My wife has had Alzheimer's now for 4 plus years. There are times when she is "down in the dumps" or at least looks that way. She will be trying to tell me something, and I have no idea what she is trying to tell me, none. Then she will break down and start crying, and I know she is confused and or scared of what's happening to her. When I try to redirect her to something "nice" it just doesn't work. I will give her a hug and just hold her but that doesn't seem to help. I will then let my frustration take over and just let her cry it out for a time. Let me add that my mother also has vascular dementia, thus my frustration level pops up sorta quickly now a days. Just looking if others have dealt with this.
I agree with others that trying a low dose anti depressant may help. It is worth discussing with your wife's doctor. I wish you the best of luck.
How to Communicate
It’s true that a person with dementia may not remember. But they can still feel. When you’re impatient, they know. If you make fun of them, they get upset. When you disrespect them, they feel sad. But when you treat them with dignity, when you treat them with empathy and kindness, they perk up. They look. They pay attention.
Sooner or later, the patient’s ability to speak will be impaired. The timing of speech loss varies across different types of dementia and among patients. Patients with Alzheimer’s disease may retain the ability to speak into the late stage of the disease, while in some types of frontotemporal dementia speech is an early casualty of the illness.
Understanding the Patient
My mom’s speech has become vague and garbled, to the point that I can’t understand what she is trying to say anymore. When she says something, I take the easy way out and say okay, then continue with whatever I was doing.
When the patient tries to communicate with you, they are expressing a need that should be addressed. It could be as simple as a need for connection, to have a moment of togetherness, or to feel included in whatever that is going on around them. Or it could be that they are hungry, thirsty, uncomfortable, or in pain.
1. Sit next to the patient. Hold their hand in yours and gently caress it. Give them your undivided attention.
2. Try to find out what they need by asking simple questions requiring yes/no answers. Bear in mind that the patient may answer no when they actually mean yes. Ask things like: Are you thirsty? Do you want some orange juice? Is the room too hot? Do you have pain? Do you need to go to the bathroom?
3. Take your time. Do not rush the patient. Sometimes the process of trying to solve a problem is itself the solution.
Reduce Cognitive Load
My mom speaks very little. Sometimes, if we ask a question several times, she responds with a single word or facial expression.
Over time, it becomes necessary to simplify the patient’s environment before attempting to communicate with them. As the patient’s cognitive capacity declines, you’ll have to reduce their cognitive load, especially during demanding activities such as communication.
· Eliminate distractions when communicating with the patient. Turn off the TV, ask others to keep quiet, or if necessary, leave the room. Alternatively, you can take the patient to a secluded area, like their bedroom.
· Stay in the patient’s field of view. Face the patient and get their attention. Use eye contact, and employ hand and facial gestures to make your point. Do not cover your face or mouth when communicating with the patient.
· Be mindful of your demeanor. Stay relaxed and speak in a soft tone. Reassure the patient by staying calm, caring, and attentive.
· Speak in simple, clear, and short sentences. If the patient does not understand, express yourself in another way.
· Ask questions that are easy to process. Instead of “What would you like for lunch?” ask, “Do you want soup or salad for lunch?” or better yet, “Do you want soup?”
Structure Your Interactions
Just as your demeanor and body language are often more important than the actual words being spoken, the way you start and end an interaction is just as critical in helping the patient understand and cope with what is going on.
1. Each time you approach the patient for an interaction, introduce yourself again and declare the reason for the inter
Alzheimer’s Society: how dementia progresses
Alzheimer’s Society: communicating and dementia
Google this:
https://www.nhs.uk/conditions/dementia/living-with-dementia/communication/
In part, it says:
Communicating with someone with dementia
Dementia will gradually affect the way a person communicates.
Their ability to present rational ideas and to reason clearly will change.
Their ability to process information gets progressively weaker and their responses can become delayed.
Encouraging someone with dementia to communicate.
Try to start conversations with the person you're looking after, especially if you notice that they're starting fewer conversations themselves. It can help to:
- Speak clearly and slowly, using short sentences
- Make eye contact when they're talking or asking questions
- give them time to respond, because they may feel pressured if you try to speed up their answers
- encourage them to join in conversations with others, where possible
- let them speak for themselves during discussions about their welfare or health issues
- try not to patronise them, or ridicule what they say
- acknowledge what they have said, even if they do not answer your question, or what they say seems out of context – show that you've heard them and encourage them to say more about their answer
Give them a choice of two options vs open ended:
Would you like to do xx or xx ? (2 choices)
What would you like to do (No).
use other ways to communicate – such as rephrasing questions because they cannot answer in the way they used to
Communicating through body language and physical contact
- Gestures, movement and facial expressions can all convey meaning or help you get a message across.
- Body language and physical contact become significant when speech is difficult for a person with dementia.
When someone has difficulty speaking or understanding, try to:
- be patient and remain calm, which can help the person communicate more easily keep your tone of voice positive and friendly, where possible
- talk to them at a respectful distance to avoid intimidating them – being at the same level or lower than they are (for example, if they are sitting)
- Hold a person's hand while talking to them to help reassure them and make you feel closer – watch their body language and listen to what they say to see whether they're comfortable with you doing this
Encourage the person to communicate what they want, however they can. Remember, we all find it frustrating when we cannot communicate effectively, or are misunderstood.
Be acutely aware of non-verbal messages:
- facial expressions and body language.
- Reassure with gentle touch: pats on the arm - smile often
ACTIVE LISTENING helps:
- Reflective Listening: I hear you saying XXX
- use eye contact to look at the person
- try not to interrupt them, even if you think you know what they're saying
- Give the person your full attention while they speak
Minimize distractions that may get in the way of communication: TV, radio (can I turn it off or down so we I can hear you?)
Gena / Touch Matter
If she is able to spell out what she wants, this could help ease frustration for both of you. Imagine how frustrating this is for her to not be able to communicate!
If that is too much for her, maybe print up common phrases or words, things she might want to say, that she can point to. You can also buy communication boards with images to indicate, hungry, thirsty, bed, toilet,...etc.
If she ever was good at typing, that may be a "muscle memory" that she can still use effectively to type out something on the computer.
Her brain is failing her. She doesn't want to be re-directed, she wants to communicate something to you. If she is still having trouble with words, then an image communication board may be most helpful. Even if you make something up yourself with photos or images printed on a sheet, with a single word under each image.
A photo of you, kids, food, activities that she likes, anything that would be a common topic or request - along with faces to depict different emotions, sad, happy, angry, hurt - even a heart for love. Maybe she just wants to say "I Love You".
My husband with vascular dementia is still able to point to letters to spell out what he is trying to say when I can't understand. He also has a small vocabulary of common requests, but he uses them inaccurately, for instance he says "Me Up", but what he wants is for me to change the tv to something else, or he wants one of his protein drinks, or he is having a bowel movement. He knows he wants something, but he doesn't express the right thing, and I have to guess, by going through the list of what he could want.
I think a picture board at her level might be useful. Spelling words may not work but maybe worth a try. She has Parkinson's as well as dementia and that makes many things worse.
then she can just point.
I has been spent most of his time watching old, cowboy movies, Gilligans island, hogans, heroes the beaver, etc.
we did some physical therapy swallow therapy, cognitive therapy every day.
some of the cognitive therapy was multiple choice just so he could not or grunt the right answer. But it kept him engaged.
please make sure you’re thoroughly aware of her wishes for end-of-life care, including feeding tubes.
before it’s too late.
it was such a blessing to have had him select all that in the early stages of dementia.
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