”
I’m pretty confident that if I ever have difficulty communicating orally with someone, if the person kissed me on the head or sang “You Are My Sunshine” to me, it would mean the world.
And if my only means of communication is through actions and gestures instead of language, then what you think is an uncalled-for “fit” may very well be my reasonable reaction to the black and gold T-shirt you want this die-hard Cyclone to wear or to the disgusting coconut you just sprinkled onto my food.
In the early stage of Alzheimer’s, a person is able to convey thoughts and feelings through language and able to be involved in and make decisions about her care. But he may begin to have difficulty finding the correct word. She may take longer to speak or respond. He may start to withdraw from conversations. She may begin to struggle with decision-making and problem solving.
Ask how you can help. Does he want you to try to fill in the word that’s not quickly coming to him, or does he prefer for you to be patient and wait for him to find the word? Work to keep your sentences clear and straightforward. Use shorter sentences and simpler words. Leave plenty of time for conversations. Don’t think you can run in and out, getting a bunch of questions answered in a few minutes, or everyone will be frustrated.
Create memory aides. Write things down for her. Put photos on things, such as a photo of a toilet on the bathroom door.
In the middle stage, there will be increased difficulty in finding the correct word or a tendency to invent new words to describe familiar things. He may speak less frequently and easily lose his train of thought.
Use basic words and sentences, and help to create a smaller world. Continue to simplify. Ask one question at a time, and ask it exactly the same way several times — don’t change it or paraphrase. That could be confusing.
Try a different way if saying the same thing the same way several times doesn’t work. Make directions simple and one at a time. Think wedding vows. The pastor didn’t say the entire thing and expect you to repeat it. You got it in little snippets to repeat.
Be concrete. Say, “Here’s your shirt, please put it on” instead of “Get dressed.”
Approach the person from the front. Don’t surprise him from behind. State who you are, and call her by name. Avoid quizzing. Maintain eye contact, and get to his level, that is, sit if he’s sitting. Pay attention to your tone. Take your time. Avoid criticizing, correcting or arguing.
The goal is to positively connect. Strive to keep respect and empathy in your heart and mind. Validate and redirect if necessary.
It’s our job to join the person’s reality. It’s a bit like futurist time travel. Maybe the person is in a different place or a different location. Jump in and go there with him. Sure, let’s go to California of the 1960s. Why not?
Let her know you hear her. If you don’t understand the words, respond to the emotion. Limit distractions. Be patient. Use visual cues and gestures — mimic taking a bite, getting up, sitting down. Think charades.
In the late stage of Alzheimer’s, listen for expressions of pain, and respond promptly. Help him feel safe and happy. Keep talking, but bring all five senses to the communication — visuals, touch, sound, taste, smells.
So listen to favorite songs. Visit with animals. Knead bread dough. Sculpt clay. Give a hand massage. Look at photo albums. Visit an aquarium. Paint with watercolors. Go outdoors. Watch videos. Read to him. Sing to her. Smell flowers, herbs, lotions. Share some ice cream.
The possibilities are only limited by our own creativity and imagination.
The onus is on us to understand and accept what we cannot change. It’s on us to reach out and connect. Think of the iconic E.T. poster with the boy and E.T. touching fingers — that’s the human connection.
The Alzheimer’s Association provides examples of Dos and Don’ts:
Don’t reason with a long explanation and “I told you.” Provide a short explanation, and accept blame, “I’m sorry if I forgot to tell you,” even if you told him multiple times. Soothing him is soothing for you, too.
Don’t argue. If she thinks someone is forging her signature or stealing from her, respond to her feelings, reassure and distract — “That’s a scary thought. I’ll make sure they don’t do that. Would you help me fold the towels?” Think Tae-Kwon-Do or leading a dance partner — redirect.
Don’t confront. Respond to his feelings, reassure and distract — “I’m sorry this is such a tough time. I love you, and we’re going to get through this together. You know what? Suzy has a new job and she’s really excited about it.”
Don’t remind them they forget. Don’t respond to “Joe hasn’t called me” with “Joe called you yesterday.” Try instead: “You enjoy talking with Joe, don’t you? Let’s call him after dinner.”
Yes, I’m asking us to be time travelers, singers, mimes, detectives, masters of redirection and more — all to connect with a loved one for a moment, to share a smile and make her feel loved and safe. No doubt that’s the way she always made us feel. Priceless.