Ways to Help Communication - Tip Sheet
The following discuss the best conditions for communication. They include: (1) the best place for communicating, (2) the best state of mind to express oneself and understand others, and (3) the best way to talk to someone with a communication disorder..
The Best Place
When you are talking with a person who has a hard time communicating, it is important to choose the best place.
The Best Place is:
- Quiet - It is hard to understand speech when there is a lot of noise. When talking to people with dementia, try to make sure everything is quiet. Remember that people with dementia may have a hard time understanding and are easily distracted. For example, turn down loud music, shut off the television, stop the dishwasher, and avoid other household noises when talking with these people.
- Peaceful - Peaceful surroundings might also aid the patient's under-standing. By removing distracters, such as playful pets, the focus can be on the task at hand. By moving away from the distracters, paying attention and understanding become easier.
A room divider, a folding door, a curtain hanging from the ceiling, or a folding screen around the "work area" or activity area creates a smaller, more private space for those easily distracted. The room divider or screen absorbs some of the extra sounds, especially in a large room with echoes. The privacy wall blocks out some of the visible distracters, such as other people in a dining room, so a person can focus on speaking and understanding.
- A Small Group - People with dementia communicate best when face-to-face with one other person. When talking to people with Alzheimer's disease in a group, keep the group as small as possible, address the person by name, and use eye contact. Have only one conversation going on at a time.
Provide help when the topic of conversa-tion changes. For example, "Tom, now we are talking about Sam. Sam has the red car. Sam played the clarinet last night at the concert."
The Best State of Mind
The best state of mind is to be rested, calm, adaptable, and open to new possibilities with a positive attitude. Usually when people are tired, troubled, or upset, they cannot understand or remember as well. People with severe dementia will pay attention better if first their basic needs such as hunger, thirst, exercise, or toileting have been met.
The Best Way to Talk
There are many ways to say the same thing. It is important to speak simply so that the person can understand. The following hints will help make speech simpler and perhaps better understood.
To keep the person's attention, it is helpful to:
- Use their name to get their attention before talking.
- Try a gentle touch on the arm or shoulder to get their attention. Wait until they look at you; then begin to speak.
- Always look at them when talking. Keep eye contact.
- Talk slowly and wait between sentences.
- Talk about only one thing at a time.
Use Everyday Words - For example, instead of saying, "Cultivating a garden is so demanding," say "Weeding is hard." It is much easier to understand.
Use Exact (Concrete) Words - Avoid abstract words, which can be confusing. Abstract words refer to things such as feelings or a state of mind. Concrete words are words that can be sensed (seen, felt, heard, smelled, or tasted). The sentence, "Jim walked to the store" has concrete words. The concrete words are "Jim" and "store." This sentence talks about action that can be seen directly.
A more difficult sentence, "Jim wondered about his anger" has two abstract words ("wondered" and "anger"). Although the anger may be seen, "wondered" may be hard for someone with Alzheimer's disease to follow and understand.
Limit Describing Words - For example, do not say, "We need to walk down Frasier Street to the new big discount furniture store." Instead say, "Let's walk to the store." This sentence has fewer extra words for a person to listen to and thus is easier to understand. When near the store, it may help to point to the object and use one describing word at a time, such as, "There is the new store. The store sells tables."
Do Not Use Metaphors (Words Expressing a likeness) - For example, do not say, "Let's walk like a bear is chasing us." Instead say, "Let's walk fast." This last sentence is much easier to understand.
People often use analogies or sayings to make a point. Saying "Being a good friend is like being a good gardener" may confuse a patient with dementia. They may not be able to connect the relationship between friend (caring for someone else) and gardener (caring for plants). The sentence, "You are a good friend," is much easier for them to understand.
Be Direct - Do not say, "Would you like to go to the store?" Instead say, "Let's go to the store." This last sentence is direct and less likely to be confusing.
Use Short Sentences With Simple Grammar - It is helpful to use sentences with a subject, verb, and object. For example, in the sentence "Jim ate candy"-"Jim" is the subject, "ate" is the verb and "candy" is the object. People with dementia may tire easily and may not be able to follow a long sentence.
Do Not Use Pronouns When Using More Than One Sentence - For example, the sentences, "Jim ate candy. He got sick." contain "he" and may not be understood. It is helpful to repeat the names, "Jim ate candy. Jim got sick." without the pronoun "he".
Speak Briefly - Say one thing at a time. For example, do not say, "Jim ate too much candy, had an upset stomach, was sick for a while, and is sleeping in bed now." Instead, "Jim is sleeping" is easier to understand. When talking about actions with many steps, give the correct order. For example, do not say, "Before coming home, Jim went to the store." Instead, put the sentence in the order in which something happened. For example say, "Jim went to the store. Then Jim came home."
Be Patient - Speak slowly and wait between sentences. Some people with dementia need extra time to express their words. To give such people enough time, it may help to remember the 15-second rule. The listener should count silently to 15 to allow enough of a pause for the slower person to respond.
Speak Slowly and Clearly - A person with dementia may also be hard of hearing. Most of the time, shouting does not help the person hear better. A helpful way to communicate with hearing impaired persons is to speak each word slowly and clearly. The person with hearing loss may miss words that are shouted. Instead they may sense a strong emotion, misunderstand, and think you are angry.
Repeat Sentences, Word for Word - People will often understand if given a second or third chance to hear it. If repeating the same words slowly does not help, try using different, simpler words to state the message. If "Let's sit down for breakfast" does not make sense, try "Let's eat" or "Breakfast" or "Hungry?" as you point to the food. Repeat the beginning message so the speaker does not have to start over. When a message is hard to under-stand, repeat what was received to help the speaker move on to the next part of the message. Never respond with "What?" or "Huh?" With each interaction, say the part that was received so that after several turns, the speaker completes the entire message. For example:
Speaker: "Lunch. "
Caregiver: "Lunch. You are asking about lunch..."
Caregiver: "What are we eating for lunch?" or "What do you want for lunch?"
Try Different Ways to be Understood - Use nonverbal ways to communicate such as:
- Hand signals or movements
- Point to the object
- Draw or show pictures
- Write the words
Check for Understanding. Ask the person with dementia to explain what was just said in their own words. People with dementia might be able to repeat without understanding. Some people may answer "yes" or "no" to everything. If all "no" answers are given, check with a question that should be answered "yes." If all "yes" answers are given, try a question that should be answered "no."
TIPS TO HELP PEOPLE WITH DEMENTIA COMMUNICATE
The person with mild memory loss may find it helpful to:
- Say it or write it.
- Think of similar words and start saying or writing them until the correct word is found.
- Think of the first letter and say it aloud or write it down.
- Think of the function and other activities linked with the word and say these aloud or write them down.
People with Alzheimer's disease may have problems making themselves understood by others. To help them express their thoughts and feelings, try teaching them several strategies to get the message across.
Ways For People With Dementia To Communicate Better
The person with severe memory loss may find it helpful to:
- Point to an object or person.
- Act out the situation or need.
- Use a different tone of voice or pace of words to show different meanings.
- Use facial expressions to show what is meant.
- Write or draw.
- Use index cards with common words or phrases or pictures they can point to. (These may be made by the family or bought in sets from stores serving people with special needs.)
If the person with dementia is not able to use these six suggestions, the caregiver may try another approach.
Direct, Simple Questions
It might help to break many choices down into simple steps or choices needing yes or no answers. The caregiver could ask questions that need only a yes or no answer, head nods, or pointing.
For example, the person with dementia may be unable to answer the question, "What do you want to eat?" Instead, ask the question, "Do you want to eat meat?" Then wait. Or ask, "Do you want chicken?" Or try pointing and asking, "Do you want this leg of chicken?" Use step-by-step questions that need either a "yes" or "no" answer.
Above all, keep a sense of humor. In difficult times just smile, take a break, and wait. A few minutes later may be a better time to do the activity.
Material adapted from “Helping People with Progressive Memory Disorders: A guide for You and Your Family” (University of Florida Health Science Center). Used with permission form the authors K. M. Heilman, Ph.D., L. Doty, Ph. D., J. T. Stewart, MD., D. Bowers, Ph.D., & L. Gonzalez-Rothi, Ph.D.