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Introduction

The brain is extraordinarily complex. It is made up of several distinct parts, each with its own function. While these parts are separate, they must work together to complete the simplest task. As Alzheimer's disease affects each area of the brain, certain functions or abilities can be lost. One link in the chain of events may be missing and the person will need help or a coping mechanism to complete the task. It is important for caregivers to remember that changes in a person"s behaviour and ability to communicate may be related to the disease process.

How we communicate

Communication is the way we share information or exchange ideas. When one person conveys a message, the other expects a response. This is how we interact with each other. As human beings, we need contact with others and the support that follows. Communication requires two people. When one person has failing abilities, communication becomes difficult.

When we think of communication we usually think of language and Alzheimer's disease has a profound effect on language. The disease affects speech and the use of words, as well as the understanding of the words heard. As the disease progresses, language as a means of communicating becomes less effective. Caregivers need to use different ways of getting the message across and staying in touch.
Communicating with a person with Alzheimer's disease requires belief, creativity, understanding, patience and skill.

Belief that every person, regardless of abilities, maintains a core of self that can be reached.
Creativity in expressing both your feelings and your message.
Understanding the effect of the disease on communication.
Patience to slow down, listen, watch, wait for a response, repeat a phrase.
Skill to convey messages or feelings effectively.

Getting a message across

Set the stage
Communicating is always easier if other things are not happening at the same time. When trying to get your message across, make sure that there are few distractions. For example, if the TV or radio is distracting the person, turn it off.

Get the person"s attention
Approach the person slowly and from the front. Gently touch a hand or arm to help get attention. Wait until he/she seems ready to listen before talking.

Make eye contact
Sit facing or standing in front of him/her, if possible. Keeping eye contact (if culturally appropriate) will help the person know who is speaking and may assist the person in concentrating on the message.

Speak slowly and clearly
Use simple words and short sentences to make the message clear. If the person has hearing problems, lowering the pitch of your voice is often better than increasing its volume.

Give one message at a time
Keep a conversation simple. Too many thoughts or ideas at one time can be confusing. Limit choices.

Pay attention
The person"s reaction to what you say can give you some idea of how much is understood. Watch facial expressions and body movements. Respond to moods and emotions especially when the words don"t make sense or are inappropriate.

Repeat important information
If you are uncertain the message was understood the first time, repeat it using the same words.

Show and talk
Use actions as well as words. For example, if it is time to go for a walk, point to the door or bring the person"s coat or sweater to illustrate what you mean.

Take time
Allow the person time to respond. Interrupting can discourage further communication.

Some suggestions to engage the person in conversation

NOTE: The material in this section, "Some suggestions to engage the person in conversation,” has been adapted from the book, Talking to Alzheimer's, by permission of the author. Copyright ©2001 by Claudia J. Strauss. Full citation below.

Getting a conversation started
You may not be sure if the person remembers who you are. Rather than "test the waters”, here are some possibilities:

"Hi, Mary, I came to visit you. Is this a good time?"
"Hi, Bob, it's me, Jane! Okay if I stay and talk for a while?"
If the person says, "I don't know you," you can say, "I'm glad to meet you, my name is Jane. I enjoy spending time with you."

Questions to ask
It is usually better to ask close-ended questions rather than open-ended questions. Close-ended questions can be answered with "yes”, "no”, "maybe” or "I don"t know” or "I don"t remember.” Here are some examples:

"Do you like to watch television?"
"Would you like to go for a walk with me?"
"Does the sandwich taste good?"
"I like hearing the story of your first job. Do you feel like telling me now?"

Some open-ended questions might work, such as:

"How did your day go?"
"How are you?"

When you can"t understand what the person is saying

Sometimes a person will start a sentence and will not be able to finish it or the words don"t make sense. One approach is to acknowledge what is happening: "It"s frustrating for us, isn"t it? You can"t find the words you want and I"m having trouble guessing what you mean. I"m sorry.”

This approach maintains respect for the person in showing that you understand the situation.
If the person doesn"t want to continue, re-assure the person with a hug and suggest doing something in the meantime, "We can figure it out later, let"s walk the dog.”

Ways to indicate you are listening

Here are some suggestions to continue the conversation:

Ways to say "no”

Sometimes you have to say "no”. Here are a variety of ways to say it:

"I wish I could."
"That's an idea, but this isn't a good time."
"I think it is too cold/hot today."
"Did you notice it is raining/snowing today? How about we try another time?"

Ways to encourage involvement in an activity

Sometimes a person might be more interested in getting involved in an activity if it is an opportunity for the person to be independent. Here are some suggestions:

"I'm looking forward to it. Would you like to come along?"
"I'd enjoy it more if you kept me company."
"I'm pretty hungry. Would you mind if I joined you?"
"It's great to do things together."

Ways to end a conversation

Ending a conversation might mean that a meaningful time together has to come to an end. The person might feel lost or lonely. Remind the person how much you have enjoyed his/her company and that you will be back soon. Here are some suggestions:

"I always feel good after talking to you."
"It's so much fun talking to you. You tell great stories."
"Seeing you is the best part of my day."

You can also tell the person that you need to go to work, or do homework, or have dinner. Try the following:

"I need to cook dinner and I still need to do the shopping. I better go"
"I didn't realize how late it was. I need to get to work early."

Things to keep in mind

• Feelings remain despite the losses caused by Alzheimer's disease. Feelings may be the only way a person understands what is going on.
• We all communicate by emotion, expression and touch. Holding a hand, or smiling when talking can convey more than any words.
• We should always be aware of our body language and of our facial expressions. Harsh glances can be just as negative as harsh words.
• The person must be included in conversations. It is painful to be talked about as if one isn"t there.
  Quality of life for people with Alzheimer's disease is largely dependent on their interactions and relationships with others. Maintaining a connection can be a complex and challenging process. Some days it may seem that nothing is understood, while on others much is exchanged and felt. Try to make the most of the good days. Let the person help you through the tough ones. Keep trying. It is important to remember that you are doing the best you can.

In addition…

We are learning more about Alzheimer's disease and its care everyday – much of it from caregivers like yourself who find solutions to problems and share them with others. You can call your local Alzheimer Society to find resources in your community. You can also exchange ideas by visiting The Care Exchange and Caregiver Forum on the Alzheimer Society of Canada website.. There is information. There is help. You are not alone.

Resources:
1. The Alzheimer Journey, Module 4, “Understanding Alzheimer Disease: The link between brain and behaviour”, video and workbook series, the Alzheimer Society of Canada, 2002.
2. Talking to Alzheimer's: Simple ways to connect when you visit with a family member or friend, Claudia J. Strauss, New Harbinger Publications, Inc., 2001, ISBN 1-57224-270-1.

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