Caring and Communicating With the Alzheimer's Patient

For more, Download our 32 page Guide to Alzheimer's Care

There are many challenges when communicating with someone who has Alzheimer’s Disease. This is because the person afflicted with Alzheimer’s disease does not interpret things the same way as a person who does not have Alzheimer’s. Additionally, the caregiver is busy with life and has a lot to do. Caregivers don’t think about the need to communicate in a different way and this is a mind shift. It is important for caregivers to understand the disease process and the benefit of a different style of communication. If the caregiver can learn to communicate differently, then they will be to accomplish more with the person who has Alzheimer’s and they can enjoy their life better together.

First, it is important to understand what the person with Alzheimer’s is going through.  The brain just does not function as it used to and the person has a difficulty keeping track of information, storing information, and retrieving information. That is why they cannot remember what they just did.  People suffering from Alzheimer’s are in the here and now. However, they may able to remember long ago, and that is because the brain degenerates in reverse order – from the present to the past, and that is why they seem to live in the past.

To help caregivers, Jo developed the ten (10) tools for caregivers to use when communicating with someone with Alzheimer’s disease. Keep in mind, that these tools are not easy initially, and will require patience and practice.

1. Absolutely, NEVER argue, instead, Agree. This includes not telling the person what they should not do.  These are generally for two primary situations: they want to see someone that is deceased and they want to go home. When you are in agreement, you can manage more together.
2. For example, if they want to visit someone that is deceased, which is difficult for family. Instead of telling them that the person is deceased and going down the road of not knowing, and so you are not lying to them, find a sentence of truth such as, “I have not seen him today.” Then, change the subject to a better topic.
3. If they want to go home: It is a common phrase for people with Alzheimer’s disease. A good answer is “so do I.”  Generally, home to them is a better place in time.  The statement puts you in agreement.
4. Never Reason instead divert or change the subject. Giving someone a reason to do something is unable to be processed. It is best to change the subject and divert them.
5. Never Shame or embarrass instead distract. It is important to be aware that the person is impaired, not their feelings. They are easily embarrassed even though they don’t know what they just said or did because of your expression. 
6. Never Lecture instead reassure them. Shame and lecture go together. When someone is having difficulty keeping track of the most recent things and retrieving what they promised, we tend to get in their face. It is important to remember  that by the time these tools become effective, the person with Alzheimer’s is probably far enough in the disease process to have frontal lobe damage. The frontal lobe is where manners are stored and it is responsible for impulse control. So, people will say what is on their mind. If we start to question them about why they said something and they can’t tell us, it becomes an argument and they may become aggressive as this is where the aggressive combative stage of the disease kicks in and the person becomes aggressive with the caregiver.
   
   You can apologize even if you have not done anything wrong. You can then go on to something else by changing the subject.

5. Never say Remember instead Reminisce with them. When you are talking to someone, don’t put them on the spot by not asking direct questions. They know that they don’t know the answers to questions which is why even yes/now questions don’t work very well.
   
   Picture books are great for reminiscing because pictures are taken of things in the past.  So instead of asking, “ who is in this picture?” you can say, “this looks like…” and if they don’t know, they don’t care.  But if they do, they can be the smart person and say” that looks like Tom.” It is a wonderful reminiscent tool. You go back in time, and can start a sentence by saying, “Well, that time we went to the park at Columbus and ..” and they will chime in.

6. Never say “I told you” instead repeat or regroup. Don’t get stressed. Oftentimes, caregivers try to do too much and get frustrated with the repetitive behaviors and hearing the same thing over and over. When you get stressed, it is time to regroup. Regrouping can be as simple as walkout of the room and coming back again, changing the way in which you breathe, count to 10.
7. Stop saying “you can’t” instead tell them what they can do. They are aware of the many things they cannot do. Find out what they can do and provide them activities that they can do so they can have meaning and purpose in life.
8. Never command or demand instead ask them or model the behavior. When you are busy and trying to get things done, you get demanding and commanding and they don’t respond well to that. They have disease processes that are coming in and sometimes their body does not do what they want it to do. If you want them to do something, model the behavior. I you want them to eat, sit down in front of them and show them how to eat.
9. Don’t condescend instead encourage or praise . For example, you take them to the doctor’s and when you get a chance to talk to the doctor, you are talking to the doctor about them in front of them. What is better to do, is when the doctor comes in position yourself to greet the doctor and say “we have some questions and concerns” and the two of you talk to the doctor and the doctor includes both of you in the conversation.
10. Never force instead reinforce . When a person is forced to do something, their psychological response of “fight or flight” kicks in and somebody will get hurt. Then they are labeled as a danger to themselves or others. If you need something to be done, you need to find skills and techniques to get it done, or you might have to wait and try again at a later time.

For more, Download our 32 page Guide to Alzheimer's Care