Caring for someone with Alzheimer’s disease or dementia – Communication

You might be the carer of someone with dementia or you might think that someone has symptoms of dementia but there has been no diagnosis yet. Of course, it’s important to know what’s going on but it can sometimes be a frustrating, long and complex process of getting a diagnosis.

So what is dementia anyway? It’s an umbrella term for a number of diseases of the brain. It’s a progressive illness: the brain shrinks and connections between different parts of the brain are progressively being lost. There are many types of dementia, the most common form is Alzheimer’s disease. You might think it just affects the memory of a person. However, think of the the brain as the command centre for all our behaviour and basically everything that makes us human. It controls and directs what we say and do, how we react and how we make sense of the world.

Communication becomes more difficult as the person with dementia becomes less and less able to make sense of the world as they used to. This can be very sad for you, frustrating and might sometimes make you just plain angry. Some carers have shared that it sometimes help to imagine that living with dementia for a person can be like being talked to in a foreign language that one doesn’t know or only has some rudimentary knowledge of.

Here are some useful ideas around communication.

Smile Although a person might not understand your words, smiling or sharing a laugh can be a positive way to connect. People with dementia are often acutely aware of body language and facial expressions and react more positively when you approach them with a smile.

Calm voice – less noise When you smile it’s also a lot easier to talk to someone in a calm, low pitch voice. When you are trying to talk to the person, make sure TV and radio are off and other noises are being kept to a minimum.

Touch Sometimes it’s just enough to hold or gently stroke a person’s hand or arm. Also, to get their attention, gently taking their hand or placing your hand on their shoulder is a good way of starting a conversation. Make sure they can see you before you take their hand.

Simple Only make one point at the time. Have you considered that the person might simply not see or hear you because they are not wearing their glasses or hearing aids? Talking at the top of your voice is simply exhausting.

Physical closeness A person with dementia might not know that you are talking to them. Make sure that they can see you and that you are close enough. Use the person’s name and don’t approach them from behind. When you are moving around while you are talking you are a lot harder to understand.

Slow – be patient It takes longer for a person with dementia to understand. Give enough time for a response Observe their body language. If a person looks concerned, turns away or gets angry, don’t take it personal. Try something else. Giving time for a response helps to understand if the person agrees to what you’ve suggested.

Steps – break it down Most people feel better when they can participate and do meaningful or enjoyable activities. Think of what a person can still do, what they used to enjoy or what they now enjoy. A person might still be able to dress themselves when you give them clear instructions what to do next. Communicate the order of a task in a clear and calm way – step by step.

Validate As short-term memory is being progressively you will notice that the person’s reality can be different to your’s as they spend time in the past. E.g. your mother might say she is waiting for her husband who has died years ago to return from work. Although it is tempting and only understandable to want to tell her that he is dead it would be more useful to try and enter her reality by trying to figure out what the feeling behind her expressed reality is. You could say something like ‘you really miss dad’. This might feel initially very unnatural to you.

Avoid arguments As a person with dementia progressively looses the ability for insight avoid arguments whenever you can. They usually make the situation worse. Sometimes distraction might be useful. Otherwise, if there are no safety concerns, simply agreeing would be the best strategy. Acknowledge that anger might sometimes get the better of you. Leaving the room in a situation that might otherwise lead to an argument and escalate gives yourself and the person time to calm down. Use a simple mindfulness technique like STOP (stop – breathe, open your senses and notice what’s around you – proceed). Once you have calmed down try to understand why the person has reacted in that way. Sometimes a person is restless or angry because they need something or are in pain and can’t communicate this in any other way.

Play music and sing The ability to enjoy music and sing is often maintained for a very long time. To spend some relaxing time together try to sing songs a person used to like. They might join and become calm and joyful. It is important to remember that every person with dementia is different. Allow yourself to try different ways and notice for yourself what works best.

Claudia is a registered psychologist who has a special interest in working with carers and has particular experience with carers of a person with dementia. She primarily helps people with Acceptance and Commitment training to increase psychological flexibility and mindfulness. She offers an initial free chat for new clients (20-30 minutes).

Please call Claudia on 0408 428 110 and visit http://www.claudiagross.com.au for more information.