Communication

Other than difficult behaviors, communication issues are one of the triggers that lead to nursing home or dementia-facility placement. Many times the placement is warranted and correct. Sometimes, though the placements is the result of difficulties that can be addressed.

http://www.dreamstime.com/-image17808436Early Stages
In the early stages, you may notice only subtle and infrequent communication issues. Sometimes your loved one will lose her train of thought, make up words, use words awkwardly or repeat over and over what she just said. If she looks to you to answer a question or to complete a thought, try to oblige if you think you know what she wants to say.

Also in the early stages, our loved ones express fears or feelings of dread. Please don’t dismiss those expressions out of hand. Honor their content and the emotions they convey. You can reassure her that she will always be cared for or say “we are in this together” whatever works to reassure your loved one.

If your loved one is living alone at this stage it can be helpful to leave medication reminders in strategic places, if she’s forgetting them. Or if she’s anxious and you left the house while she was napping, leave a note close by telling her you went out and will be back shortly. Try to keep it simple.

Mid Stage Communications
Most of the communication issues in dementia occur during this mid-stage, both because it is the longest of the 3 major stages and because while there are fewer issues in early stages, the verbal communications deteriorate in the late stages.

http://www.dreamstime.com/-image16708893Be aware that the difficulties in communication are both expressive and receptive. In other words, not only will your loved one make ‘word salad’ out of a sentence she utters, but she will often misunderstand or not understand what you are saying, even if her hearing is excellent. To maximize her ability to connect, keep sentences short. Otherwise, by the time you get to the end of a sentence, she’ll have forgotten the beginning.

You might have to deal with these issues your mom/dad/partner is having:
*Struggling to find and organize what he wants to say
*Swearing or saying inappropriate things
*Needing more time and explanation to understand what you are saying
*Losing her train of thought

If she says something you don’t understand wait and ask again. Or accept the funny or made up words she uses. Once when I gave my mom a piece of toast she said:
Can I have some schmeer on here? (my mom never spoke Yiddish, but i understood she wanted some butter or cream cheese or something to smear on the  toast). 

Swearing or saying something inappropriate can be embarrassing when you are in public. Once in the doctor’s office waiting room my mom blurted out: Do you think I should tell that woman over there I know a doctor who can fix her nose? 

I replied, while turning her wheelchair around to face me, with her back to the woman, “I don’t think so mom, here, have a piece of candy”. Other people have business cards made up with the saying “Please forgive my mom: she has dementia” and hand them out when something nasty comes out of their loved one’s mouth.

Mid Stage Choices Empowerment and Guidance
It is very empowering to give choices. It makes our loved ones feel important and that they still have agency. Just as important is not giving too many choices (too overwhelming) and being directive as the need arises:

*Instead of: Time for us to have our lunch now, okay? try Here’s soup: let’s eat
*Instead of: Which dress do you want to wear today? Hold up two choices and ask: Which: the blue or white dress?  (Giving her choices makes her feel like she still has some control over her life. She’ll probably pick the white one because that choice was closest to the end of your question.)

Tips for Communicating in Mid Stage 
* Try to be patient and not get angry at repetitive stories and especially repetitive questions.
* Redirect if the repetitious questions are endless.
* Approach from the front.
* Try to set a positive mood for connecting. Body language, voice tone, facial expressions and demonstrating affection all help in sending a positive message.
* Use simple words and short sentences, in a friendly and calm tone and a clear, low voice.
* Try to eliminate distractions when you or she are trying to talk: turn off the radio or the t.v. during those times.
* Listen with your heart. Try to imagine the frustration your loved one is experiencing trying to communicate with you. What he wants more than anything is the connection that speaks love, the understanding and the comfort of your closeness. What he need most is reassurance and affection.
* Try to generate trust by being as patient as possible. 

http://www.dreamstime.com/-image22247749Late Stage Communications
In some ways communications at this stage are easier, even if sadder. Your loved one will make fewer attempts to talk and when she does, it might be unintelligible or just a single word or gesture.

Try to pick up on the non-verbal cues which are more apparent now: pulling on clothing to indicate discomfort, closing lips tightly to refuse food, smiling (if she can still do it) as an invitation for you to smile back and perhaps stroke her arm, give a kiss.

Just because patients with dementia lose the ability to communicate with words doesn’t mean they don’t understand body language, anger, gentleness and love. They do, even late in the disease. Try to remember that.

For more information about communication check out these resources.