Communicating with those who have Alzheimer’s disease can definitely be a challenge.

 

Poor communication can be a frustrating situation that can create a serious healthcare problem. Lack of effective communication can result in a decline in your client's quality of life, cause depression and an increase in isolation. Your client may become more and more withdrawn and not want to socialize or participate in activities, exercise programs, and so on. Plus, effective communication with your clients can help you spot health problems early-on, before they become serious.

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Bottomline: You want to do everything you can to keep your clients interested, involved in activities, and socializing as much as possible ... and good communication with them is the key.

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BASIC TIPS
Most experts advise that the following tips and suggestions will work well for you in communicating with your Alzheimer’s clients:
 

• Gain their attention. Gain your client's attention before you begin talking. Approach him/her from the front and identify yourself.

• Call the client by name and make sure you have their attention before speaking.

• Allow enough time for a response. Try not to interrupt ... let them finish their train of thought.

• Maintain eye contact. Look them in the eye as you chat with them ... good eye contact shows your client that you are interested in them. Plus, it makes you more aware of how they’re reacting.

• Get down to their level. If they’re seated or lying down, get down to their level when attempting to converse with them. This gives better eye contact, and shows that you’re interested in them.

• Choose simple words and short sentences.

• Give one-step-at-a-time directions for tasks. Break down their various tasks into step-by-step instructions.

• Use a gentle, calm tone of voice.

• Avoid talking to them like a baby or talking about your client as if he or she weren’t there.

• Reduce background noise. Try to reduce background noise, such as from the TV or radio, when speaking. In addition to making it harder to hear, the TV or radio can compete with you for the listener’s attention.

• Always be attentive. Show that you are listening and trying to understand what is being said. Use a gentle and relaxed tone of voice, as well as friendly facial expressions.

• When talking, try to keep your hands away from your face.

• Speak naturally. Don’t shout. Speak at a normal rate, not too fast or too slow. Use pauses to give them time to process what you’re saying. Use short, simple, and familiar words.

• Keep it simple. Ask only one simple question at a time and patiently wait for an answer.

• Be prepared to repeat yourself. You may have to repeat yourself many times in order to be understood. This is when you need to be very patient and understanding, and not become angry with your client. They can’t help it that they don’t understand you on your first try.

• Be positive. Instead of saying, “Don’t do that,” say, “Let’s try this.”

• Rephrase as necessary, but avoid repeating things too much. If your client has difficulty understanding what you’re saying, find a different way of saying it.

• Be patient. Encourage your client to continue to express his or her thoughts, even if he or she is having difficulty. 

• Be careful not to interrupt.

• Do not correct them or argue with them.

• Be kind, gentle and understanding. Even during times of bad behavior.

• Be ready for outbursts, anger, frustration and so on — these issues are common as the disease progresses. When they happen, remain calm and positive. Don’t respond with negative comments, a loud voice or gestures that show you’re upset. This can be easier said than done, at times! It also is important to remember that while they may say hurtful things, they are not meant personally.

• If you do lose your temper, don’t worry needlessly. You may feel sad or guilty about losing your temper, but the impaired person forgets such incidents quickly, and so should you. Just try to make each day go as well as it possibly can for both of you.

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DISTRACTION
When things start getting out of hand, here’s a technique that often works very well — change the subject. For example, ask them for help with something, or suggest going for a walk.

When using this technique, you’ll have greater success if you can keep the train of thought going. For example, if your client is complaining about something, you could say, “I see you’re feeling angry — I’m sorry you’re upset. Let’s go get something to eat.”

 

REMINISCENCE
Most clients suffering from Alzheimer’s will still retain much of their memory of past events in their lives. You can often redirect them to pleasant, distant memories by asking questions about their past. Base your questions on your knowledge of each client’s past history, hobbies and so on.

Show them a photo album or other pictures of their past, and get them talking. This is where a box that contains your client’s personal information including photo albums, information on hobbies, and so on can come in very handy.

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THERAPEUTIC FIBBING
Honesty is not always the best policy when it comes to someone with Alzheimer’s or dementia. That’s because their brain may experience a different version of reality. Dementia damages the brain and causes progressive decline in the ability to understand and process information. That’s why forcing someone to abandon their version of reality and join our “real world” can cause confusion, pain, anxiety, fear and anger.

Dementia care experts often recommend a technique called therapeutic fibbing. It helps you step into their current reality and spare them unnecessary upset and distress.
 

This technique takes some getting used to because going along with your client’s new reality can feel like you’re lying to them.
But using white lies to validate their feelings and reassure them is certainly not the same as lying for a malicious reason.
 

Telling the truth could be cruel. Most of us are taught from a young age that any kind of lying is horrible and dishonest, especially lying to family and anyone we care about and respect. So when we hear about using therapeutic fibbing to lie to someone with dementia, it seems cruel and wrong. But always sticking to the truth, especially about an emotional subject or something trivial, is more likely to cause your client pain, confusion and distress.
 

Dementia prevents people from properly processing and retaining information. Plus, having short-term memory issues mean they’ll probably soon forget the conversation, so it will come up again. Telling the truth each time forces them to experience fresh distress over and over again. Is it really necessary to cause them so much distress, especially when the truth you tell them is likely to be misunderstood or quickly forgotten?

Therapeutic fibbing helps you step into their reality. An effective way to step into your client’s reality is to use therapeutic fibbing. It means agreeing or saying things that are not true to avoid causing someone distress and to make them feel safe and comforted.
In many ways, this technique is similar to telling a friend that you love the thoughtful gift they gave you, even if you don’t actually like it. Telling the absolute truth in that case doesn’t change the situation and would only hurt your friend’s feelings.
 

Here are two examples that illustrate the difference between being completely truthful and using therapeutic fibbing. While your specific situations will be different, the same principles of gently going along with their reality and finding a distraction will apply:

 

Example 1
Being completely truthful:

Your Client: School is over. My mommy is coming to pick me up now. I need to go outside to wait for her!
You: You’re 89 years old. You haven’t been to school in decades. And don’t you remember that your mom died 25 years ago? You don’t need to go outside because she’s not coming to pick you up.
Your Client: What? What do you mean my mom is dead? No! She can’t be dead!! I saw her this morning! She told me she would pick me up!!! I need to go outside to wait!! (She’s crying, agitated and screaming.)
Using therapeutic fibbing:
Your Client: School is over. My mommy is coming to pick me up now. I need to go outside to wait for her!
You: Oh yes, it’s almost time to go. Your mom asked me to give you a snack first so you won’t get hungry on the way home. Let’s have some juice and crackers while we wait.
Your Client: Okay, I’ll have a snack.
You: Use this distraction as an opportunity to occupy her with the snack and a fun activity until she lets go of or forgets about the idea of her mother picking her up.

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Example 2
Being completely truthful:
Your Client: I need to go to work now. I’m already late.
You: What do you mean? You don’t have a job. You retired 20 years ago. And remember, you have Alzheimer’s now. Stop trying to go out.
Your Client: Why would you say that!? You’re lying and trying to keep me prisoner! Why are you trying to stop me! I’m leaving, get out of my way! (They’re angry, agitated and banging things around.)
Using therapeutic fibbing:
Your Client: I need to go to work now. I’m already late.
You (suggestion 1): That’s right, I almost forgot. Well we can’t have you going off without a good breakfast. Don’t worry, you have plenty of time, I forgot to change the clock after the time change. Give them a meal if it’s the right timing or a snack if it’s not. While they eat, have a pleasant chat about a topic they enjoy to distract them from the idea of going to work. Or, when they’re distracted enough from eating, talk about an enjoyable activity you’ll do together when they finish eating to set up the next transition.
You (suggestion 2): That’s right, I almost forgot. Let’s get your jacket, it’s a bit chilly today, and make sure your lunch is packed. Here, I’ll help. Gently lead them to get their jacket and find a pleasant distraction along the way ... look out the window and start talking about the birds, stop in front of a partially completed fun activity like a puzzle, stop for a drink of water, etc. When they’re engaged in something else and become distracted, they’re likely to let go of the idea of going to work.