Techniques for Talking to, Understanding Those with Alzheimer’s

Families of people living with Alzheimer’s and related dementias often feel the disease has turned their loved one into a stranger. Its impact on verbal communication accounts for much of this problem. Experts say if we understand dementia’s effects, we are better able to sustain a relationship with those with the disease and can be better at caring for them.

“Something that families notice early on is that their loved one’s communication style starts changing,” said Juliet Holt Klinger, M.A., senior director of dementia care for Brookdale. “Perhaps a husband and wife have always had a pattern of affectionately teasing one another, but now the wife no longer responds in that same way. She might even appear unsure of what her husband means.”

The declining ability is what’s known as receptive aphasia, or the lack of an ability to process what others are saying, that causes this shift. Receptive aphasia, deficits in a person’s ability to receive language, can often appear sooner than expressive aphasia, which is the difficulty in using language.

“Because the person doesn’t seem to have trouble talking, the caregiver doesn’t realize that her ability to comprehend has been affected,” Holt Klinger said. “It can be very frustrating, because the caregiver may feel his loved one is being obstinate or ignoring him, when in fact she just doesn’t understand him.”

For people with Alzheimer’s disease, which represents the majority of dementia cases, advancement of the condition often causes word loss.

“Issues begin to arise with searching for the right word to use,” said Holt Klinger. “Then the person may start having issues with pronouns, using “he” instead of “she” when meaning the opposite, for example. Eventually, nouns become a problem.”

Over time, those with Alzheimer’s may start speaking in shorter sentences and using a limited vocabulary. As the disease moves into its later stages, they may be able to use just a few words and eventually, lose all verbal capacity.

Suggestions for communicating successfully with those living with dementia:

  • Don’t speak too rapidly: Slow down speech and be sure to speak clearly.
  • Simplify directions: “Try to focus each sentence on a single request or piece of information. Don’t give too many directions at once.”
  • End sentences with the action the loved one is being asked to take: “Examples are: ‘How about if you get dressed?’ or ‘Let’s eat.’”
  • Add gestures and facial expressions for emphasis: “If you are asking your wife to go with you somewhere, smile and use your hand to beckon her as you say, ‘Honey, come with me.’”
  • Use sensory experiences for those without speech: “Even if a loved one has lost all ability to speak, she hasn’t lost the capacity or need for human contact.” Holding her hand, playing music, humming and speaking to her so she can hear a familiar voice even if she doesn’t recognize the language are all important.

Addressing the Frustration of Repetitive Questions

One of the greatest communications frustrations for caregivers comes when their loved ones begin asking the same question over and over, regardless of how many times it is answered.

“This is a major contributor to caregiver burnout because it can go on for hours, all day and sometimes for days,” Holt Klinger said. “Many times, the question is motivated by an underlying emotion or unmet need. If you can pinpoint and address what that the emotion or need is, your loved one’s need to keep asking the question may be alleviated.”

For example, if she repeatedly asks when she is going to the doctor, it may indicate she is anxious she will forget her appointment and miss it. “You could post notes with the appointment day and time that she can easily see. You can also keep reassuring her that she will get to her appointment on time and she doesn’t need to worry about it.

Involving her in activities that shift her attention can be helpful, as well. “It could be as simple as taking her on a walk or asking her to help fold the laundry,” said Holt Klinger.

For caregivers who find the frustration becomes too much to handle, it’s important to take a break and seek support. “Accept offers from family and friends to take over for a little while or look for respite care,” Holt Klinger said. “Use your time off to relax and recharge your energy. Also consider joining a caregiver support group and look into online caregiver chat rooms.”

If a caregiver is experiencing burnout on an ongoing basis despite these measures, it may be time to consider moving the loved one to an Alzheimer’s care community. “Family caregivers should realize that an entire team of people is dedicated to caring for residents in our Clare Bridge dementia programs,” Holt Klinger said. “Even in the early stages of the disease, the care needs can outstrip what a family caregiver can personally handle, regardless of the great love and devotion brought to the task. A move into a dementia care community can turn out to be best thing for the loved one and the whole family.”