Speaking Their Language

I’m going to put it all together now that I’ve discussed the stages of Alzheimer’s disease, as well as language deficits specifically.

It is reasonable to assume that your approach with your loved one will change over time as their disease progresses. To me, this was one of the hardest things about dementia caregiving. It was such a moving target! I found that a technique that worked well for months suddenly no longer did. You will have to adjust how you communicate with your loved one based on where they are in the disease process.

For purposes of this discussion, I’m going to use the simplest staging system of Alzheimer’s disease–mild, moderate, and severe.

In the mild stage of the disease, it’s important not to assume that a person with dementia cannot speak for him or herself, so address the person themselves, not the caregiver. It may take a longer time for the person to express themselves. Be patient. It’s OK to laugh together about mistakes in communication, but take that cue from them.

Talking on the telephone can be very difficult for a person with even mild Alzheimer’s disease. They just cannot help to carry a conversation along. It’s good to call at the time of day when they are at their best. Be ready with topics of conversation, or just go with their flow.

In the moderate stage, language deficits become quite obvious. It’s best to have one-on-one conversations in a quiet space, directly facing the individual while maintaining good eye contact, and with few distractions. Speak more slowly and with fewer words. Because you’ll need to give the person plenty of time to comprehend what you are saying, pause between sentences. Grant them enough time to formulate a response.  If you don’t understand what they are saying, try rephrasing what you think they are trying to convey, or offer your best guess, using context. If they don’t understand you, try rephrasing your statement or question.

It’s better to ask “yes” and “no” questions or to give a choice between just two items. For example, rather than asking, “What do you want for lunch today?” ask, “Would you like a grilled cheese sandwich?” or, “Would you rather have grilled cheese or soup?” Remember to ask just one question at a time. A barrage of questions can be very intimidating.

When working with your loved one on a task, it’s best to break the task down in simple steps. So, instead of saying, “Please make the coffee this morning,” you may have to first say, “Please get the coffee can.” Then progress step-by-step for the entire process. Giving too many steps at once is overwhelming. I also found it helpful to mimic what I wanted my husband to do. “Please stir the soup” was accompanied by my air-stirring. I would also point to where an object could be found rather than explain in which drawer or on what shelf it was.

In the severe stage of Alzheimer’s disease, communication and conversation are quite difficult, but not lost entirely. It’s best to approach the person directly, at their eye level, say their name, and then identify yourself. Don’t startle them. Pay close attention to their nonverbal cues. Are they relaxed, smiling, in distress? Physical touch, such as holding hands or touching foreheads, if the person doesn’t object, is a very real form of communication that conveys that you care.

I think I’ve said all I can say about communication!