Gerontology 130 Working with the Frail Elderly

UNIT 5 Communication
Overview Principles of Communication Required Reading Online Activities

Overview

Perhaps the most challenging aspect of dementia has to do with the person's eventual inability to communicate with words. This is not only frustrating for the caregiver but for the elderly person suffering from dementia as well. Communicating with a person who has Alzheimer's is particularly challenging because he or she can be argumentative, resistant to suggestions, and does not appreciate being "told" what to do. Often persons with dementia are afraid—and aware on some level—that they no longer function to the best of their ability. Caregivers tend to give directions, that the A.D. (Alzheimer's Disease) person cannot understand or remember. In exasperation caregivers may indicate impatience with the tone, pitch and volume of their voice. Immediately the person being cared for senses that he/she is not doing something "right". This can lead to a battle of wills; and feelings of depression and hopelessness on behalf of both the caregiver and the person with A.D.

When a person who has been diagnosed with dementia due to A.D. caregivers often correct the person with A.D. or say such things as "You remember me—don't you? I'm your daughter!" In fact the person with Alzheimer's disease does not remember, and reminding him/her that you are the daughter can add stress and frustration to the situation at hand. Not reminding the loved one that you are the son or daughter, means letting go of the relative's identity. No longer is that person your mother, father, or aunt. Learning to accept the person as they are now, rather than they were in the past, can lead to acceptance and compassion.

To communicate effectively, it is important to know something about the individual you are working with. It is essential to try to understand; his/ her likes and dislikes. Often times something triggers the person with dementia. Their frustration at being fed, or having a different caregiver can create a "catastrophic reaction". Perhaps the most important aspect about communicating with a person who has dementia, is reassuring the individual to feel "safe" through the softness and tone of your voice; being patient and kind to the individual; learning to listen for feelings rather than words, and holding or appropriately touching the individual as long as they are comforted by this action.

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Principles of Communication

One of the most important traits to have when working with individuals diagnosed with dementia, is the ability to communicate and to listen for the feelings rather than the content. This is especially important when the person with dementia can no longer communicate his/her desires or wishes.

As noted previously, it is normal for elderly individuals to lose some of their hearing as they age. To promote positive communication no matter what the age or diagnosis, individuals should become aware of the following general principles of communication:

1. Be sure you have the person's attention before beginning to speak.
2. Face the person you are speaking to.
3. Avoid background noise such as a radio, or television.
4. Use short sentences.
5. Speak slowly and clearly.
6. Do not shout.
7. Do not speak with something in your mouth, or with hands covering your mouth.
8. Recognize that if a person is ill or fatigued they will have difficulty communicating.

Adapted from Cervantes, Heid Grubman, Schuerman, Charolette. The Paraprofessional in Home Health and Long Term Care (1995). Health Professions Press. Baltimore, MD.

In addition to the principles listed above, people diagnosed with dementia require skills which makes communication even more demanding. Remember, people who have dementia gradually lose the ability to communicate meaningfully, because they lose the ability to remember words, and organize or verbalize their thoughts. Key principles to remember when communicating with the persons diagnosed with dementia are as follows:

• Don't take negative responses personally.
• Remember that this person has changed due to a disease and not due to a fault of his/her own.
• Do not expect this person to react the same as he/she has in the past.
• Try not to argue.
• Try to distract or divert attention when behavior or communication becomes difficult.
• Be patient.
• Do not whisper.
• Speak calmly and reassuringly.
• Remember that the person will forget what was said and you may have to repeat yourself.
• Be wary of body language.
• Approach from the front, not the back.
• Use simple sentences.
• Avoid abstract discussion.
• Avoid using analogies.
• Try to make statements positive statements, rather than negative.
• Respond to feelings rather than content.
• Avoid reasoning, and logic. State what needs to be done.

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Required Reading

pp. 1-52, It Takes More than Love: A Practical Guide to Taking Care of An Aging Adult (2000) Anita G. Beckerman, and Ruth M. Tappen. Health Professions Press, Baltimore, MD.

Review the web-site below to further research communication techniques:
http://www.alz.org/caregivers/daytoday/communication.htm.

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Online Activities

1. Watch the videos below and reflect upon the questions below:

   Crystal Orr is a family caregiver who has taken care of her mother, Mary Jones, at home for the past five years. Crystal is in her sixties, and her mother is 84. Her mother has been diagnosed with dementia—with probable cause due to Alzheimer's. As she starts her personal story she says, "Communication is very difficult...I have to keep reminding myself how to word things. I need to remember to 'ask' my mother to do things, and not 'tell' her to do things." Watch the video and answer the questions for reflections below.

   	First Signs of Dementia  · Transcript
   	Communication Issues  · Transcript
   	Coping Strategies  · Transcript
   	Advice to Other Caregivers  · Transcript

2. Opportunity for Reflection: Consider the following questions for reflection when watching the video:
   • As you listen to her personal story, what specific advice does she give other caregivers?
   • At one point Crystal says, "One of the things I found is she is 'here for a moment, then gone in the next'." What implications does this have in terms of communication?
3. Complete the Communication Exercise and post to the WebBoard under Unit 5 Communication.

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