How do you talk to someone who has Alzheimer’s disease?
No matter how deeply we care about friends or family, Alzheimer’s disease or dementia can make us uncomfortable – especially when we don’t fully understand it.
Seeing your loved one struggle with memory loss, confusion, or the ability to understand situations and surroundings is difficult. Learning about the disease and knowing what to expect can be helpful as you navigate this journey with your loved one. Read more about Alzheimer’s disease.
How Alzheimer’s affects emotions
Alzheimer’s disease is marked by memory loss, personality changes and impaired reasoning. The most common symptom is difficulty remembering new information.
“Alzheimer’s dementia most often affects the hippocampus. This is the memory and learning center of the brain, so short term memory loss – repeating questions and difficulty learning new things are often noted first in the disease,” says Lindsey Dahl, M.D., an internal and geriatric medicine specialist at Sanford Health in Fargo. “Oftentimes people are more apathetic or withdrawn than in the past. This can be a normal part of disease progression, but also can be a result of fear of saying the wrong thing because of the dementia. Depression can also contribute and often coincides with a dementia diagnosis.”
Common triggers for someone with Alzheimer’s
As your loved one’s disease progresses, you may notice that certain things make them more agitated.
“If you’re putting them on the spot and making them feel threatened that they have to know something that they aren’t going to know, that can be a trigger,” says Dr. Dahl.
Triggers that worsen confusion include:
- Dehydration
- Constipation
- Pain
- Cold and flu symptoms
- Urinary tract infection
“Even little things that wouldn’t affect somebody without dementia can cause a huge change or trigger a huge change in a person’s cognitive functions so they become more confused or more agitated,” Dr.Dahl says.
And those situations can sometimes happen unexpectedly, causing challenges for family members.
“I think of one situation where a husband was driving his wife home and they pulled into the garage and she didn't think it was their house. And so he sat there and he couldn’t physically get her out of the car because she was very adamant that it wasn't their home. He tried to argue and reason with her and it didn’t help,” says Dr. Dahl.
Because people who have Alzheimer’s disease aren’t able to reason, it’s helpful to remember that their reality is probably different than ours.
“When the husband couldn’t get his wife to go inside because she said they were at the wrong house, we talked about what he could do in the future. And the plan was if it happened again, he would just say, ‘You're right.’ And pull out of the garage and drive around a little bit more and come back in and hopefully things reset and it would go a little smoother. Sometimes I think the triggering thing is trying to make them see what our truth is and reason in ways that they are maybe no longer able to at that time,” says Dr. Dahl.
Meaningful activities for someone with Alzheimer’s
Fortunately, there are ways you can make your time with a loved one fulfilling and peaceful.
Good Samaritan Society experts suggest planning activities that focus on past experiences, rote learning and long-term memory.
It’s also important that activities are mentally stimulating because they can help improve concentration, language retention and word-finding abilities.
Things you can enjoy together:
- Sorting familiar objects such as large beads, small toys or craft supplies
- Reminiscing using items that are most likely to encourage a response, such as an old photo album or a favorite piece of jewelry
- Listening to or singing familiar songs and helping your loved one recall events or feelings associated with the music
Mentally stimulating activities:
- Playing games with letters and/or numbers
- Matching cards or colors
- Playing modified or simplified board games or card games
- Working on modified or simplified crossword puzzles
- Playing word games such as completing phrases, common proverbs, opposites, similes or rhymes
Don’t become discouraged if you’re not able to immediately find an activity that matches your loved one’s functioning level. It will take time to find the things that work for them.
Whatever activities you decide on, it’s also good to allow a sufficient response time during each one.
Tips for communicating
As Alzheimer’s disease progresses, it will become more difficult for your loved one to communicate. You will need to assume the role of leader and carry more of the conversation.
For some, this is a challenge, but there are strategies you can use to enhance your visit.
“You have to figure out the right level of engagement. Sometimes it’s feeling things out and adjusting as things progress,” says Dr. Dahl.
Read the tips below about how to talk to a loved one who has Alzheimer’s.
Do’s
- Face the person directly.
- Allow additional time for the person to respond.
- Try other forms of communication (such as singing).
- Share and discuss memories of the past.
- Give them options so they feel in control. For example, if they struggle with wanting to bathe, you can say, “Do you want to bathe now or after we watch your favorite show?”
- Follow the person’s lead during discussions and allow the conversation to occur on its own rather than expecting it to happen within a specific time frame.
“If you want to have a good conversation in the later stages, you can say, ‘I remember one time when we went on this trip to so and so and we had such a good time,’ and then hopefully you can bring them along in that memory, but you’re not making them feel like they have to remember it, too,” says Dr. Dahl.
Don’ts
- Minimize asking questions or quizzing your loved one. For example, don’t ask, “Do you remember who I am?” Instead, introduce yourself when you talk to them, saying, “Hi Mom, it’s your daughter Jennifer.”
- Avoid correcting or arguing. Keeping things positive is more important than facts. If you can’t understand what the person is telling you, try to respond to the emotional context of the conversation.
- Be aware that periods of silence during the visit are OK.
- Avoid elderspeak. See below for more information on elderspeak.
“If you meet them where they’re at, it’s a better situation. Know that any behaviors they’re displaying are the disease and not them,” Dr. Dahl says.
What is elderspeak?
Elderspeak is the term used for speaking to older adults in a simplified, childish way.
Its features include:
- Speaking slowly and loudly, or in a singsong voice
- Using inappropriately intimate pet names, such as sweetie, honey or dear
- Using smaller words and shorter sentences
- Using pronouns like “we” and “us” instead of “you,” such as, “How are we doing today?”
- Asking questions that assume role loss, idleness or powerlessness, such as “Who did you used to be?” or “What did you used to do?”
While many caregivers feel like speaking in a cheerful, simple way or using terms of endearment shows they care or makes them easier to understand, many older adults are less than receptive to this form of language.
Studies have shown that even people with mild to moderate dementia react negatively to elderspeak, causing them to act aggressively and reducing their cooperation.
To avoid elderspeak, be sure to speak in a normal tone at a normal pace, using normal words. Refer to the person by their name or the term you've always used to address them (Jane, Mrs. Jones, Mom, Grandma).
Remember, Alzheimer’s disease and other forms of dementia are progressive diseases, so what works one day might not work the next. The trick is to be flexible and patient.
And, remember that your presence is what matters most to your loved one.
Do you have a loved one struggling with memory issues?
