A poster wrote that her mother became very argumentative with one of her aides. At these times, it is difficult to reason with her. (The aid says that the mother hurts her feelings!)

Chances are that this situation would improve with an aide who has more experience with dementia. A wrong answer, or a response containing emotion can easily provoke a response in people with dementia. They react poorly to “No”, “don’t do that” or being corrected.

She wrote “at those times it is difficult to reason with her”. You can not reason with a person with Alzheimers – their reasoner is broken. (It’s not just a memory problem) You will not win an argument with a person dementia (they cannot process the information to change their viewpoint) and they react primarily to the emotion of the message.

Experienced caregivers know to ignore emotions, distract and redirect. They learn to communicate in a manner that does not provoke responses.

Norbert



What follows is a number of articles on the role of communication in Dementia caregiving:

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*Tips on communication with dementia patients from Jo Huey's book, Alzheimer's disease Help and Hope: Ten Simple Solutions for Caregivers:

Never argue, instead agree. Never reason, instead divert. Never shame, instead distract. Never lecture, instead reassure. Never say “remember”, instead reminisce. Never say “I told you”, instead repeat what you previously said. Never say “You can't do that”, instead say “do what you can”. Never command or demand, instead ask or model. Never condescend, instead praise and encourage. Never force, instead reinforce.

This was simplified form was originally posted on this board as - The Ten Absolutes of Caregiving:

• Never argue -- Agree • Never reason – Divert • Never shame – Detract • Never lecture – Reassure • Never "remember" – Reminisce • Never "I told you" – Repeat • Never say "You can't" – say "Do what you can do" • Never command or demand – Ask or model • Never condescend – Encourage or praise • Never force – Reinforce

-------------------------------------------------------- previously posted by sweethome55 (3/22/05)

I passed this advice around to a few of our family members and friends because of my mother in laws current stage of AD - unreasonable, aggitated, etc. I found it very easy to follow and helps remind one to not take it personal.

DON'T

Don’t reason.

Don’t argue.

Don’t confront.

Don’t remind them they forget.

Don’t question recent memory.

Don’t take it personally.

DO

Give short, one sentence explanations.

Allow plenty of time for comprehension, then triple it.

Repeat instructions or sentences exactly the same way.

Eliminate 'but' from your vocabulary; substitute 'nevertheless.'

Avoid insistence. Try again later

Agree with them or distract them to a different subject or activity

Accept blame when something’s wrong (even if it’s fantasy).

Leave the room, if necessary, to avoid confrontations.

Respond to feelings rather than words

Be patient and cheerful and reassuring. Do go with the flow.

Practice 100% forgiveness. Memory loss progresses daily.

My appeal to you: Please.elevate your level of generosity and graciousness.

read more about this set of tips at-- http://www.alznorcal.org/abtalz/compcomm.asp

--------------------------------------------------------------- STEPPING INTO THEIR WORLD (Source: Lowell Sun) – When you care for a loved one suffering from Alzheimer's disease, there are two worlds – yours and theirs. “Oh yeah, sure, the sky is green. What difference does it make, as long as they're smiling and content?” said Gloria Brunelle of Lowell about her mother, Yvette, who suffers with Alzheimer's. “Get over the shock.” Trying to “correct” the mindset of an Alzheimer's patient will likely lead to an unhappy outcome, said Mal Allard, a licensed practical nurse. It’s better to step into their world and work to connect with the person emotionally. For example, if a man with dementia calls out for his long-dead mother, it serves no purpose to admonish him, explained Allard. That only causes them to relive the death over and over, and it's not helpful. A call for a deceased parent may really be a disguised plea for reassurance. Try to recognize the source of angst or unhappiness, said Allard. “Validate what they are feeling,” she said. “Give them a hug. Tell them you understand. We need to address their emotional needs first.”

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"Twelve Basics For Alzheimer's Care" (from caregiver-information.com alzheimers,communication)

Alzheimer's is a disease, not a normal part of aging.

Accept the disease. Persons are not "misbehaving" or forgetting on purpose. You can not change this reality, but you can manage the behavior.

Arguments are useless; in fact, they make matters worse. Confusion, memory loss and frustration are making the person behave irrationally and you can't "argue" them out of it.

Allow as much freedom and independence as possible while keeping safety and comfort in mind.

Actions help when verbal communication may fail. Help the person by demonstrating what you mean, or sometimes, start them in the activity.

Assume that the person may hear and understand what you say even if they are confused. Do not say things to others in front of them as if they are deaf.

Appreciate good moments or good days, even though the person's ability is not going to remain that way.

Appropriate activities which help persons pass the time meaningfully and productively and reduce agitation, boredom, daytime sleeping, and depression.

Agitation can be alleviated when the caregiver remains calm, reassuring and respectful of the person's feelings.

Adults with disabilities are still adults. Mental level is not always equal to social level.

Adapt the task to fit the ability of the person. Break down the activity into separate steps, or simplify task by eliminating parts that could be frustrating.

Assessment is ongoing. What is safe and effective for now may not be so at a later time. Keep watching and reevaluating.

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(From Caregiver’s SEAD at Massachusetts General hospital) Tips for Successful Communication

SMILE!!!...it helps alot!!!

Problems With Communication:

Alzheimer’s directly affects parts of the brain responsible for communication. Someone with Alzheimer’s finds it harder to both understand others, and explain themselves. It also leads to forgetting the names for once familiar objects such as watches or pens. Early in the disease, people with Alzheimer’s are often able to hide these problems quite well. In later stages, it is difficult to have a normal conversation. By keeping a few tips in mind, it is possible to talk to people with Alzheimer’s and avoid much frustration.

Tips for Better Communication:

Be aware of what your body and face is saying: Smile as much as possible, use slow hand gestures, keep your body relaxed. Try to make normal eye contact.

Be aware of your tone of voice: Avoid yelling, but also be aware that you may be talking to someone with a hearing loss.

Speak slowly and clearly: Alzheimer’s makes it harder to understand many words. Speaking fast may mean the person you are talking to does not hear all of what you are saying.

Try not win arguments: Avoid reasoning or trying to convince them. Often they don’t understand the argument. They can become frustrated by not understanding, or because they are talking to someone who is frustrated.

Limit choices to only a few: Ask questions which can be answered yes or no. Avoid giving lists or forms to fill out.

Avoid conversations in crowded or loud places: Someone with Alzheimer’s is easily startled. It is harder to focus on one conversations when many others are going on. It is also hard to concentrate when always being startled.

Acknowledge what is said: Repeat back key points, and work to let the individual with Alzheimer’s know you heard them. Agree as often as possible: Stay calm and soothing, agree often with what they are saying, and tell them you understand. Avoid using the word "no:" arguing and confronting. Know first languages: Alzheimer’s can lead to forgetting second languages. A language spoken since birth can also be comforting when heard.

Rephrase words that are upsetting: Individuals with Alzheimer’s may not recognize or understand words you use. Try to find simpler and more comforting terms or those you are using are upsetting. For example, "day care" often becomes "going to work" or "the [insert name here] club."

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Caregiver's Guide to Understanding Dementia Behaviors

(from Family Caregiver Alliance )

Caring for a loved one with dementia poses many challenges for families and caregivers. People with dementia from conditions such as Alzheimer’s and related diseases have a progressive brain disorder that makes it more and more difficult for them to remember things, think clearly, communicate with others, or take care of themselves. In addition, de-mentia can cause mood swings and even change a person’s personality and behavior. This Fact Sheet provides some practical strategies for dealing with the troubling behavior problems and communication difficulties often encountered when caring for a per-son with dementia.

Ten Tips for Communicating with a Person with Dementia We aren’t born knowing how to communicate with a person with dementia—but we can learn. Improving your communication skills will help make caregiv-ing less stressful and will likely improve the quality of your relationship with your loved one. Good communication skills will also enhance your ability to handle the difficult behavior you may encounter as you care for a person with a dementing illness.

1. Set a positive mood for interaction. Your attitude and body language communicate your feelings and thoughts stronger than your words. Set a positive mood by speaking to your loved one in a pleasant and respectful manner. Use facial expressions, tone of voice and physical touch to help convey your message and show your feelings of affection.

2. Get the person’s attention. Limit distractions and noise—turn off the radio or TV, close the curtains or shut the door, or move to quieter sur-roundings. Before speaking, make sure you have her attention; address her by name, identify yourself by name and relation, and use nonver-bal cues and touch to help keep her focused. If she is seated, get down to her level and maintain eye contact.

3. State your message clearly. Use simple words and sentences. Speak slowly, distinctly and in a reassuring tone. Refrain from raising your voice higher or louder; instead, pitch your voice lower. If she doesn’t understand the first time, use the same wording to repeat your message or ques-tion. If she still doesn’t understand, wait a few minutes and rephrase the question. Use the names of people and places instead of pronouns or abbreviations.

4. Ask simple, answerable questions. Ask one question at a time; those with yes or no answers work best. Refrain from asking open-ended ques-tions or giving too many choices. For example, ask, “Would you like to wear your white shirt or your blue shirt?” Better still, show her the choices—visual prompts and cues also help clar-ify your question and can guide her response.

5. Listen with your ears, eyes and heart. Be patient in waiting for your loved one’s reply. If she is struggling for an answer, it’s okay to suggest words. Watch for nonverbal cues and body language, and respond appropriately. Always strive to listen for the meaning and feelings that underlie the words.

6. Break down activities into a series of steps. This makes many tasks much more manageable. You can encourage your loved one to do what he can, gently remind him of steps he tends to forget, and assist with steps he’s no longer able to accomplish on his own. Using visual cues, such as showing him with your hand where to place the dinner plate, can be very helpful.

7. When the going gets tough, distract and redirect. When your loved one becomes upset, try changing the subject or the environment. For example, ask him for help or suggest going for a walk. It is important to connect with the person on a feeling level, before you redirect. You might say, “I see you’re feeling sad—I’m sorry you’re upset. Let’s go get something to eat.”

8. Respond with affection and reassurance. People with dementia often feel confused, anxious and unsure of themselves. Further, they often get reality confused and may recall things that never really occurred. Avoid trying to convince them they are wrong. Stay focused on the feelings they are demonstrating (which are real) and respond with verbal and physical expressions of comfort, support and reassurance. Sometimes holding hands, touching, hugging and praise will get the person to respond when all else fails.

9. Remember the good old days. Remembering the past is often a soothing and affirming activity. Many people with dementia may not remember what happened 45 minutes ago, but they can clearly recall their lives 45 years earlier. Therefore, avoid asking questions that rely on short-term memory, such as asking the person what they had for lunch. Instead, try asking general questions about the person’s distant past—this information is more likely to be retained.

10. Maintain your sense of humor. Use humor whenever possible, though not at the person's expense. People with dementia tend to retain their social skills and are usually delighted to laugh along with you.

Handling Troubling Behavior Some of the greatest challenges of caring for a loved one with dementia are the personality and behavior changes that often occur. You can best meet these challenges by using creativity, flexibility, patience and compassion. It also helps to not take things personally and maintain your sense of humor.

To start, consider these ground rules:

We cannot change the person. The person you are caring for has a brain disorder that shapes who he has become. When you try to control or change his behavior, you’ll most likely be unsuccessful or be met with resistance. It’s important to:

Try to accommodate the behavior, not control the behavior. For example, if the person insists on sleeping on the floor, place a mattress on the floor to make him more comfortable.

Remember that we can change our behavior or the physical environment. Changing our own behavior will often result in a change in our loved one’s behavior.

Check with the doctor first. Behavioral problems may have an underlying medical reason: perhaps the person is in pain or experiencing an adverse side effect from medications. In some cases, like incontinence or hallucinations, there may be some medication or treatment that can assist in managing the problem.

Behavior has a purpose. People with dementia typically cannot tell us what they want or need. They might do something, like take all the clothes out of the closet on a daily basis, and we wonder why. It is very likely that the person is fulfilling a need to be busy and productive. Always consider what need the person might be trying to meet with their behavior—and, when possible, try to accommodate them.

Behavior is triggered. It is important to understand that all behavior is triggered—it doesn’t occur out of the blue. It might be something a person did or said that triggered a behavior or it could be a change in the physical environment. The root to changing be-havior is disrupting the patterns that we create. Try a different approach, or try a different consequence.

What works today, may not tomorrow. The multiple factors that influence troubling behaviors and the natural progression of the disease process means that solutions that are effective today may need to be modified tomorrow—or may no longer work at all. The key to managing difficult behaviors is being creative and flexible in your strategies to address a given issue.


[This Message was Edited on 12/24/2005]
[This Message was Edited on 12/26/2005]
[This Message was Edited on 02/07/2006]

for spelling it out once again for all of us -

"Communication in Dementia Caregiving."

I am sending a copy to all in our family and also to a few of our best friends.

It is an eye opener for all who are willing to learn from it.

Bless you for always being here for us, even today on Labor Day!

MaryKathryn

I echo Mary Kathryn; this is priceless information for those of us who deal with this on a daily basis and are willing and eager to learn. But then we contend with well-meaning relatives who remain in denial and "correct" the patient and try to motivate them to do things they are not able to do, such as "start walking again and go home." It takes days to undo the damage and start the trust and rebuilding again. I know you can't help us change this but guess I just need some advice on facing these patient reactions and setbacks after family visits Ev

Thank you so much for the above!! I learned something last week about myself. I never thought I had much of a southern accent and had also been told I don't, but ... My Dad has a new roommate who is pretty "with it" and we were talking last week--well, he was repeating back to me what I said, but it came out odd; I just went with it. While driving home I came to realize that must have been what it sounded like to him. I find that I do speak slower with my Dad and a bit louder (he's hard of hearing), but never thought about what I sound like. I will focus on that this week and see if Jackson can understand me better. He's not a southerner, so imagine how we all must sound like to him. Although his Wife is from Tennessee, so am sure I don't sound too different. What an eye opener it was for me.

I had to get rid of one aide who called my mother an idiot and just did not seem to know how to deal with an Alzheimer patient. They sent another one who seemed to carry the problems of the world on her shoulders, she never smiled and was very unfriendly with my Mom. My sibling said I was being picky, I dont think so. You need a certain type of person to deal with someone with this disease. I could have an terrible headache and I still walk in Mom's home with a smile and a hug for her. A lot of these aides are not properly trained. As of now the ones we have are fine, one does not clean but she is excellent with my Mom and that makes all the difference in the world. I am so glad you posted this info. I am going to print and put it on the board at home. Thanks again Norbert if you only knew how helpful you truly are. Take care, Jackie
[This Message was Edited on 09/08/2005]

I'm new here and really needed to hear the information your post gave. I went to get my mom in mid-june after hearing some troubling things from her over the phone. She was telling me my Dad fixed her breakfast (he passed 6 yrs ago), and that she couldn't undress in front of the TV anymore cause the people on TV made bad comments. Then she got lost a mile from her home, and finally fell and possibly broke a hip. I went to get her and made major changes in her life immediately. Her conditions were shocking. I put her in the hospital when I got her back to my home and they said she had severe Alzheimer's. They wanted to put her in total care. I disagreed. I didn't feel my mom's disease was that advanced, but that she was just having major issues due to all the changes she had gone through in a short time. Also they didn't take into account that she is almost totally deaf, so she didn't answer all of their questions right.

At any rate, I felt I needed to get her into my home, settled and into a routine. I did this and the home health psych nurse after only a month released her and said she tests out as mild to moderate Alzheimer's. I'm not sure what that means, but what I do know is that some days it's like I am raising a rebellious teenager again, and other days it's like having a 5 year old who cries and pouts etc... I can see that the Namenda helps some from when she first got here, but still the mood swings are challenging.

It's really hard some days. My life has changed completely. I want to do what's best for my Mom but God she is so difficult at times. I looked for this site cause I really just needed someone to talk to about all this sometimes.

Here I am complaining about my troubles when many of those who post here have loved ones so much worse and appear to be dealing with so much more.

I just needed the reminder you gave in your post about how to handle things. Thank you again.

great reading again and again.

Thank you Norbert!

of talking about mom to others in front of her....aides, nurses,visitors

not in a negative way but someone will ask me something about her and i answer.

i'm learning though and i make sure that she's spoken to respectfully and as an adult.

as mom communicates, she makes sounds and sometmimes full sentences. i dont correct her but i do tell her, tell me what you're saying, mom...she'll repeat it and between the two of us we manage.

i figure she knows what she saying... the rest of us just have to CATCH up!

when she talks to me i give her my full attention because what she's saying is important to HER and to me.

what i notice is that some aides are too immature to have patience when dealing w/dementia afflicted. even w/ all the training...i remember chastising an aide feeding mom when she complained to mom that she talked too much. i caught her saying it as i approached her room.

i took the aide aside and told her that mom is 75 not 7 and she can talk as much as she likes and if she(the aide) cant deal w/it to ask to be reassigned but dont EVER tell mom to be quiet!

I have been dealing with my wife's AD for about three years, although I have read this several times, it is helpful to review this thread from time to time.

She seems to be entering another phase of AD, it is getting more diffcult for me to deal with her on a day to day basis, I am printing this out and will pass along a copy to the children. It will help increase our awareness of the adjustments we need to make to help us relate to her feelings.

There is so much good information available here.


[This Message was Edited on 05/15/2006]

This is very helpful. So much to learn and keep in mind.

Hello there! I have read much of what is posted in other forums, articles, books etc. It's good stuff...but some days are just too difficult.

My mother was diagnosed last year with AD, but the symptoms were evident for a number of years. She is still at home; we live in a mother-daughter home. So far, it has been ok, although I know the time is quickly approaching when I will have to get a care-giver in, as I work full time. She has never been a very social person outside of the family, and will resist having a care-giver...unless of course she reaches a stage where she forgets she does not like people in her house...lol!

She has reached a very negative stage...everything is negative, she has something unpleasant to say about everyone and everything. She bombards me with this negativity constantly, even though I attempt to turn the converstaions around (as the above message reflects,) all to no avail.

Her sisters and cousin live nearby and have been very supportive by taking her out to places, for visits, lunch, movies, etc. However, they are becoming aggravated with her behavior as well. My sister lives about an hour away and really only shows up once in a while...for a 'visit' and will not commit herself to more than that.

I guess I am just venting. I know the time has come to consider other options, but I wanted her to be at home as long as possible. It has been very taxing on me and my family. And to make my life even happier, I fell down a spiral staircase last week and I am in a leg brace, bruised from head to toe, and waiting to go to the orthopedic surgeon next week. Yipee!

Whew...just needed to vent.

You are a gem. Somewhere I have not noted or have forgotten who the loved one you have that has AD. (just curious) I think the best thing in your long article for me was "there are 2 worlds, your world and theirs". I sometimes look into my husbands eyes and wonder what is behind them, what he is thinking or not thinking................in other words, his world. Thanx Norbert

Love ya, bless you

Tks

BUMP

YOu may want to print this and the other "bump", and keep them for future reference. It will become very helpful. Gladness