Comforting Words and Alzheimer’s

Communicating Safety and Love

 

What words bring comfort to you…. cat, dog, mom, church, maybe even the word blue brings a sense of calm to you? Why do you suppose these words hold some sort of importance to you? Chances are they evoke feelings from somewhere deep inside you. If you think of a word as an emotion, rather than as the item the word describes; your new found ability to communicate could be the key that opens the door of understanding to communicate with a person living with Alzheimer’s.

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Not only words but familiar surroundings like sitting at a dinner table or passing a church can bring emotions to the surface. How about a familiar task such as folding laundry or washing dishes? What about a picture of a baby or a picture of a field of flowers? All of these simple things we may take for granted every day may have great meaning for a person living with Alzheimer’s. When I hear the words “homemade bread” or even bread pan….. I smile. It takes me back to the feeling of being loved by my Gram. All her hugs and kisses she bestowed upon me throughout her life. It also can bring back sadness. I miss the wonderful smell of baking bread as I entered her kitchen. I miss my Gram.

Listen with your heart

When your loved one says a word. Don’t take it for its literal meaning. Take a minute and think about what may revolve around that word. It may take them back in time, unlocking emotions from deep within their heart. Instead of just listening with your ears…..Listen with your heart. Let the true communication begin.

 

 

 

 

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What Do You Mean

I Don’t Understand

“What do you mean?” and” I don’t understand “… As a caregiver for a person living with Alzheimer’s, these phrases can be frustrating. Something that seems simple to us, such as, saying ” Let’s go this way”, then just walking away …..Can make the PLWA feel abandoned and frustrated. The words must sound more like Whant, Whant, Whant and Blah, Blah, Blah than an actual request or suggestion. Instead of just saying something to them, take the person by the hand or make a forwarding gesture as you say “Let’s go this way”.

What about after your sixth try to assist your loved one to the restroom. You finally get them to the restroom, give their pants a tug and say “Ok, now pull your pants down”. Just for them to look at you like you are crazy and cling to their pants with clenched fists. They probably feel vulnerable and afraid which may lead to anger. This anger may lead to aggression. Wow…… this situation just got bad in a hurry. But why? You have a request and made a simple gesture…Think about the intimacy involved in using the restroom and the trust the PLWA has to have with the person assisting them. Does their reaction make sense now? Use step by step instructions with non-invasive gestures. Take your cues from them….. They will let you assist them when they feel comfortable and safe with you.

It takes lots of patience.

It takes patience, lots of patience. Sometimes it will be a success and sometimes it won’t. Trial and error…… Keep trying. What works today may not work tomorrow. Remember, you are not the only struggling caregiver. With support from others like us. You can hold our caregiving head up high and say, “I Can Do This!!!!”

Morning Confusion

 

Basic Needs

I have never been a morning person. You can ask my husband or my children and they would all agree….. coffee first…. conversation later. How do you feel in the morning? If you’re anything like me…. your head is foggy, your joints are stiff and your tongue feels like sandpaper. If you were a person living with Alzheimer’s, add the confusion of not knowing where you are or who is in the room with you or why are you cold and wet? I don’t know about you but I’d be afraid, probably very afraid.

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Now this strange person is saying something about clothes and a bath….. you don’t understand…The person reaches for you and you say “No” and pull away from them and try to get through the doorway. You’re still cold, a little unsteady and that person is still following you saying words you don’t understand and reaching for you. Sounds pretty terrifying to me. You might start swearing, crying or even hitting this strange person.

A Smile and a Soft Gentle Voice

Wow ….. I thought my mornings were tough. How can we as caregivers make mornings less stressful for everyone? A smile and a soft gentle voice may help. How about a familiar tune to set the mind at ease. Remember, if we were lucky enough to sleep for six or more hours we’re probably thirsty and hungry. Try offering a favorite drink or food. Is there a favorite robe or stuffed animal that brings them comfort. Most of all be patient. It may take fifteen minutes or maybe hours to regain their trust.

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Remember every day is a new day. So turn on a tune, enjoy a cup of coffee and be patient with yourself. It’s gonna be a good morning.

Tips for Coping with Sundowning

Tips for Coping with Sundowning

Late afternoon and early evening can be difficult for some people with Alzheimer’s disease. They may experience sundowning—restlessness, agitation, irritability, or confusion that can begin or worsen as daylight begins to fade—often just when tired caregivers need a break.Woman with Alzheimer's experiencing sundowning

Sundowning can continue into the night, making it hard for people with Alzheimer’s to fall asleep and stay in bed. As a result, they and their caregivers may have trouble getting enough sleep and functioning well during the day.

Possible Causes

The causes of sundowning are not well understood. One possibility is that Alzheimer’s-related brain changes can affect a person’s “biological clock,” leading to confused sleep-wake cycles. This may result in agitation and other sundowning behaviors.

Other possible causes of sundowning include:

Coping with Sundowning

Look for signs of sundowning in the late afternoon and early evening. These signs may include increased confusion or anxiety and behaviors such as pacing, wandering, or yelling. If you can, try to find the cause of the person’s behavior.

If the person with Alzheimer’s becomes agitated, listen calmly to his or her concerns and frustrations. Try to reassure the person that everything is OK and distract him or her from stressful or upsetting events.

You can also try these tips:

  • Reduce noise, clutter, or the number of people in the room.
  • Try to distract the person with a favorite snack, object, or activity. For example, offer a drink, suggest a simple task like folding towels, or turn on a familiar TV show (but not the news or other shows that might be upsetting).
  • Make the early evening a quiet time of day. You might play soothing music, read, or go for a walk. You could also have a family member or friend call during this time.
  • Close the curtains or blinds at dusk to minimize shadows and the confusion they may cause. Turn on lights to help minimize shadows.

Preventing Sundowning

Being too tired can increase late-afternoon and early-evening restlessness. Try to avoid this situation by helping the person:

Avoid things that seem to make sundowning worse:

  • Do not serve coffee, cola, or other drinks with caffeine late in the day.
  • Do not serve alcoholic drinks. They may add to confusion and anxiety.
  • Do not plan too many activities during the day. A full schedule can be tiring.

If Problems Persist

If sundowning continues to be a problem, seek medical advice. A medical exam may identify the cause of sundowning, such as pain, a sleep disorder or other illness, or a medication side effect.

If medication is prescribed to help the person relax and sleep better at night, be sure to find out about possible side effects. Some medications can increase the chances of dizziness, falls, and confusion. Doctors recommend using them only for short periods of time.

Source: Tips for Coping with Sundowning

Alzheimer’s and Hallucinations, Delusions, and Paranoia

Alzheimer’s and Hallucinations, Delusions, and Paranoia

Due to complex changes occurring in the brain, people with Alzheimer’s disease may see or hear things that have no basis in reality.

 

  • Hallucinations involve hearing, seeing, smelling, or feeling things that are not really there. For example, a person with Alzheimer’s may see children playing in the living room when no children exist.
  • Delusions are false beliefs that the person thinks are real. For example, the person may think his or her spouse is in love with someone else.
  • Paranoia is a type of delusion in which a person may believe—without a good reason—that others are mean, lying, unfair, or “out to get me.” He or she may become suspicious, fearful, or jealous of people.

If a person with Alzheimer’s has ongoing disturbing hallucinations or delusions, seek medical help. An illness or medication may cause these behaviors. Medicines are available to treat these behaviors but must be used with caution. The following tips may also help you cope with these behaviors.

Hallucinations and Delusions

Here are some tips for coping with hallucinations and delusions:

  • Discuss with the doctor any illnesses the person with Alzheimer’s has and medicines he or she is taking. Sometimes an illness or medicine may cause hallucinations or delusions.
  • Try not to argue with the person about what he or she sees or hears. Comfort the person if he or she is afraid.
  • Distract the person. Sometimes moving to another room or going outside for a walk helps.
  • Turn off the TV when violent or upsetting programs are on. Someone with Alzheimer’s may think these events are happening in the room.
  • Make sure the person is safe and can’t reach anything that could be used to hurt anyone or himself or herself.

Paranoia

In a person with Alzheimer’s disease, paranoia often is linked to memory loss. It can become worse as memory loss gets worse. For example, the person may become paranoid if he or she forgets:

  • Where he or she put something. The person may believe that someone is taking his or her things.
  • That you are the person’s caregiver. Someone with Alzheimer’s might not trust you if he or she thinks you are a stranger.
  • People to whom the person has been introduced. He or she may believe that strangers will be harmful.
  • Directions you just gave. The person may think you are trying to trick him or her.

Paranoia may be the person’s way of expressing loss. The person may blame or accuse others because no other explanation seems to make sense.

Here are some tips for coping with paranoia:

  • Try not to react if the person blames you for something.
  • Don’t argue with the person.
  • Let the person know that he or she is safe.
  • Use gentle touching or hugging to show you care.
  • Explain to others that the person is acting this way because he or she has Alzheimer’s disease.
  • Search for things to distract the person, then talk about what you found. For example, talk about a photograph or keepsake.

Also, keep in mind that someone with Alzheimer’s disease may have a good reason for acting a certain way. He or she may not be paranoid. There are people who take advantage of weak and elderly people. Find out if someone is trying to abuse or steal from the person with Alzheimer’s. For more information, visit Elder Abuse.

Source: Alzheimer’s and Hallucinations, Delusions, and Paranoia

Coping with Agitation and Aggression in Alzheimer’s Disease

Coping with Agitation and Aggression in Alzheimer’s Disease

People with Alzheimer’s disease may become agitated or aggressive as the disease gets worse. Agitation means that a person is restless or worried. He or she doesn’t seem to be able to settle down. Agitation may cause pacing, sleeplessness, or aggression, which is when a person lashes out verbally or tries to hit or hurt someone.Older man in a wheelchair with a nurse

Causes of Agitation and Aggression

Most of the time, agitation and aggression happen for a reason. When they happen, try to find the cause. If you deal with the causes, the behavior may stop. For example, the person may have:

  • Paindepression, or stress
  • Too little rest or sleep
  • Constipation
  • Soiled underwear or diaper
  • Sudden change in a well-known place, routine, or person
  • A feeling of loss—for example, the person may miss the freedom to drive
  • Too much noise or confusion or too many people in the room
  • Being pushed by others to do something—for example, to bathe or to remember events or people—when Alzheimer’s has made the activity very hard or impossible
  • Feeling lonely and not having enough contact with other people
  • Interaction of medicines

Look for early signs of agitation or aggression. If you see the signs, you can deal with the cause before problem behaviors start. Try not to ignore the problem. Doing nothing can make things worse.

A doctor may be able to help. He or she can give the person a medical exam to find any problems that may cause agitation and aggression. Also, ask the doctor if a medicine is needed to prevent or reduce agitation or aggression.

Tips for Coping with Agitation or Aggression

Here are some ways you can cope with agitation or aggression:

  • Reassure the person. Speak calmly. Listen to his or her concerns analzheimers-rummaging-hiding-things-metad frustrations. Try to show that you understand if the person is angry or fearful.
  • Allow the person to keep as much control over his or her life as possible.
  • Try to keep a routine, such as bathing, dressing, and eating at the same time each day.
  • Build quiet times into the day, along with activities.
  • Keep well-loved objects and photographs around the house to help the person feel more secure.
  • Try gentle touching, soothing music, reading, or walks.
  • Reduce noise, clutter, or the number of people in the room.
  • Try to distract the person with a favorite snack, object, or activity.
  • Limit the amount of caffeine, sugar, and “junk food” the person drinks and eats.

Here are some things you can do:

  • Slow down and try to relax if you think your own worries may be affecting the person with Alzheimer’s.
  • Try to find a way to take a break from caregiving.

Safety Concerns

When the person is aggressive, protect yourself and others. If you have to, stay at a safe distance from the person until the behavior stops. Also, try to protect the person from hurting himself or herself.

Source: Coping with Agitation and Aggression in Alzheimer’s Disease

Communication

 

 

Through the Severe Stages

 

 

You and your loved have now entered the diagnosed stage seven of dementia. You have struggled through the confusion of  “What is wrong with my loved one?”, the loss of dreams with the initial diagnosis, watching the gradual decline of their cognitive abilities and now their physical abilities are diminishing. How do you continue to communicate?

Having worked in a nursing home activity dept I learned that communication drastically changes during this final stage. Words no longer have the same meaning or any meaning at all. Touch and gestures become your trusted connection to helping the individual living with Alzheimer’s navigate this final stage. These suggestions may seem difficult for some because they are more intimate ( unless you’ve helped with personal care) than other means of communication…. Holding hands, applying lotion to arms and legs, brushing hair, washing hands and face and polishing fingernails are just a few suggestions.

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Just because someone can no longer verbally communicate doesn’t mean they won’t enjoy hearing you talk to them. Make eye contact and be animated…..widen your eyes or wrinkle your nose. Talk to them about their former occupations, the hobbies they once enjoyed or just talk to them about the weather. The gift of gab can be a very important trait for a caregiver. Read to them… the newspaper, a short story or passages from the Bible. Play music for them ….. tap them gently on the arm to the beat of the music or sing to them. Sometimes just the presence of another person close by is comforting…..a touch to their hand or forearm may be all they need or can tolerate. Remember to take your cues from the person living with Alzheimer’s. Pay close attention to their facial expressions or attempts to move their arm or hand away from your touch to ensure they are comfortable with the interaction.

The Power of a Smile

Never underestimate the power of a smile. Most people can’t help but smile back when someone smiles at them. Why would that be any different for someone living with Alzheimer’s? Smiles are inviting and contagious. One smile… happy or sympathetic can set the tone for the whole interaction. Communication is not always about what you say, but about how you make someone feel. Make them feel safe, loved and understood…. there are no better feelings in the world.

 

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Alzheimer’s Caregiving: Changes in Communication Skills

Alzheimer’s Caregiving: Changes in Communication Skills

Communication is hard for people with Alzheimer’s disease because they have trouble remembering things. They may struggle to find words or forget what they want to say. You may feel impatient and wish they could just say what they want, but they can’t.Older man shaking hands with a younger person

The person with Alzheimer’s may have problems with:

  • Finding the right word or losing his or her train of thought when speaking
  • Understanding what words mean
  • Paying attention during long conversations
  • Remembering the steps in common activities, such as cooking a meal, paying bills, or getting dressed
  • Blocking out background noises from the radio, TV, or conversations
  • Frustration if communication isn’t working
  • Being very sensitive to touch and to the tone and loudness of voices

Also, Alzheimer’s disease causes some people to get confused about language. For example, the person might forget or no longer understand English if it was learned as a second language. Instead, he or she might understand and use only the first language learned, such as Spanish.

Help Make Communication Easier

The first step is to understand that the disease causes changes in communication skills. The second step is to try some tips that may make communication easier:

  • Make eye contact and call the person by name.
  • Be aware of your tone, how loud your voice is, how you look at the person, and your body language.
  • Encourage a two-way conversation for as long as possible.
  • Use other methods besides speaking, such as gentle touching.
  • Try distracting the person if communication creates problems.

To encourage the person to communicate with you:

  • Show a warm, loving, matter-of-fact manner.
  • Hold the person’s hand while you talk.
  • Be open to the person’s concerns, even if he or she is hard to understand.
  • Let him or she make some decisions and stay involved.
  • Be patient with angry outbursts. Remember, it’s the illness “talking.”

To speak effectively with a person who has Alzheimer’s:

  • Offer simple, step-by-step instructions.
  • Repeat instructions and allow more time for a response. Try not to interrupt.
  • Don’t talk about the person as if he or she isn’t there.
  • Don’t talk to the person using “baby talk” or a “baby voice.”

Be Direct, Specific, and Positive

Here are some examples of what you can say:

  • “Let’s try this way,” instead of pointing out mistakes.
  • “Please do this,” instead of “Don’t do this.”
  • “Thanks for helping,” even if the results aren’t perfect.

You also can:

  • Ask questions that require a yes or no answer. For example, you could say, “Are you tired?” instead of “How do you feel?”
  • Limit the number of choices. For example, you could say, “Would you like a hamburger or chicken for dinner?” instead of “What would you like for dinner?”
  • Use different words if he or she doesn’t understand the first time. For example, if you ask the person whether he or she is hungry and you don’t get a response, you could say, “Dinner is ready now. Let’s eat.”
  • Try not to say, “Don’t you remember?” or, “I told you.”

If you become frustrated, take a timeout for yourself.

 

 

Helping a Person Who Is Aware of Memory Loss

Alzheimer’s disease is being diagnosed at earlier stages. This means that many people are aware of how the disease is affecting their memory. Here are tips on how to help someone who knows that he or she has memory problems:

  • Take time to listen. The person may want to talk about the changes he or she is noticing.
  • Be as sensitive as you can. Don’t just correct the person every time he or she forgets something or says something odd. Try to understand that it’s a struggle for the person to communicate.
  • Be patient when someone with Alzheimer’s disease has trouble finding the right words or putting feelings into words.
  • Help the person find words to express thoughts and feelings. But be careful not to put words in the person’s mouth or “fill in the blanks” too quickly. For example, Mrs. D cried after forgetting her garden club meeting. She finally said, “I wish they stopped.” Her daughter said, “You wish your friends had stopped by for you.” Mrs. D nodded and repeated some of the words. Then Mrs. D said, “I want to go.” Her daughter said, “You want to go to the garden club meeting.” Again, Mrs. D nodded and repeated the words.
  • Be aware of nonverbal communication. As people lose the ability to talk clearly, they may rely on other ways to communicate their thoughts and feelings. For example, their facial expressions may show sadness, anger, or frustration. Grasping at their undergarments may tell you they need to use the bathroom.

Source: Alzheimer’s Caregiving: Changes in Communication Skills

What Makes Conversation Difficult for a Person with Dementia?

Dementia is a time that gets extremely complicated for a person with dementia and their spouse, family, friends, new social acquaintances, healthcare providers, and caregivers.

Probably the biggest issue is that those who interact with the person with dementia expect the PWD to communicate in a way that is diminished but still like the way a typical person without dementia communicates just now at a lower level.

It is difficult to communicate with a person with dementia because their own experience of communications is now shaped by the brain changes and other symptoms of dementia. What about your Mom who no longer smiles when you say something she has always liked or when you bring her the pistachio ice cream she has always loved? Ever consider the possibility that she thinks she is smiling but has no control over nonverbal communication such as her smile. Brain damage of various types can cause the loss of nonverbal communication abilities or control of facial muscles.

Why does your friend always get overwhelmed and say something stupid when there are lots of other people around? Perhaps they can’t focus on what you are saying because there is so much noise and motion from distracting sources?

Ever wonder why your friend with dementia comes back with an answer to a question five minutes after you asked the question? Brain changes and damage during dementia may make it hard to retrieve information or think and a loss of a sense of time may mean your friend keeps working on answering the question long after the conversation has moved on.

In dementia, a daydream may be as vivid as something in the real world, and just as distracting. In dementia, you can’t deal with too much information because it distracts you and can’t “fill in the blank spaces” if you receive too little because your “executive functioning” has been destroyed. You tend to get anxious during a conversation not only from unpleasant topics but also from worrying so much about missing a word or forgetting a name or misinterpreting a suggestion as hostile when it was just a normal joke.

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Source: What Makes Conversation Difficult for a Person with Dementia?