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Post Diagnoses of Alzheimer's These are some general
guidelines for communicating with the memory impaired person.

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Communicating occurs on both a verbal and a non-verbal level. The tone of your voice and facial expressions are just as important as the actual words. Alzheimer patients can be sensitive to non-verbal communications.

VERBAL:

-Speak slowly and simply. Use short sentences and words. Avoid complex conversations or instructions.
-Use nouns and proper names frequently. Avoid using "he, she, it those", etc. Cue the person with necessary information.
-Begin conversations (especially at night) by calling the person by name, toughing them gently, and identifying yourself if needed.
-Discuss only concrete actions and objects. The person cannot relate to concepts.
-Don't ask questions with multiple choices, this adds to confusion and stress. Try to ask questions that can be answered with a yes or no, or with a gesture.
-Do not expect a quick response. Allow time for information to be processed. Wait silently for several minutes until they answer.
-Use simple directions for tasks being done. Go one step at a time.
-If you must repeat a question, repeat it exactly. Do not re-phrase the sentence or use different words.
-Speak in a lower voice tone, do not express excitement in your voice.
-Maintain eye contact, sit or kneel if necessary. Don't tower over the person in bed or in a wheelchair.
-Repeat the person's last words to stimulate memory and assist them to continue their thoughts.

General Considerations:

-If possible, correct any visual or hearing problems the person may have.
-Reduce environmental noise, activity and distraction.
-Keep your face well lighted.
-Use gestures or other clues to aid your communication. (Objects, pictures, smells, things to touch and feel).
- Look for reminiscence in the person's hallucinations, delusions, or fragmented conversations.
-Do not argue with or contradict the impaired person. Respond to feeling rather than fact.
-Do not assume the person lacks insight or does not understand. Do not speak in a negative manner in front of the person.
-Praise and reassure! There is a great loss of dignity and confidence as the person's knowledge and abilities deteriorate.
-If you are unable to "get through", try again later.

NON-VERBAL:

-Stand in front of the person, keep at eye level. Do not startle by approaching from behind.
-Use exaggerated facial gestures to emphasize your point.
-Walk with the person if he/she starts to walk away. Do not restrain - distract to a new activity.
-Use touch to:
*gain attention and enhance listening behavior.
*show you care and that they are worthy of care - touch can reinforce trust.
*reduce feelings of isolation, rejection.
*increase interaction.
*let them know you are listening.
*fulfill a need greater than the need to talk.
-Listen actively. If you don't understand, say so. If the person becomes agitated, offer your best guess. If wrong, guess again.
-Indicate you understand the person by nods, smile, or touch.
-Be aware of the impaired person's non-verbal responses. (Smiling, relaxed appearance vs. hand wringing, fidgeting).

GENERAL CONDITIONS

-There is an increased awareness of non-verbal clues as the disease progresses; the non-verbal level becomes more important.
-The Alzheimer patient is extremely sensitive to the emotional climate of the environment.
-If the person doesn't understand he may avert the eyes, look down, or increase hand gestures.
-Non listening behavior includes: lack of eye contact; lack of nodding or affirmation; lack of facial expression, turning body away.
-Receptive behavior includes; nodding, relaxed appearance, smiling, touching.
-Signs of anxiety may include: pacing, hand wringing, crossing and uncrossing legs, fidgeting.

SOURCES:

Bartol, M.A. Non-verbal Communication in Patients with Alzheimer's Disease. Journal of Gerontology Nursing, 1979, 4.
Ernst, P., Shaw, 3. Touching is not Taboo. Geriatric Nursing, Sept/Oct. 1980, 193-195.

   

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