By aritz arozarena and Enrique GomezPsychology team
Communication impairment is one of the earliest manifestations of Alzheimer’s disease, after memory-related problems. It is estimated that around 40% of patients in the mild or moderate phase of the disease present these alterations, while the prevalence in the severe phases is 100%.
It should be said that not all aspects of language are affected in the same way, and that there is great variability between subjects and between the different phases. Despite this, we can make use of a series of guidelines and good practices to promote communication between patient and caregiver or family member.
Guidelines to facilitate communication with patients with Alzheimer’s and other dementias:
• Search for current affairs to keep in touch with reality.
• Search for topics of interest that motivate you.
• Allow time for them to intervene and for you to convey what you are trying to say.
• Ask for their opinion on the activities to be carried out (it helps to maintain the sense of autonomy, independence and control of the situation).
• Offer two response alternatives (even just one)
• Ask questions, even if you can only answer yes/no (do you like the shirt? are you hungry?)
• Use all the senses to help remember and start a conversation.
• Show old photos to recall remote memories and pleasant situations.
• Use music as a means of expressing feelings and to evoke words.
• Promote automatic language (poems, songs…)
• Use the game to communicate and interact with others.
• Try to show him visually what you want to say.
• Say things simply
Putting the focus on verbal communication:
• Speaking softly and deliberately conveys confidence.
• Language must be adapted to the new and constant limitations imposed by the disease.
• Comments made with a sense of humor are often more effective than the use of imperatives.
• Although the ability to understand and follow conversations decreases, it is important to include the patient in conversations in which he can participate to some extent.
• When faced with meaningless questions or explanations, discussion should be avoided. It is better to change the subject or play along, but without adding elements that could confuse him more.
The importance of non-verbal communication and body language:
• Match verbal and nonverbal communication.
• The gaze and facial expression should not show concern.
• Nonverbal communication takes on much more relevance.
• The sick person should be conveyed a sense of security.
• Gesture little by little.
• You should not be verbally or physically nervous.
• The person affected by this disease is extremely sensitive when interpreting the state
• The mood of the people around you has a direct effect on the mood of the patient.
• Touching the patient affectionately, caressing him, is a good way of transmitting security, if he got used to it before.
• Always stand in front of the patient, introduce yourself and look him in the eye.
• Approach the person head-on and slowly.
• Touch them before you speak, so they don’t get scared.
• Convey a feeling of well-being and warmth.
• Physical contact should be gentle and gentle to show love and care.
• Do not use force or shout
• Maintain eye contact
Adapting our way of speaking:
• speak slowly and clearly
• Use simple language and short sentences.
• Use familiar words.
• Use concrete and short sentences.
• Use simple vocabulary
• Conversation should be simple, but at an adult level (don’t treat like a child)
• Do not raise your voice
• Be positive. speak positive
• Accompany speech with slightly exaggerated gestures and using facial expression and other signs of non-verbal communication.
• Verbal and non-verbal communication must be consistent
How to facilitate understanding:
• Know how to listen to them, observe facial expressions and gestures.
• Repeat the information using other words.
• Not pretending that you have understood the message if you have not, can cause frustration for both parties.
• Observe the patient’s response to physical contact (acceptance, more reluctance…) and adapt this contact according to the needs of each person.
• Strengthen any other communication system (visual, proprioceptive, with non-verbal sounds…)
• Make sure that you have understood us.
• Make continual references to the person or topic being discussed.
• Try to guide them using names of relatives and type of relationship.
• Talk about topics or events that they can remember, or about simple or everyday things.
• Do not jump from one topic to another in the conversation.
• Pay attention to the emotional tone with which he speaks.
• Keep calm and be patient.
Simplify activities:
• Give step-by-step instructions.
• Use simple and simple instructions: “Let’s prepare the salad”, “Take a tomato”, “Now, take a carrot”…
• Make it easy for them to participate in the conversation.
• Ask the questions one at a time.
• In social situations, avoid rapid conversations in which several people speak at once, or the subject is quickly changed.
How to act when faced with repetitive questions:
• Keep calm.
• With simple answers.
• Asking for the patient’s participation (look at the clock on the wall…).
• Using distraction devices: Distract the sick person with something else to see, hear, or do.
• Write the answer to the most frequently asked questions. Hug and show affection, if appropriate for the person.
Last but not least: attitudes:
• Active listening can help you respond positively.
• Avoid giving wrong information or making false promises.
• Help and encourage them to exercise the tasks they can perform.
• Respect things that are important to the patient (personal hygiene, not talking about them in front of other people, respecting their customs, beliefs…).
• Express feelings with affectionate words and touches. Stimulate them and help them show their affection.
• Have a lot of patience. Give them enough time to act and/or rectify.
• Be understanding and tolerant.
• Do not scold them, do not shame them, do not make negative comments.
• Participate with them in activities, supervise and stimulate them.
• While carrying out ADL, break down complex activities into several simple ones, always following the same steps, in the same order and accompanying it with clear and simple instructions.
• If he does not respond to instructions: imitation.
• Avoid discussions about false or mistaken ideas.
• Be flexible, adapt to: the needs and rhythm of the patient, changes in behavior and the current state of the patient (modify our way of communicating depending on the evolution).
• Listen and learn to recognize feelings and emotions, more than words.
About the authors:
Enrique Gomez and aritz arozarena
Enrique GomezGraduated in Psychology from the University of Barcelona and Master in Psychology and Aging from the UAB, is Technical Director of and tutor of Studies in Psychology Open University of Catalonia.
aritz arozarenaGraduated in Psychology from the University of Barcelona, is a Psychologist of the psychology team of and content manager for the Communication Area of Grupo Atlantida.