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November 25, 2020 09:00pm
By Sara Karlovitch, Assistant Editor
Patients with Alzheimerâ€™s disease and other forms of dementia often have difficulty communicating.
Good communication starts with good listening, which has 4 parts:
But, what if the patient has suspected or obvious dementia?
Patients with Alzheimer’s disease and other forms of dementia often have difficulty communicating. Older patients who develop dementia retain their histories and experiences, which color their behaviors, verbalizations, and perceptions. Hallmarks of Alzheimer’s disease include forgetting the meanings of words and phrases, struggling to find the right words, and inventing new words to fill the memory gap. As dementia patients’ verbal skills decline, they rely more on gestures, such as hand waving or pointing to objects.
Many clinicians give up on communicating with patients with dementia, not realizing they can communicate in meaningful ways into the later stages of the disease. It requires patience on the listener’s part and use of patient-centered interventions. When dementia patients have acute care needs and visit convenient care clinics, certain steps can make the experience more comfortable and productive for all involved.
First, it’s critical to get the patient’s attention before you begin talking. Reduce background noise from any source (music, health videos playing, babies crying, cash registers clanging), and always approach dementia patients from the front so they can see you. Address them by name, and identify yourself. Repeat the patient’s name often throughout the conversation; when dementia patients hear their name, they tend to refocus and stay involved.
Next, maintain eye contact. Many dementia patients develop unpredictable anger, frustration, agitation, or lack of comprehension, and if you monitor the patient’s facial expressions and body language, you’ll see it developing. Keep your own expression friendly, and keep your hands away from your face so the patient can see your expression.
Just like other patients, dementia patients want your undivided attention. Show that you’re listening and trying to understand what’s being said. Alzheimer’s patients need time to concentrate, comprehend, and formulate responses. Use pauses of 4 to 5 seconds or more to give the patient time to process what you’re saying, and allow up to a minute for the patient to respond. Say, “Take your time. I can wait for an answer.”
Speak naturally—not too loudly and not too fast—and stay gentle and relaxed. Use short, simple, and familiar words, like high blood pressure instead of hypertension. If you need to raise your voice to be heard, lower the tone (pitch).
Simple, positive language is essential. Give one-step directions using short words and sentences of no more than 4 words, conveying only one message or thought (eg, please lean this way, lower your arm, lift your shirt please). Ask only one question at a time. Avoid pronouns, and identify individuals and things by name. Instead of telling patients whatnotto do, suggest what theyshoulddo. For example, instead of saying, “Don't go into that closet,” say, “Let’s go into this exam room.”
Often, patients with dementia will misunderstand you. In this case, alwaysrephraserather thanrepeatwhat you said previously. That is, say it differently instead of saying the same thing louder. Encourage your patient to continue to express his or her thoughts, even if he or she is struggling. Avoid interrupting, criticizing, correcting, or arguing.
Many clinicians are unaware humor is a durable personality trait that often remains intact as dementia progresses, and these patients usually appropriate humor. Allow (and appreciate) patients’ attempts to express humor, especially in difficult and trying situations.
You’ll also need to adapt to your patient, and try to understand the patient’s unique words and gestures. Family members and caregivers may be able to help because they have known the patient for years. Use the patient’s memory loss to your advantage in stressful situations. Distract or redirect the patient from distressing situations, and the patient may forget what was upsetting him or her.
Sometimes, regardless of what you say and how you say it, you’ll be unable to convey your message. Ask the patient if you can reschedule the discussion. If the patient is alone, it’s also wise to seek help by asking, “Is there someone you trust who explains things better than me who might help us?”
Finally, follow the cardinal rule: Never assume that a patient is completely oblivious. Dementia patients’ abilities fluctuate, and they have good and bad days. Talking about a patient to another individual in front of the patient as though the latter is invisible is inconsiderate and demeaning.