Alzheimer's A to Z

with Dr. Jytte Fogh Lokvig


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Communication

Examples


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Verbal traps that challenge a person’s memory:


“Do you remember . . . ?”

Instead, start with a description of the event or person you want to talk about:  

“I was just thinking of your friend Sally whom we ran into a few days ago. You really liked her new dog, that cute little brown poodle.” At this point you may see that glint in her eyes that tells you she follows what you’re talking. She may join in and add to the conversation or she may just choose to listen as you reiterate your visit that day. When you use story telling to share particularly joyful experiences in all the glorious details, it’s an opportunity to relive them. If the stories are particularly pleasurable, they may bear repeating often. Good anecdotes can be used as effective diversions. When you retell these shared experiences with delight, you’re not only given her the joy over again, but you’re letting her know by your attitude how happy you are that she was there sharing with you.



Use with care: “Do you want?”

Find a different way to ask “Do you want . . .?”

unless you already know the answer, as in:

“Do you want ice cream?”


If she's unsure of what you mean, or can't picture somehing in her mind, the safest response for her will be a "NO"


When you ask Mom “Do you want to take a walk?” she may not be sure at that moment what kind of “walk”

      “Mom, do you want to go for a walk?”

      “NO!”


Instead, present it in another way: “Mom, it’s so beautiful outside. And it’s springtime. Yesterday morning you made me promise that we’d go for a stroll around the block if the weather stayed warm. Maybe the daffodils will be in bloom in our neighbor’s yard down the road. Come on, let’s put on our walking shoes and go for a walk, okay?”


As much as possible, include Mom in the suggestion. Be positive and upbeat:


            “I promised you this.” (Meaning: this is something you wished for.)


            Or:     “This is your idea; I think it is a really good one.”


            Or:     “You asked me to remind you that you wanted to do this now. I’m so glad I remembered.”


            Or:     “This is one of your favorite things to do, isn’t it?”



Now that Mom has trouble expressing herself, you’ll often have to speak and think out loud for her. Complete your sentences with “isn’t it?” or “don’t you think?” or the like so she feels as if you’re including her in the conversation:

            “That was a good lunch, don’t you think?”


            Or:    “I think this is good idea, don’t you agree?”


All Mom has to do is answer “yes” or “no,” yet she feels as if you’re asking for her opinion.


As you get used to this kind of communication, you’ll find it much easier to deal with the more challenging situations.


             “Do you want to take a bath?” is almost guaranteed to solicit a resounding: “No!” (Also, go to BATHING)


            Instead, try this:  


             “Friday’s a good day for a bath, don’t you think?”


            Or:     “I bet you need to go to the bathroom right about now, don’t you?”


            Or:     “I’m tired and feel like going to bed, don’t you?”



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COACHING


Grandma’s confusion often makes it difficult for her to perform even simple tasks. Her brain is no longer processing incoming information in the same fashion as yours. You can help her out by coaching her, verbally and physically. As you talk her through a process, be extra conscious of keeping your tone on an adult level, which is extra difficult in these situations because it can be heartbreaking to watch a loved one be so helpless.


Any movement our bodies make involves this kind of subconscious planning. We dash down a busy sidewalk at rush hour and we don’t stumble over the curb or bump into other people. As we go through the process of walking, our subconscious minds are constantly surveying and memorizing the terrain ahead. Grandma’s no longer able to process these subconscious impressions. She walks with hesitation and uncertainty because of her inability to plan ahead. You have become her “movement guide” as you describe out loud what’s a few steps ahead, leading her gently by the arm.


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Grandma looks at you in bewilderment. She has no idea how to get into the car. She needs your help, so you take her through the motions with gentle coaching. Approach this as though it’s the first time she’s ever gotten into a car. Guide her step-by-step in a clear voice, gesturing and demonstrating as much as possible.


“This is your seat (as you pat it.) First you step in here with this foot (as you pat her left leg,) then you sit down on the seat. I’ll support you so you won’t fall. Now pull your other foot in and move over to the middle of the seat. Perfect! There, you did it!”


You’ll probably have to go through it all again the next time you go for a drive. With practice, your coaching will be as smooth as a flight attendant’s safety spiel. Make sure that you are clear and precise, without sounding patronizing.


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Ask for Grandma’s opinion, even if she’s not coherent or her “input” has no relation to your question. Simply respond as if she has offered an excellent idea, but don’t go overboard in your positive reaction. Keep it natural and sincere.


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Your friend Molly is in the advanced stage of Alzheimer’s. You still want her to do as much as possible for herself. However, she is very confused and you need to coach her through all sorts of everyday tasks, from how to use the toilet to how to button her blouse. You’ll discover that your coaching will be easier if you alter your vocabulary and guidance. Molly’s often confused about “left” and “right,” so you can rephrase by saying “this one” and “the other.”


“Are you ready to put on your shirt? Here, put one arm into this sleeve (as you hold it open for her) and then your other arm into the other sleeve – right here.”


“Come sit in this chair (as you pat the seat of the chair) and I’ll sit in the other one.”


When Molly sees a spoon, she may not remember what it is, so she’s not able to prepare her hand to grab it. You can help her by placing the spoon in her hand until she or her fingers remember what to do.


“Here’s your soup. This is the soupspoon. You can hold it in this hand” (as you place the spoon in her hand).


If she continues to have problems, you can use “hand-over” method. (You place your hand over hers and gently guide her movements.)


Molly may have forgotten the words for the parts of her body, so whenever you need her to do something specific, you can help her connect by patting her on her limb as you use the correct term.


“I’m going to turn on the water for your shower. Feel it with your hand (as you pat her hand) and let me know if it feels comfortable to you.”


If the shower becomes too problematic, you can switch to "sponge-baths" or "no-rinse" washcloths.


Other directions may also baffle her, such as turning around or facing in a certain direction. If you say, “The glass is right behind you,” she may have no idea what that means since she can’t see the glass. Instead, go to her and gently turn her around so she can see it, guide her to a chair and place the glass in her hand while you offer her a reassuring remark:


“Here’s your glass with your favorite juice. Come sit in this chair (as you pat it). Now you can enjoy your juice.”


This step-by-step guidance may sound tedious, but it’ll soon be second nature to you. The little extra time it takes now will spare you a lot of aggravation that would result from Molly’s confusion and frustration.


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