If you have a loved one with Alzheimer's or dementia, then you know how difficult it can be to communicate with him or her. Maybe there are good or bad days. Maybe there are certain times of the day that are better or worse. Whatever the case may be, this article will walk you through techniques that are sure to improve communication with the person you love.
Put Yourself in Their Shoes
Imagine, for a moment, that you are getting dressed for work. You've worked in the same office for thirty-five years, and today is like any other weekday. Perhaps you're having trouble tying your tie, which makes you wonder whether your daughter is home; she's great at fixing your tie. You call out her name. She comes into the room and asks where you're going. You tell her you've got ten minutes to catch the train or you'll be late for work. Your daughter tells you that there is no train and you've been retired for 10 years; you have no job, but you do have dementia.
Reawakening a person to the fact that he or she has dementia used to be the social norm, even for caregivers. It was even considered a "gentle reminder" or "correction." However, we know better now. These small reminders shatter that person's reality, and repeated experiences can be psychologically damaging. Dementia affects the brain, but the person retains his or her humanness, and still has a mind, an ego and feelings that should be respected. It's cruel to force a person with dementia to accept aspects of reality that he or she cannot comprehend. So if, for example, your loved one is excited about a new job (that doesn't exist), it's better to offer congratulations than to correct him or her. Of course, this is sometimes easier said than done. The main coping skills you'll need to improve communication with your loved one are redirection and validation.
Redirection
People with dementia sometimes display behaviors that seem out of character or are far too emotional for a specific situation. Sometimes their behaviors are due to delusion or hallucination. Redirection techniques divert those individuals' attention away from the stressful event to something that is more pleasant. The following is an example:
JOE [agitated]: I need to get to work. I'm going to miss my train!
MARY: Okay, Dad, but I just made breakfast. How about you eat with me first and then I'll drive you to the station. You'll make the train and get a good meal that way.
Obviously, techniques and their usefulness depend on what seems sensible in the situation. You'll need to be creative and experiment to see what works and what doesn't with your loved one.
A few pointers on redirection techniques:
- People with dementia pick up on body language. Be warm and open when redirecting, to reduce stress levels and/or tension.
- Ask pointed questions. Try to get to the bottom of any unexplained behavior. It will make it easier to redirect if you understand the context.
Validation Therapy
Validation therapy, first conceived of by Naomi Feil (MS, ACSW), runs the fine line between bluntly explaining reality and simply allowing a person with dementia to believe what he or she wants. Validation therapy often integrates redirection techniques, but it is not solely about moving an individual's attention from one thing to another; it is also about validating feelings and emotions.
Validation therapy is based on the idea that a person with dementia may be sorting through past issues (albeit somewhat disguised) in the present. Some may even retreat to the past significantly, to restore a balanced feeling, especially if his or her present memory has begun to fail. Proponents of validation therapy say that allowing the dementia patient some measure of control will aid in self-worth and will reduce the occurrence of negative behaviors.
A few pointers on validation therapy:
- Try to understand why your loved one is behaving a certain way; what's the trigger or underlying concern? Then figure out a way to address it. So, for example, if your loved one is hoarding or hiding items, ask what he or she is fearful of losing. Give a "safe box" that can be used to store those items.
- Don't get caught up in whether or not something makes sense. A person with dementia may not be able to piece everything together, but their emotions are still valid. In fact, their distress or anxiety can be amplified when they aren't being understood. Accept that your loved one's emotions have more validity then the logic that leads to them.
- Ask specific questions about how certain actions or situations make your loved one feel. After you receive an explanation of those feelings, validate them with phrases that show your support, such as, "I'd be upset too, if that happened to me" or "I understand why you feel that way."
- Allow your loved one a graceful exit and be mindful of his or her ego!
Hallucinations and Delusions
People with dementia sometimes experience delusions and/or hallucinations. Hallucinations can involve any of the five senses-a person with dementia may see, hear, smell, taste or feel something that isn't there. Dementia affects the brain, and as a result, people who suffer from this disease can experience delusions that stem from distorted ideas and false beliefs.
Some people understand that their minds are playing tricks on them, even in the midst of experiencing a delusion or hallucination. Others are completely absorbed in the experience and believe that it is really occurring. Whatever the case, understand that these experiences can be quite vivid and upsetting. Ask simple questions to determine whether the experience is causing any anxiety and take it from there. Instead of trying to talk your loved one "out of it," try redirecting his or her attention, and make sure that he or she knows you are trying to help.
I am not sure how to use validation in my situation. My mother thinks her home aide is dealing drugs in our apartment and has enemies that are in pursuit of the drugs that she thinks are on the premises.
These suggestions, especially, the first one, aren't helpful. My mother is in a nursing home and she wants to leave. She can't really be distracted. If she thought she was going to work and I suggested we eat first, at the end of the meal she'd still insist on leaving. I was hoping for a way to make her understand that she will not be safe on her own. I gently remind her that someone who can't remember that her parents have been dead for over 20 years is ill and that people are taking care of her because she's sick. "Allow your loved one a graceful exit and be mindful of his or her ego!" That's just flip/
Validating the person's feelings is essential. Agreeing with them is also good if their thoughts are safe and non-threatening. If they see a person in the mirror, you might say "How nice to have a friend over!' You can then redirect them to a happy task. Include them in daily tasks that they enjoy. They may hear music, or see a person sitting in a chair, or looking in the window. Just assure them that things are ok.
I'm not sure what state this originates but Minnesota is more advanced in the care of the cognitively declining. First of all, the use of the term "Dementia" is almost archaic plus, it hasn't been the 'social norm" to tell someone s/he has Dementia since the early1980's. To even try to explain Alzheimer's has a great deal to do with what stage the person is in to whether s/he could comprehend what is being explained. It's not like telling a person they can't have a Soda because they're Diabetic. I attended a workshop and purchased the book by Ms Feil not long after she developed the "Feil method". Your explanation of her concept is not at all close to it. I believe you misunderstood her that she said to "bluntly explain reality". If that were the case, there would be no point in any of her well-thought out ego saving method. Validation T. is to "say it's OK" 'where the person is at that moment' whether physically or emotionally: If the person is agitated, allow them to pace but pace with them. Repeat what is said, not as a question at first but after a while, "I can't find the dog, the cat, Rex , for example. Add in the questions " How old were you when you got the dog, etc.? What kind of dog was it (if you were supposed to know this ask carefully), 'did he do tricks? Then bring in statements of self worth-" I'm sure you took very good care of Rex", "I bet you took long walks with him." What this exercise is doing is assisting the person in redirecting themselves from the anxiety of the "lost dog" to the calmness of the "good dog owner" they were and usually a calm conversation will naturally take the place of the anxious pacing partially due to the natural symptom of short term memory. Which goes into the next part -redirecting. Because of the short term memory loss, when the person with cognitively declining individual does not keep bringing up the issue that the individual is perseverating on, that individual can have a chance to "lose" it. The individual is doing a fine job on her/his own keeping that thought alive- it is up to the other person (& it is best to keep it to ONE or 2 at the most to prevent more confusion) to "redirect". However, the example with the train and being late for it, actually, it is usually not that the individual is worried about being late for the train but what comes after- and has developed a very intricate scenario of catastrophe of what happens if the train is missed and this is what the anxiety is about- probably all the way to losing one's job and not being able to get another & support the family. So, to bring up the train is NOT going to be helpful. What needs to be done is to praise the individual for being so conscientious and caring bread winner and great employee, bring up perfect work record, talk about the job, what kind of person the boss is, as s/he is assisted to the kitchen table and served breakfast. This is redirecting. It has nothing to do with the other person being involved in the activity of getting the individual to work. This goes to the Validation Therapy pointers also: Do Not ever ask a cognitively impaired individual to tell you what they are "fearful of losing"? THINK ABOUT IT! Also, more than likely s/he is not hoarding either as this begins much earlier in life as a behavior. Someone who worked as a Secretary may like to have a 2 drawer file and could have the ads that come in the mail. (Occasional careful thinning will need to be done). A non functioning orwith preset auto call numbers (time& tempeature) cell phone to keep in one's pocket is another idea. There are baby dolls that are very life-like and even men respond tenderly. Look at photos of an individual's siblings at younger ages to see "spittin' images" of the next generations so don't be surprised to be called by an aunt's or uncle's name. For someone who has "sundowners" (more agitated in the afternoon or evening), take a walk around 2 PM in a quiet park, pathway, then keep TV off, lights minimum but still able to function. Someone who tries to go out or wants to "go home", take walks daily around the neighborhood, point out/comment on same "landmarks" so this becomes "home". Again, keep consistent, with same 1 or 2 persons when possible -helps to set memory in earlier stages. Often, when an individual wants to "go home" it's the feeling of what "home" is- security and safety- which s/he no longer feels. The definitions of Hallucinations and Delusions should have been discussed completely separately. Yes, they seem similar to the practitioner but not to the unexperienced and thus it's difficult to follow the information from this perspective. Again, the "solution" given is too vague (or, complex because of adding in the part about "talking one 'out of it'", if a person doesn't know what that phrase means may be doing this behavior anyway.) Dementia is not the only cause of Hallucinations -medications and especially anesthesia is a major culprit. There are DNA testing that can be done to determine if an individual is unable to process particular drugs especially anesthetics, pain, blood thinners and antibiotics. Unfortunately, Medical Insurance companies rarely pay for the testing but check into it before surgery especially. Anesthesia can have devastating effects on an older person without cognitive impairment and even worse on an individual with it. (I realize this doesn't fit in directly with "communicating" but it's important enough to add.) For Hallucinations, using Validation technique to find out the cause can be helpful but most important is the individual needs to feel and know s/he is safe. Asking what you can do to help is an option, being truthful. Don't be caught in a "lie". Because safety is important, attention may be needed by a qualified Geriatric Psychiatric Practitioner. This care needs to be accepted as equally important as if a loved one was experiening a cardiac arrest, stroke or any other incident and the care needed for those. One more thing- do not confuse PTSD episodes with Hallucinations. Many Vets can have flash backs especially as the memory declines backward toward those years, so be aware of this if a loved one is a Veteran. As for Delusions, more information could have been provided. Such as, if an individual's delusion is benign, there is nothing wrong with letting her/her keep it. It's not hurting anyone. However, if it impacts health as a dietary issue such as a delusion that an individual believes their food is being poisoned, let them assist with the meal or if they can, fix their own toast, sandwich. Bring them grocery shopping (when it's quieter if possible or to a smaller store), buy milk & juice in smaller bottles, same with fruit in single serve. Ask them what they want to eat for a meal from the food they picked out (usually if they are delusional, they have intact memories to this) so that it's made just before eating. The fear could stem from the anger of losing control, of the loss of independence, medication changing taste, not recognizing food or even just from a too-dry mouth as a side effect from meds- these might be starting points. However, do not ever say you know how an individual feels because you do not and s/he knows that because you are not losing your mind. Also, it's good to be sure to know if it is a delusion and not what it might be in the caregiver's mind. An example: "the black devils" to the patient was her pain as she envisioned it relating to pictures she had seen about her religion; to the doctor a delusion, to the African-American staff- a racial slur. It wasn't until "The Fifth Vital Sign" was added and a nurse talked to her about pain using a picture pain scale that 1- it was determined she wasn't delusional, 2 -the level of pain she was experiencing was realized, 3- the caring attitude towards her changed remarkedly and 4- she stopped screaming about the "black devils" once her pain was controlled. You can see I am passionate about this subject. As a RN my career was in Long Term Care and with many individuals having cognitive decline I found myself drawn this direction and this is where I chose to work. It doesn't takes special people to care for and understand the cognitively impaired, but it does take much patience and willingness to be on someone else's time and follow someone else's agenda much of the time. And, humbleness and a sense of humor. I appreciate the time and space to add my knowledge.
This is very helpful for me. My husband is having a difficult time changing his behavior towards his Mom now that she has Alzheimers. This artical will help him understand what she needs to hear, how he can make it easier for her.
I stumble thru this daily and drop the ball quite often. I feel so all alone in the day-to-day negotiation of this strange mine field where the topography keeps flipping and rotating without warning!
Hugs clouds22
Great artc;e ... interesting to go deeper into the responses and needs of the patient. Eating a problem? Creating "safe place" for the ego & emotions
Hi ipoe47140, I'm so sorry to hear about the pain you and your husband have been going through. If you would like to get advice about how to improve or help cope with your husband's change in behavior, you can go to our forums and chat with other Caring.com members who are in a similar situation: http://www.caring.com/forums. I hope that helps. Good luck -- Emily | Community Manager
Most of husband's time is spent wanting to go home when he is home..I can redirect but when the distraction is done..he goes right back to wanting to go home. I have questioned him about where home is and he doesn't know. he has lived in this area all his life and has only 2 childhood homes. he says neither of them are home..He is not interested in anything that requires participation. he used to golf, fish, bowl, camping, traveling, reading, etc. and now nothing. I think he is depressed because he is distraught at night especially. I have to watch what meds we give him because some of them make him more anxious..He is so distraught and thinks he is no good, even tho i reassure him repeatedly, that he is almost crying and he was never a cryer..He did have a mild stroke a month ago and he is worse mentally, but recovered a lot physically. I do not know what to do..
Prayers The Good Witch
What if the patient keeps saying, "take me home; I can't sleep here" - even though she is home and has lived in her home for 50 years. Just this morning she went to the bathroom (she had to ask where the bathroom was; she couldn't remember) and a few minutes later I went to check on her and she was outside in the freezing cold. My question is: if I tell her, "ok we will take you home", then who's to say she won't get up in the middle of the night thinking she will just leave and go home on her own? What are we supposed to do? Everyone in my family has a different opinion.
Hugs DariaTX
Your articles are extremely helpful; looking forward to more articles, especially on more activities we can utilize for dementia/Alzheimers individuals or in groups. I have been using cards for sorting, ordering, colors, math facts (adding, subtracting, multiplication. Giving instructions also keeps patients alert for following directions. What do you think about having computers available. Some of these patients used to be quite nimble at using them before coming to a facility. I think facilities underestimate the abilities of dementia patients.