Alzheimer’s disease and other dementias affect areas of the brain responsible for communication. In this section, you will learn ways to adapt your behavior to communicate better with your clients.

COMMUNICATION CHANGES

Early Stage:

  • Vocabulary shrinks

  • The person may use wrong or similar words

  • The person may become quiet and withdrawn

Middle Stage:

  • More vocabulary loss

  • Difficulty finding words for common items

  • The person may not understand what is spoken

  • The person may be aware of their language mistakes but unable to correct them

Late Stage:

  • Limited vocabulary

  • Extreme difficulty speaking and cannot correct speech

  • May appear like they cannot speak at all

  • Probably cannot understand written words

  • Unclear how much spoken words are understood

At any stage, do not assume the person can’t understand. Never speak as if the person is not there.

Someone told a story about a woman who appeared as she could not understand. A friend spoke about her to her husband as she stood next to him. Tears began to stream down her cheeks. She clearly understood and her feelings were hurt.

Watch Video on the Bookcase Analogy:

Watch the entire video—it clearly explains what is happening as Alzheimer’s progresses and how our non-verbal communication is so important. It also makes it easy to understand so you can explain Alzheimer’s to someone else.

The old saying, “It’s not what you say, but how you say it that matters” becomes so very important.

Alzheimer’s and Dementia Best Practices for Communication:

  • Approach the person from the front, make eye contact.

  • Address the person by name. “Good morning, Mary, it’s Susan, your caregiver. I’m here to help you today.”

  • Use simple, easy sentences, giving direction. “Mary, sit in this chair.” NOT “Would you like to sit down?”

  • Give choices if it is really okay for them to make a choice, but don’t give suggestions. For example, instead of saying, “Wouldn’t it be nice to get a shower and be clean before bed?” say, “Mary, it’s time to take a shower so you can be all clean for bed and get a great night’s sleep.”

  • Avoid inappropriate questions or asking a person if they remember. For example, don’t say, “You raised 4 children so you should remember how to brush hair” say, “Mary, you raised 4 children, I bet you brushed a lot of hair in your days.”

  • If the person says they are hungry and have not eaten, don't say, “You had a big breakfast, don’t you remember?” Instead say, “It has been a while since you ate breakfast, I bet you are getting hungry. We will have lunch soon.”

  • Divide tasks into small steps. Instead of saying, “Get ready for lunch” say, “Mary, it’s almost lunchtime. Let’s wash your hands before we eat.” Then add the next step, “Please place a napkin at each plate.”

  • Touch is important. Use nonverbal cues. Do not patronize and be kind in words and tone of voice.

  • Speak slowly and repeat phrases using the exact same words.

  • NEVER argue or correct. If Mary asks when her mother is coming, don’t say, “you know your mother is dead.” Instead say, “Your mother was a kind person, tell me about her.”

We are told from the time we are young children to always tell the truth. As a caregiver for Alzheimer’s clients, it is important that you remember their reality may be very different. In order to comfort them, you need to join their world. This may often mean that you pretend to provide for their best interests.

Pay attention to non-verbal communication, it will often be more important than verbal. This goes for both you and the client. In later stages, when the person loses the ability to speak, being attuned to their non-verbal clues will help you communicate more effectively.

Don’t Take Anything Personally

Don’t expect the person to recognize you or recall your relationship each shift.

Watch Video on Communication:

EXERCISE MAY IMPROVE COMMUNICATION

A recent study at the University of Miami with 30 nursing home participants diagnosed with probable Alzheimer’s (in the moderate to severe stages) were divided into 2 different groups. One group participated in planned walking while communicating for 30 minutes, three times each week. The comparison group did not walk or perform any other type of physical activity, but rather, they engaged in conversation only.

The study authors discovered that when group participants walked as they conversed, communication improved significantly, compared to the study group that just conversed without engaging in any type of physical activity.

In just 10 weeks, communication improved significantly in the planned walking group with Alzheimer’s, compared to the participants with the disease who only had conversations.

The study data suggests that planning a regular schedule of walking, at least 30 minutes, 3 times per week, while talking with a person with Alzheimer’s, is an effective tool for improving communication performance, in people diagnosed with moderate to severe stages of the disease.

HELP MAKE COMMUNICATION EASIER

Remember to:

  • Make eye contact

  • Use simple sentences

  • Ask Yes/No questions, not vague open-ended questions

  • Be aware of your tone and body language

  • Don’t pretend the person is not there or does not understand

  • Use touch

  • Try distracting the person or changing the subject if communication creates problems

Validation Therapy

Validation therapy was developed in the 1960s and ‘70s by Naomi Feil to help treat Alzheimer’s disease. It is a holistic therapy that focuses on empathy and helps people communicate. Its goal is to promote peace and wellbeing.

How the Validation Method Began:

Naomi Feil, a social worker for the elderly, was unhappy with the common practices at the time and developed her own methods. She published Validation: The Feil Method, in 1982 and The Validation Breakthrough, in 1993.

  • Validation therapy emphasizes empathy and listening

  • The caregiver’s job is to offer these individuals a means for expression, verbally or nonverbally, so at the end of life they can pass in peace

Example:

A woman is convinced someone is throwing away her most precious belongings, including photo albums and scrapbooks. The woman is actually hiding these things.

Instead of arguing with the woman, you could rephrase the situation, helping her reminisce about her youth in a positive light: “Your wedding ring is gone. You think I’ve stolen it?,” “It was a beautiful ring,” “How did you and your husband meet?”

Watch Video on Validation Therapy:

💡 Tip Sheet

Communication Abilities Change According to Alzheimer’s Stages, Never Speak as Though the Senior Doesn’t Understand, You Can Still Communicate Non-Verbally, Never Argue or Correct, Exercise May Improve Communication, Validate Your Client’s Feelings