COMMUNICATION STRATEGIES

As Alzheimer’s dementia progresses, the person’s ability to communicate begins to deteriorate, and the following changes may occur:

• Difficulty finding the right words
• Repetitious use of familiar words
• Describing familiar objects rather than calling them by name
• Inventing new words for familiar objects
• Losing one’s train of thought
• Reverting to one’s native language
• Problems with organization of words
• Reduced efforts to speak
• Relying on gestures more than speaking

The following are means to communicate more effectively with someone in the early stage of Alzheimer’s:

• If the individual has a vision and/or hearing deficit, make certain they wear their glasses and/or hearing aids.
• Avoid making assumptions about the person’s ability to communicate.
• Do not exclude the person from conversations.
• Speak directly to the person rather than to their caregiver or companion.
• Be patient and take time to listen to the person express their thoughts, feelings, and needs.
• Give the person time to respond and do not interrupt unless the person requests help.
• Ask the person what help may be needed.
• Discuss which method of communication is most comfortable, which may include face-to-face conversation, email, or phone calls.
• Use humor to lighten a mood and make communication easier.
• Don’t pull away; honesty, friendship, and support are important to the person.

In the middle stage of Alzheimer’s, as the disease progresses, the person will have more and more difficulty communicating. It is helpful to:

• Engage with the person in one-on-one conversation in a quiet place with minimal noise and other distractions.
• Speak slowly and clearly, keep sentences simple focusing on one idea at a time.
• Face the person, maintain eye contact.
• Give the person adequate time to respond.
• Ask one question at a time.
• Ask yes or no questions; avoid open-ended questions.
• Avoid correcting or criticizing.
• Repeat what the person has said for clarification.
• Make statements rather than ask questions.
• Avoid arguing.
• Offer clear, step-by-step instructions for tasks.
• Give visual cues or demonstrate tasks to encourage participation.
• Attempt written notes when spoken words seem confusing.

In the late stage of Alzheimer’s, the person may rely on nonverbal communication such as facial expressions or vocal sounds. At this time:

• Approach the person from the front and identify yourself.
• To understand what the person is saying, ask them to point or gesture.
• Use touch, sights, sounds, smells, and tastes as a form of communication.
• Consider the feelings behind words or sounds.
• Avoid talking down to the person and do not talk to others about the person as if they were not present.
• Use positive body language.
• Repeat your message as often as necessary.
• Distract the anxious or agitated person.
  (Alzheimer’s Association, 2021a)

As dementia progresses, nonverbal communication may become the main way a person communicates. Consider that the person with dementia will read and interpret others’ body language, and make sure body language and facial expression match what is being spoken. Visual prompts are helpful for the person with dementia, including cue cards or a book with pictures to point to for communicating needs and wants. Careful observation of the person’s facial expressions, eye contact or lack of eye contact, and body language can help the caregiver assess comfort or pain, anger, hostility, and misunderstanding.

Persons with Alzheimer’s may ask the same question repeatedly because they do not remember the answer given. Respond to the question, and then try to distract the person with an activity or a change of topic or a change of scene (Alzheimer’s Society, 2021).