Tools and Strategies for Improving Communication Skills for Alzheimer’s Caregivers

Losing the ability to communicate thoughts and emotions is one of the most frustrating and challenging aspects of Alzheimer’s disease, both for the individual with the cognitive disorder and for the caregiver. Physiological changes within the neurological system cause widespread death of neurons in areas of the brain associated with memory and language, which causes serious communication problems in people with the disease. While caregivers cannot reverse the loss of brain cells in the people they care for, they can make changes in the way they communicate with the patients in their care.

Alzheimer’s disease (AD) and other forms of dementia gradually reduce a person’s ability to communicate. Communicative declines associated with AD affect primarily the semantic and pragmatic levels of language processing, making it difficult for someone with Alzheimer’s disease to distinguish the literal meaning of a phrase from the actual meaning of the sentence. This inability to understand the meaning of a conversation within context can lead to breakdown in communication, which is frustrating for both the individual with Alzheimer’s and for the caregiver.

The Process behind Communication Decline in Patients with Alzheimer’s Disease

The healthy brain contains tens of billions of neurons, according to the National Institute on Aging, and these cells process and transmit information. In the early stages, AD destroys neurons and their connections.

Alzheimer’s disease begins with neurons in the entorhinal cortex, an area deep within the brain. The entorhinal cortex is near the hippocampus, which is associated with learning and converting short-term memory into long-term memories, and had deep connections to it. In people with AD, healthy neurons in the entorhinal cortex begin to work less efficiently, lose their ability to communicate, and eventually die. In time, this functional deterioration spreads to the hippocampus and negatively affects learning and memory.

Regions affected by AD begin to die and shrink away. Fluid-filled ventricles enlarge and take up the empty spaces created by the shrunken tissue. The physiological effects of brain cell dysfunction, tissue death and the development of ventricles frequently manifest as communication disorders.

Recognizing Signs of Declining Communication

Caregivers are frequently the first to recognize signs that an individual is losing the ability to communicate, but these signs may not always be clear. Every person with Alzheimer’s experiences communication loss in a slightly different way. Communication will not seem remarkably different in the early stages of the disease, except that the individual may repeat stories or struggle to find a word.

Changes in communication become more marked as the disease progresses. While these changes are still unique to each patient, there are some common signs of deteriorating communication. The caregiver may notice the individual:

• Uses familiar words repeatedly
• Invents new words to describe familiar objects
• Loses his train of thought easily
• Reverts back to her native language
• Has difficulty organizing words in a logical order
• Speaks less often

Facilitating Communication between Caregiver and Person with Alzheimer’s Disease

Communication is a two-way street, of course, but the individual with Alzheimer’s loses his ability to express and understand thoughts and emotions. This means the caregiver carries an ever-increasing burden of keeping the lines of communication open. A caregiver can do this in two ways: by helping the person with Alzheimer’s communicate and by improving the way he expresses his words and emotions.

How to Help Someone with Alzheimer’s Disease Communicate

People with AD find it more difficult to express thoughts and emotions; they also have more trouble understanding others. Caregivers can facilitate communication by:

• Being patient
• Demonstrating interest
• Expressing support
• Making it evident that they are listening and trying to understand
• Not interrupting
• Offering reassurance, comfort, and encouragement
• Avoiding arguing, criticism, and correction
• Not pointing out mistakes but instead listening closely to find the meaning in what the individual is trying to express
• Offering a guess at the right word or the deeper meaning of the communication
• Repeating what the individual said to help clarify the thought
• Avoiding unnecessary frustrations
• Encouraging nonverbal communication, such as pointing and gestures
• Creating a quiet environment and limiting distractions to help the individual focus on her thoughts
• Focusing on emotions rather than facts, paying special attention to tone of voice and behaviors for insight on what the individual is trying to express

Ways the Caregiver can Improve Their Own Communications

While people with Alzheimer’s disease and other forms of dementia lose their ability to express themselves or understand written or oral conversations, they still benefit from communicating with their caregivers. Ongoing communication is essential to the health and wellbeing of the individual, no matter how confused or agitated the person with AD appears. This makes it incumbent on caregivers to create new ways to keep lines of communication open.

The caregiver should identify herself with every encounter as necessary and call the patient she cares for by name.  Calling the person by name gets the individual’s attention. The constant introduction helps orient the person to who he is and to identify others in the room.

A caregiver should always approach someone with AD from the front. It is important to maintain good eye contact so, if the person is sitting or lying down, the caregiver should position himself to be at eye level with the patient.

Short, simple words and sentences are better, as lengthy instructions are frequently overwhelming. Caregivers should give one instruction or ask one question at a time and wait patiently for a response, as it AD slows information processing in the brain. Caregivers should repeat information or questions as needed when it is clear the individual with AD is confused or has forgotten the task.

Because Alzheimer’s disease affects the semantic and pragmatic language centers, caregivers must always avoid vague statements and confusing language. Instead of saying, “Jump in the shower,” he could say, “Please step into the shower.” Using the specific name of an object, person, or place is more effective than using vague language. For example, the caregiver should say, “Here, put on this sweater” instead of “go find something warm to wear.”

Caregivers can make statements rather than ask questions. A caregiver could say, “Here is your lunch” instead of asking, “Are you hungry?” for example.

While reminiscing can be healthy, quizzing can be frustrating to a person with memory problems. Caregivers should avoid starting conversations with “Do you remember when…?”

Demeanor is Everything

The Alzheimer’s Association says that when “communicating with a person with dementia, it’s especially important to choose your words carefully.” Caregivers should speak slowly and clearly. A gentle, relaxed tone with a lower pitch is calming.

A friendly tone of voice with an easygoing manner helps diffuse even the most emotionally charged situations. Caregivers can use friendly facial expressions, supportive words, and positive nonverbal cues to facilitate communication with people with Alzheimer’s disease.

To avoid frustration and resentment, caregivers should choose words and phrases with positive annotations. Rather than saying, “It is too cold to wear a short-sleeved shirt,” the caregiver can say, “Put on your favorite sweater.”

Visual cues are especially helpful. The caregiver can simply point to or touch the item she wants the individual to use. In some cases, she can start the task and invite the person with AD to take over. Written notes are effective reminders but they must be clear enough for someone with AD to understand them.

Even though they cannot control the physiological effects of Alzheimer’s disease, caregivers who improve how they communicate with people with Alzheimer’s disease can reduce frustration, stress, and agitation.