Interacting - Tip Sheet
TIPS FOR INTRACTING WITH PERSONS WITH MILD MEMORY LOSS
It is important to understand the different types of memory storage because a person with severe or progressive memory loss may have one kind of memory loss and not another. For example, people with brain damage on their left side (the left hemisphere holds verbal or word memory) may not be able to remember a shopping list. Or they may not be able to remember the words in a conversation. However, they may be able to use their visual skills (the right hemisphere stores nonverbal memories). For example, they may remember the faces of people they meet at the store.
A person with a great deal of damage on the right side of the brain may not be able to remember and follow directions to a friend's house but may be able to remember conversations.
- Organize - Keep items that are alike in the same place. For example, keep all keys on one ring.
- The Same Place - Make a list of items that tend to get lost and decide where to keep them. Once you decide where you are going to put items, keep them in the same place. Keep shoes by the side door or in the bed-room closet. Wear your eyeglasses or keep them on your bureau top. If you can afford a second pair of eyeglasses, keep one pair for home use and the other pair in your purse or jacket for outside activities.
- The Same Time - Do a particular activity at the same time each day. For example, awaken and get out of bed the same time each morning. Brush or clean your teeth at the same times each day. Take your medicine at the same time each day. Try to set aside a particular day each week for special tasks, like shopping for food on Thursdays.
- Remove Clutter - Give or throwaway odds and ends, extra end tables, many knickknacks, piles of old newspapers, broken tools, worn out shoes, pencil stubs, and anything unusable or not in current use. If you have not used it or worn it within the past year, get rid of it. Have a garage sale!
- Concrete Cues - If somebody has problems with word memory, use concrete cues, such as visual helps, on a regular basis. A visual help, such as a picture of dishes on the door of a kitchen cabinet, may help the person remember where to find a dish. It may take time for the caregiver to make these changes, such as applying picture labels, but more time and effort will be saved over the long run.
Other visual helps include showing or pointing. For example, point to the object or the destination, such as going to the front room window and pointing outdoors to the newspaper or mailbox. Another way of cuing is to accompany the person with memory loss to the actual place and point out landmarks to remember along the way.
- Show Them and Have Them Practice - People with declarative or fact memory problems may have good procedural (how to) memory. Instead of telling a person with memory loss what to do, show them how to do something and have them practice. For example, after they practice unrolling the garden hose, watering the plants, and rewinding the garden hose a few times, they may remember how to water the garden. Keeping busy helps a person with dementia to feel useful and it provides exercise. During these activities, the caregiver has time for other responsibilities.
TIPS FOR PEOPLE WITH SEVERE OR PROGRESSIVE MEMORY DECLINE
Even though there are no medical treat-ments for curing severe memory impair-ments, changing the way things are done at home can help. People with memory problems do best when they have a lot of hints or reminders to help them figure things out. Saying you are "making sandwiches for lunch time" tells them what meal is coming next. Also, telling time in terms of purpose-such as lunch time, bath time, or bedtime-may have more meaning than using numbers, such as one o'clock.
People with severe memory disorders do not function as well when there are many changes and surprises. Often they get upset when there are changes in their usual routine. Caregivers should under-stand this and see that the routine changes as little as possible from day to day.
- Reminders Help - Talk frequently about important information, such as the next thing to be done or events that are coming up. It is best to talk casually about these things in the natural flow of conversation. Try not to make the person feel foolish as if they cannot remember. Reminding them in any way of their poor memory will probably upset them.
- Keep Clocks and Calendars Handy - Leaving the curtains open during the day will help them keep track of the day-night cycle of time. At the end of each day, cross the day off the calendar so that in the morn-ing, the new day is clear.
- Use Old Photographs and Songs - People with severe memory problems usually remember events that hap-pened long ago. Family heirlooms, old photos or old songs from their teen years may be comforting to them and should be kept handy. Sometimes these mementos remind them of fun times and friends. These memories can calm down a restless or angry person. The person becomes caught up in the happy mood of the me-mento and stays that way for a while. When an old photo or song creates sadness or anger, distract the person immediately with a new activity-go to a different room, get a drink of juice, or go for a walk (indoors or outdoors).
- Limit Choices - The fewest number of items should be kept available; extras should be put away or stored. For example, a kitchen drawer should hold a few spoons and forks. The extra utensils should be stored and unavailable. In the clothes closet there could be two pairs of shoes, two shirts, and a pair of pants. Extra clothes should be kept in a separate, locked closet.
- Choices could be limited to one item. As much as possible, the caregiver should honor the preferences of the person with the memory disorder. The person has the right to choose. It helps to use "Do you want" questions.
"Do you want to wear the black shoes?"
"Do you want to wear the brown shoes?"
- Night Lights - People with severe memory problems often have trouble at night. A night light may help them know where they are if they wake up to use the bathroom. A night light may also keep them from tripping over the edges of furniture and falling.
- Changes in Sense Systems - People with severe memory problems have trouble when their sense systems change they cannot see, hear, taste, smell, or feel as well as before. When not tuned in to the sights, smells, sounds, etc. around them, people become information-deprived and may suffer in physical or emotional health. Caregivers should make sure that people who need eyeglasses or hearing aids use them. Extra flavoring or seasoning may help food taste better. Taking time to feel the chair may help them to sit safely. Appropriate touching and hugs can satisfy skin hunger, the need all people have for contact or touch from another individual.
- Show Them How - As discussed before, a person with memory prob-lems may have a strong procedural (how to) memory even when the declarative (fact) memory is very weak. Instead of telling a person with memory loss what to do, show them how to do something and have them practice. Many people with severe memory problems cannot remember the facts of where and when something happened (declarative memory), such as where and when they bought a shirt. At the same time, they may remember how to put on the shirt (procedural memory). Thus, people with progressive memory disorders such as Alzheimer's disease may be able to learn new skills by practicing in small steps how something is done. It may take them a few weeks to learn a new skill that someone else may be able to pick up in a few minutes. The sense of pride, of feeling capable, a bit self-sufficient and independent, is worth the effort.
- Routine Versus Change - Specific routines should be set as often as possible. The same activities done the same way everyday, such as dressing before breakfast or watering plants before lunch, are easier for people with memory loss to understand and follow. If there is a change in plans, such as a visit to the doctor or a vacation, it is important to tell and repeat the information before the event. A positive, pleasant style of approach with a smile should help. During such changes other parts of the daily routine, such as mealtimes or taking a walk, should stay at the same time to provide some stability.
Material taken from: Helping People with Progressive Memory Disorders: A Guide For You And Your Family, 2nd ed." (University of Florida Health Science Center). Used with permission from the authors: K. M. Heilman, MD, L. Doty, PhD, J. T. Stewart, MD, D Bowers, PhD, & L. Gonzalez-Rothi, PhD. (1999).