Communication and Alzheimer’s: Loving Ways to Connect

11 May 2022
by Megan Mullen

Communication and Alzheimer’s disease can be challenging as the dementia progresses, but there are loving ways to connect despite the difficulties.

Watching a loved one suffer from the increasingly destructive effects of dementia – especially Alzheimer’s disease – is heartbreaking. When the disease first manifests, we often mistake it for forgetfulness. But it eventually becomes apparent that something far worse is happening.

Dementia is a term encompassing for symptoms linked to a decline in memory, reasoning, or other cognitive abilities. Alzheimer’s is the most common form of dementia, accounting for 60-80% of cases.

Without a grasp on memories and details, people with advanced dementias have difficulty communicating. Eventually, people with Alzheimer’s disease might not recognize their family and close friends. Still, the need for caring and effective communication persists, for the sake of the individual as well as their loved ones. But what if the usual communication methods no longer work?

Here are some effective and loving ways to bridge communication and Alzheimer’s challenges, to break through the barriers.

Stages and changes in communication and Alzheimer’s

Early in the illness, Alzheimer’s disease destroys parts of the brain involving memory, such as the entorhinal cortex and hippocampus. It later damages areas in the cerebral cortex that control language, reasoning, and social behavior. Then, as it continues, it destroys other brain regions until this gradual but highly destructive disease takes the person’s life.

The disease has three distinct stages. The Alzheimer’s Association suggests specific recommendations for successful and sensitive interactions with the person who has the condition.

Early stage

Someone with early-stage Alzheimer’s generally shows only subtle signs of memory loss. In fact, you might find that person hard to distinguish from someone simply repeating stories or fumbling to find the right words and expressions.

During this stage, you should treat the person diagnosed with Alzheimer’s the same as you would anyone else, suggests the Alzheimer’s Association. It’s best not to make assumptions about that person’s status, still keeping them engaged in conversations – talk to them directly, not to their caretaker or companion. Be an attentive listener and wait patiently for their response. And try to be your usual self, since your spontaneity and warmth will be reassuring.

Middle stage

Middle-stage or “moderate” Alzheimer’s can last for many years. The person will have more communication struggles and need more hands-on care as it progresses.

Since this is a more advanced stage of the disease, you’ll need to practice increased patience and tact. Set the stage for better communications by seeking quiet places to converse. Speak slowly and clearly, and maintain eye contact. An excellent listening tactic (often used by teachers and tutors) is to re-state what the person said through paraphrasing. Doing this helps them focus and shows interest on your part.

Use closed-ended questions (yes or no) rather than open-ended questions (requiring a more difficult response), or providing a few specific options, suggests the Alzheimer’s Association. For example, instead of “What would you like to drink?” ask “Would you like water to drink?” or “Would you prefer coffee or tea?”

Never criticize, correct, or argue, as doing so might upset the person without achieving any positive results. Patiently repeat or demonstrate instructions. It could be helpful to write things down to help the person remember details.

Late stage

younger and older hands touching. Photo 148214400 © Pop Nukoonrat | For article on communication and Alzheimer's, dementia, challenges

This stage, severe Alzheimer’s, could last from weeks to years. As the disease runs its course, the patient might rely on nonverbal communication, including facial expressions and vocal sounds. This stage usually requires around-the-clock care.

When visiting, approach them from the front and remind them of who you are. If they don’t remember you, try to refresh their memory by sharing happy moments from the past. Although it’s upsetting to have a loved one not remember you, know that it’s not personal and try not to display hurt or anger.

Try using nonverbal forms of communication, including touch. It’s fine if you don’t know precisely how to act or what to say (with Alzheimer’s, few people do); your presence and friendship matter. But whatever you might be feeling, always treat the person with dignity and respect.

Using improv for communication and Alzheimer’s

Whatever our stage in life, improv performances make us laugh. Improvisation (as in “Whose Line Is It Anyway?”) can also be useful offstage to hone skills in personal life and business, including interaction and communication and Alzheimer’s.

Seniors Guide did a deep dive into improv and dementia, with insights from experts who have honed their skills through direct interactions with people with memory loss. Tips include:

  • Use the “Yes, and …” approach. Agree with the individual and add a positive comment of your own.
  • Step into their world. Whatever they seem to be experiencing, join them in an imaginative, uplifting conversation.
  • Don’t argue. Instead, acknowledge and validate.
  • Be flexible. Be ready for anything and go with the flow.
  • Limit choices. This helps to minimize confusion.
  • Redirect when possible. Just move along without contradicting.

Alzheimer’s challenges and strategies to distract and comfort

Alzheimer’s patients often get stuck in an endless loop of the same story, in part because repeated stories recall strong and significant memories. The person with Alzheimer’s might repeat themselves because they want to communicate but are stressed and can’t find the words.

We all share memories like these sometimes, but most healthy people understand when and why to change topics. Unfortunately, late-stage Alzheimer’s patients seldom remember what they’ve already said – and may repeat it countless times. So having one or more go-to strategies is essential.

Since it can be challenging to empathize with someone experiencing diminishing mental capacity, you should take a mental step back to assess the situation (e.g., repetitiveness) and plan a strategy with Alzheimer’s-related complications in mind. In addition, you might need to determine the person’s level of awareness informally to gauge the situation. Try these four suggestions for dealing with repetitious stories and questions:

  1. Consider the emotion. People grasping at threads of reality can escalate an often-repeated story to a fever pitch. Communications and Alzheimer’s suggests that you turn your efforts to the person’s feelings rather than their words. Holding their hand or hugging them can make a huge difference!
  2. Be brief. Keep your response short and sweet, so you don’t get exasperated if you have to repeat yourself.
  3. Try a distraction. Divert the person’s attention to another activity.
  4. Find an escape. If you find yourself getting frustrated, get away for a few minutes if you can. Do something that will refresh your spirit and bolster your patience.

Use therapeutic fibbing

Therapeutic fibbing is deliberately lying or “bending the truth” to avoid increased agitation from a person with Alzheimer’s, dementia, or a related condition. Yes, fibbing is tantamount to lying. But often, it’s the best way to assuage those who are mentally incapacitated.

For example, suppose your elder wants to visit a long-deceased friend. Since you can’t make that happen, you need to enter that elder’s current reality and agree to contact them very soon – knowing they will most likely forget the promise. Telling them the unvarnished truth serves no positive purpose.

Alzheimer’s is a tragic and incapacitating disease that usurps people’s brain capacity and other bodily functions. Perhaps it helps the one suffering during the later stages. But their loved ones and caregivers retain memories of the disease’s ravages, possibly for years to come. So take time to relax, and reflect on all your hard work has accomplished!

by Megan Mullen

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