As with so many things in life, the key is compassion. If you feel overwhelmed or frustrated when you try to communicate, do your best to remember:
- They’re not crazy or lazy. They say normal things, and do normal things, for a memory impaired, dementia individual. If they were deliberately trying to exasperate you, they would have a different diagnosis.
- Always forgive. They don’t hide things; they protect them in safe places, and then forget. Don’t take ‘stealing’ accusations personally.
- Their disability is memory loss. Asking them to remember is like asking a blind person to read. (“Did you take your pills?” “What did you do today?”) Don’t ask and don’t test memory.
- Loss of this magnitude reduces the capacity to reason. Expecting them to be reasonable or to accept your conclusion is unrealistic. (“You need a shower.” “Day care will be fun.” “You can’t live alone.”)
- Don’t argue, correct, contradict, confront, blame, or insist. Memory loss produces unpredictable emotions, thought, and behavior that only peaceful resolution will alleviate.
- Reminders are rarely kind. They merely tell the patient how disabled they are. Reminders of the recent past imply, “I remember, I’m okay; you don’t, you’re not.” Refer only to the present or the future. (If they’re hungry, don’t inform them they ate an hour ago. Instead, offer a snack or set a time to eat.)
- Respond graciously, as if it’s the first time. They may ask the same question repeatedly, believing each time is the first.
- Some days they seem normal, but they’re not. They live in a different reality. Reminders won’t bring them into yours. Note: For vascular dementia, giving clues may help their recall. If it doesn’t work, be kind.
- Honesty isn’t the best policy. If the patient thinks their dead spouse is alive, and truthful reminders will create sadness, you can 1) Reminisce about their spouse, “I was just thinking about him/her. How did you two meet?” or, “He’s gone for a while. Let’s take our walk, now.” 2) Change the subject or 3) Start a fun activity.
- Avoid open-ended questions. “Where shall we go?” “What do you want to eat/wear/do?” are surprisingly complex and create anxiety. Give the person a simple choice between two items or direct their choice. For example: “You look great in the red blouse.”
- The person is scared all the time. Each patient reacts differently to fear. They may become passive, uncooperative, hostile, angry, agitated, verbally abusive, or physically combative. They may even do them all at different times, or alternate between them. Anxiety may compel them to follow you everywhere.
- Reduce anxiety whenever possible. Anxiety compels your loved one to resist changes in routine, even pleasant ones. Also, they can’t remember your reassurances so repeat them, over and over if necessary.
Finally, call the Alzheimer’s Association Helpline at (800) 660-1993 if you need if you need suggestions on handling challenging situations.
Adapted from, “Compassionate Communication with The Memory Impaired” © by Liz Ayre.