How Do You Communicate With A Loved One Living With Alzheimer’s?

Even with Alzheimer’s your loved one responds to what you are doing.

Alzheimer’s is one of the most common neurodegenerative diseases that cause the symptoms of dementia. The term “neurodegenerative” clearly explains what is occurring in the brain:
Neuro – “messenger”
Degenerative – “destroy”

To understand this destruction of messages, it helps to understand that within the brain is an area called the hippocampus. The hippocampus plays a crucial role in memory processing, storage, and retrieval. It is the first part of the brain thought to be damaged by Alzheimer’s. Due to this damage, the person can no longer take any new information and commit it to memory. As the disease progresses and more damage is done, it becomes increasingly difficulty to accesses and retrieve already known information. (Jump to Lessons Learned)

With Alzheimer’s, the disruption of these processes impacts communication in every way. The normal process of accessing multiple pieces of information all over the brain is impossible. It results in fragmented thinking and an attention span that becomes increasingly shorter. Add to this the need to filter out background noise and activity, and it is no surprise that the process of communication gets blown up.

Let’s look at fragmented thinking for a moment. As the disease progresses “pieces of the process” are lost impacting everything, including the simple task of brushing your teeth. Google “how to brush your teeth” and WikiHow breaks it down to fifteen steps. Those steps don’t include: find the bathroom, walk in, find the light switch, turn it on etc. If the person with dementia loses one step of the process like find the bathroom, then he/she can’t move forward with the rest of the steps.

One of the biggest challenges with Alzheimer’s is that the person looks and often sounds like themselves. It’s easy to forget that he/she has a disease that constantly rips them between past and present. It may seem like they are remembering but they are not, they are reliving the past. How you communicate and interact with a person with dementia must change based on this truth: they are reliving the past.

Shelly’s story
Shelly’s mother has Alzheimer’s and Shelly has been her primary caregiver for years. There was a time when her mom exhibited violent behavior (pinching, pushing, punching and spitting), especially during bathing and dressing. They have moved beyond that now because Shelly changed her behavior when her mother was acting out.

“The spitting was the worst. That just got me to the core. I was at my wit’s end. I would never hurt my mother, but I realized I would still act out, just differently from mom. I would slam a drawer, throw things, kick the garbage can, anything to get out my anger and not turn it on her. One day she was so bad, her hands were against her chest and I just started to hug her, trapping her hands there. I just kept saying to her, ‘I love you, I love you no matter what. I love you, I know you don’t mean to treat me this way.’ I told her that more than once time, even telling her, ‘I’m praying for you because I love you.’ And in vowing to be nice, and not let her behavior get to me, I stopped acting out. I have come to realize that even though they have dementia they can respond to what you are doing. I wish I could tell you her behavior changed overnight but it didn’t. It was a process. Somehow through the grace of God, I was able to turn it around she is back to being the loving woman I knew.”

The following communication and behavioral techniques work no matter what the diagnosis: Alzheimer’s, Vascular Dementia, Dementia with Lewy Bodies, or Frontotemporal Dementias.

How do you communicate with a loved one suffering from dementia?

• Start with understanding that they are being ripped between past and present. Arguing and logic will not work.
• Know that those suffering from dementia have a keen awareness of environment and body language.
• Remember that over 90% of all communication is non-verbal and powerful. Use it.
• Deal with the emotion, focus on feelings not facts.

Their behavior IS their communication:
Ninety-three percent of all communication is non-verbal. Body language and eye contact makes up 55%, while pitch, speed, volume and tone of voice is the remaining 38%. Be aware of your non-verbal communication style, you may need to modify it. You will need to use multiple non-verbal communication techniques. You will need to learn how to read their non-verbal communication.

• Eyes – focus on the eyes to find moments of awareness
• Touch – use it carefully. This generation is modest, so touch while bathing can bring out behaviors that are a problem.
• Facial expressions – Be aware of your expressions. Your loved one can absolutely read them. You may not be aware that your face is expressing anger, but their behavior back to you will reflect that anger.
• Gestures/hand movements – slow down, make them gentle, be mindful of personal space.
• Body posture – Body posture means something to this generation. A straight posture conveys respect. Similarly, their body posture means something. If your loved one is leaning and straight is their normal, you need to figure out why.
• Position – Get down to eye level and be aware of invading their personal space.
• Tone of voice – a woman’s voice tends to be higher in range, blending into background noise. Dementia suffers can’t filter out background noise, so women’s voices can be difficult to hear. To offset this hearing deficit, drop your voice to a lower tone.

Past becomes present and there are moments of awareness in every stage.
Because your loved one is being ripped between past and present, know as much about their past as possible.

• Don’t argue – Asked the question “Have you seen my husband?” and you know he is dead, don’t correct or argue. Instead respond with something like: “I haven’t seen him, but I will keep my eye out for him.”
• Don’t ask questions that require the person to remember specific facts like “Do you have children?” If you know it, say it: “You have three beautiful children”.
• Don’t try to use logic – it is not your place to teach them or make them feel bad
• Don’t order the person around
• Don’t tell the person what he/she can’t do
• Don’t raise your voice
• Don’t “talk down” to the person
• Don’t talk about the person as though he/she is not there.

Lessons Learned:
Behavior’s and reactions do not come out of nowhere, remember your loved one is being ripped back and forth between past and present.

As Alzheimer’s progresses to the moderate stage, a person with dementia that spoke multiple languages will revert to their native tongue.

In certain cultures, women walk behind the men. Don’t be surprised if walking in front of a man from one of those cultures results in him becoming agitated.

People who survived the Holocaust may become agitated by the sound of feet on the floor. It can bring them back to the concentration camp and the sound of footsteps on concrete. They may become afraid to eat because they are afraid of being poisoned.

Disclaimer: The material in this blog is for educational purposes only. It is not intended to replace, nor does it replace, consulting with a physician, lawyer, accountant, financial planner or other qualified professional.

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With thanks to my collaboration partner, Amy Matthews of Engaging Alzheimer’s LLC

Amy served as Associate Director for Education and Training with the Greater New Jersey Chapter of the Alzheimer’s Association. She served as Executive Director of one of the Arden communities part of Arden Courts, an Alzheimer’s exclusive organization. And Amy served as Education and Training Coordinator and Activity Coordinator for The Family Respite Center before joining Engaging Alzheimer’s LLC as a Dementia Coach.