I attended a caregivers workshop this week on the topic of communicating with those with memory loss, dementia, or confusion. A packet was given to attendees. One of the items in the packet is this Family Caregiver Alliance (caregiver.org) handout on "Ten Tips for Communicating with a Person with Dementia." I've copied those tips below.

Robin



Ten Tips for Communicating with a Person with Dementia
Family Caregiver Alliance
Excerpted from FCA Fact Sheet: Caregiver's Guide to Understanding Dementia Behaviors

We aren't born knowing how to communicate with a person with dementia—but we can learn. Improving your communication skills will help make caregiving less stressful and will likely improve the quality of your relationship with your loved one. Good communication skills will also enhance your ability to handle the difficult behavior you may encounter as you care for a person with a dementing illness.

1. Set a positive mood for interaction. Your attitude and body language communicate your feelings and thoughts stronger than your words. Set a positive mood by speaking to your loved one in a pleasant and respectful manner. Use facial expressions, tone of voice and physical touch to help convey your message and show your feelings of affection.

2. Get the person’s attention. Limit distractions and noise—turn off the radio or TV, close the curtains or shut the door, or move to quieter surroundings. Before speaking, make sure you have her attention; address her by name, identify yourself by name and relation, and use nonverbal cues and touch to help keep her focused. If she is seated, get down to her level and maintain eye contact.

3. State your message clearly. Use simple words and sentences. Speak slowly, distinctly and in a reassuring tone. Refrain from raising your voice higher or louder; instead, pitch your voice lower. If she doesn't understand the first time, use the same wording to repeat your message or question. If she still doesn't understand, wait a few minutes and rephrase the question. Use the names of people and places instead of pronouns or abbreviations.

4. Ask simple, answerable questions. Ask one question at a time; those with yes or no answers work best. Refrain from asking open-ended questions or giving too many choices. For example, ask, “Would you like to wear your white shirt or your blue shirt?” Better still, show her the choices—visual prompts and cues also help clarify your question and can guide her response.

5. Listen with your ears, eyes and heart. Be patient in waiting for your loved one’s reply. If she is struggling for an answer, it’s okay to suggest words. Watch for nonverbal cues and body language, and respond appropriately. Always strive to listen for the meaning and feelings that underlie the words.

6. Break down activities into a series of steps. This makes many tasks much more manageable. You can encourage your loved one to do what he can, gently remind him of steps he tends to forget, and assist with steps he’s no longer able to accomplish on his own. Using visual cues, such as showing him with your hand where to place the dinner plate, can be very helpful.

7. When the going gets tough, distract and redirect. When your loved one becomes upset, try changing the subject or the environment. For example, ask him for help or suggest going for a walk. It is important to connect with the person on a feeling level, before you redirect. You might say, “I see you’re feeling sad—I’m sorry you’re upset. Let’s go get something to eat.”

8. Respond with affection and reassurance. People with dementia often feel confused, anxious and unsure of themselves. Further, they often get reality confused and may recall things that never really occurred. Avoid trying to convince them they are wrong. Stay focused on the feelings they are demonstrating (which are real) and respond with verbal and physical expressions of comfort, support and reassurance. Sometimes holding hands, touching, hugging and praise will get the person to respond when all else fails.

9. Remember the good old days. Remembering the past is often a soothing and affirming activity. Many people with dementia may not remember what happened 45 minutes ago, but they can clearly recall their lives 45 years earlier. Therefore, avoid asking questions that rely on short-term memory, such as asking the person what they had for lunch. Instead, try asking general questions about the person’s distant past—this information is more likely to be retained.

10. Maintain your sense of humor. Use humor whenever possible, though not at the person's expense. People with dementia tend to retain their social skills and are usually delighted to laugh along with you.

Another really good list. Thanks again, Robin.

Great synopsis of skills/advice. Do you suppose this could be put on a computer chip and implanted in certain people's brains so they "get it"?

My mom often has trouble naming things. I've learned that if I ask, "What is it used for?", she can answer that, and then I can figure out what it is she's trying to talk about. For example, she had to spend the night with me one night last spring, and I found her at 3:00 a.m. in my car! She was looking for something. I asked her "What are you looking for?" She answered, "The car thing." When I asked her what it's used for, she said, "To park." Then I knew she was looking for her disabled parking permit. Only Lewy can explain why she needed it at 3:00 a.m. I told her I had it in my purse, got it for her, and she went back to bed. What is scary is that my car was in the garage downstairs (17 steps). She falls frequently. We've told her she can't go down the stairs unless someone is with her, but she doesn't remember. We'll have to install a baby gate if she has to spend the night again.

SandwichMom, not to get off the track, but just voicing a concern about baby gates to restrain adults, especially confused adults--please be very careful. I have looked at a lot of baby/pet gates for use with my dogs, and there is a huge range of quality, safety and purpose. Some gates specifically say they are not to be used at the top of stairs, some are not tall or sturdy enough to restrain anyone larger than a toddler, etc. I know of one sad case where someone put a baby gate at the top of the stairs, it wasn't appropriate for the purpose, an older child tried to climb over it, the gate fell over, and he had a very bad fall down the stairs, possibly worse than if there had been no gate.

Julianne

I am in total agreement with the use of a baby gate at the top of the stairs another alternative might be to install a inexpensive screen door in the room , just a thought!

I like this list…

In the order listed….numbers 1, 2, 3, in the order listed….make me happy

1. smile
2. turn off the tv
3. to the point…ask the question….please?
4. smile…again...

Thanks for the warning about the baby gate. I thought it would just serve as a reminder to her that she's not supposed to go down the steps by herself, but I can't count on her to be reasonable anymore, so she just might try to get over it. A screen door isn't an option, though. One side is just railing. When our son was a toddler, we had one side of the gate attached to the wall and the other side attached to the railing post. I think I probably just can't have her spend the night anymore. I'll have to stay with her instead.

Sandwichmom, I recently bought a motion detector with a receiver. I use it in the bathroom, I put the detector on the floor and have the receiver in whatever room I'm in, it chimes if Frank goes into the bathroom so I can go help. I'm using them with batteries but you can buy a cord for the receiver. I have been very pleased with it. Just wanted to pass that on.

Gerry

Gerry, that is a great idea. I've thought about it for her house (except my dad is hard of hearing so needs additional equipment--bed shaker, flashing lights), but I hadn't thought about it for my own house. Thanks for the suggestion. At night I could put it in the hallway so that if she passes a certain point, I can wake up in time to keep her away from the stairs.

Robin, I also had a copy of that given to me at a Caregiver Support Meeting. They had a lot of other information that is usefull to people caring for a LO with Dementia. The document can be found on caregiver.org It's a total of 9 pages.

Yes, it's a great resource. I thought 9 pages was rather long to post here. So I posted two excerpts here -- one on dementia and another on handling troubling behavior. The second excerpt is posted here (with a link to the article on caregiver.org):

viewtopic.php?f=13&t=2846

One thing that has helped my family: I get a journal-style desk calendar/2 page a week that we keep notes of visits it & family dates & updates. I wrote: READ, WRITE, SHARE on the cover. My father can't read it, but anyone who visits him can refresh his memory on any notes we share. He will say no one ever comes & wants to know how everyone is. I can see his friend visited for breakfast & talk about his bad mood. Or sister changed her visit because she got a new job. Gives him more to talk about & laughes that he 'remembers' & makes him the center of the updates. We've also managed to catch him in his memories & make notes on some details we've forgotten, like how he dug a garden well or grandma's secret recipe. Gives us "little projects" we can work with him on and things that matter to him to talk about.

Great idea, Rabbit!

Yes, rabbit, thats a really good idea. I am going to start one of those. Thank you, Ger