Caring Currents

Decoding the Secret Language of Alzheimer's

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"Okay, dolly! Drink up all that water!" I used to cringe when my grandmother's aide would talk down to her like that. (No, Gram's name wasn't Dolly.) So at first, the news that people with Alzheimer's dislike being patronized seemed to fall into the "duh!" category. Then I realized it's a big wake-up call in two ways:

  1. It reminds us that those with Alzheimer's deserve as much respect as anyone else.
  2. It reminds us that conversations go two ways, even among those with impaired speech or no speech.

In a nutshell: When University of Kansas School of Nursing researchers analyzed videotapes of aides caring for people with Alzheimer's, they found that certain communication patterns by aides led to spikes in resistance and agitation.

What not to use, according to the researchers: Inappropriate terms of endearment (good girl, dear), a caring but controlling tone, and the royal "we" ("Are we ready for our bath?"). They call it "elderspeak."

But I think plain old 'babytalk" is a better term, because the real  "elderspeak" is what the elders with Alzheimer's were saying loud and clear through their behavior: Refusing to cooperate is about your only way left to express anger or displeasure if you don't have words. Agitation is a common reaction to the stress of something you dislike. 

Which got me thinking about other things people with dementia say or do that mystify us at first, until we decode the underlying meaning. Some examples: 

"I want to go home"

My Gram used to say this over and over in her nursing home near the end of a visit. It didn't seem to mean she was miserable there or that she wanted to go home (after a few years, she didn't seem to recall home). Many social workers say it just means, "I'm tired" or, "I'm uncomfortable here and want to go back to my room now." What to do: Watch for a pattern around when the phrase is used.

Abrupt switches in conversation

It's called losing your train of thought -- but instead of covering, you simply plow into something else. What to do: Keep talking about the original conversation to nudge the person back, without pointing out the mistake. In an excellent post on Alzheimer's communication in her Triage blog, the Chicago Tribune's Judith Graham quotes a son who does this effectively.

Lack of response

To those in mid-stage Alzheimer's, what you say and what they comprehend don't always jibe. You ask a question, but your words don't quite register as words that warrant an answer.  What to do: If you get a blank stare, don't get mad...slow down, use gesturing to help, and repeat.

Image by Flickr user Jenn Jenn, used under the Creative Commons attribution license.