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.

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.