Communicating with Alzheimer’s Patients
Good communication is essential in every walk of life, and especially in ongoing relations with victims of Alzheimer’s disease (AD), an irreversible, degenerative illness. As the disease progresses, AD patients gradually lose their ability to comprehend and function, posing a formidable challenge to professional caregivers and families alike.
That’s why communicating with AD sufferers effectively has become a “linguistic science,” one in which caregivers and families must modify their manner of speaking. AD patients can only absorb so much within a few minutes of conversation.
Caregivers and relatives must also adjust their rhetoric as the patient advances through the three stages of Alzheimer’s – mild, moderate, and late. And often a caring family member will say something he or she shouldn’t, and stands to be corrected.
For example, I visited my wife Maxine daily after I placed her in a residence specializing in memory care management. (She was clinically diagnosed with Alzheimer’s in 1990 at the age of 74.) On one occasion, I told Maxine how much I “depended on her.” A hospice nurse overheard me.
“That’s a no-no.” she said. “Maxine might misunderstand the meaning of your statement and think you were criticizing her for failing to do something. In her troubled mind, this would create more anxiety, confusion, and worry. Better just to say what a big help she is in your work.”
Dr. Kathryn Bayles and Cheryl Tomoeda of the University of Arizona have conducted extensive research in the area of cognitive communicative disorders connected with dementia, particularly AD. Their two books, The ABCs of Dementia, published in 1995 by Canyonland Publishing, and Cognitive Communication Disorders of Dementia, Plural Publishing, 2007, are excellent reference sources for the “dos and don’ts” of conversing with those afflicted with AD.
The U of A pair also produced a two-part instructional video tape (VHS) titled Understanding the Communication Problems of Alzheimer’s Patients and Improving the Ability of Alzheimer’s Patients to Communicate. Both are excellent educational tools on strategies that can be used by anyone who interacts with AD patients.
I’d engage Maxine in reminiscing, even though she had no recall. I always used simplified syntax. Complicated syntax will greatly increase the demands on memory. A slow rate of speech, pleasant tone of voice and simple vocabulary are the best techniques for eliciting positive responses.
It’s also desirable to supplement words with pictures. One of the first things I did for Maxine was to develop her own personal “memory book,” a large album filled with photos and short captions showing significant events in our lives. If she misidentified a subject, I’d explain it. And if she was at a loss for words, I’d supply them.
Before the onset of Alzheimer’s, Maxine, a 1938 journalism graduate from the University of Illinois, edited virtually all of my writing. (We even did a book together, Stunt Flying In The Movies.) After she contracted AD, I’d show her a draft of something I’d written and thank her for polishing it. It pleased her to know she still had a role in my important business projects.
Authors Bayles and Tomoeda tell us the average rate of speech is 160-170 words per minute. The more words spoken per minute, the more concepts the AD patient must comprehend. By reducing the number of concepts to be processed, the load on the memory is also reduced.
“The brain damage associated with dementing disease results in slower information processing,” say Dr. Bayles and Ms. Tomoeda. “Even many normal elders benefit from a slower-than-average speaking rate because the processes of normal aging have resulted in them being slower information processors.”
Although it went against my grain, I learned the necessity of “therapeutic lying,” a standard practice in the healthcare industry in the presence of AD patients. If I needed to take my wife to the doctor, which she always rebelled against, I’d say we were going to the post office and then McDonald’s. Entering the doctor’s waiting room, she’d usually say, “Is this the wellness clinic?”
Little white lies are ways of avoiding upsetting a loved one with Alzheimer’s. When it was time to leave Maxine after one of my visits, I’d simply say, “Well, I’ve got to go back to work now.” And whenever she’d inquire about “my husband” or “that man,” the caregivers would tell her, “He’s working today.”
Invariably she’d ask, “Why does he have to work so much?” And the caregivers would follow my script and answer, “Because he wants you to enjoy this lovely apartment.” Maxine’s response: “That’s nice of him, but why isn’t he here to enjoy it with me?” If my precious had ever addressed that question to me, I think for once in my life I’d have been speechless.
Jim Greenwood is the author of Alzheimer’s: Medical Science and Families are Still Asking Why?. His website is www.jimgreenwoodauthor.com