Interacting with those affected by dementia

Posted: Wednesday, May 14, 2008

Caring for an elder with Alzheimer's disease or related disorders may be challenging. Communication is impaired and most older adults with dementia experience and demonstrate unusual behaviors. The way in which the caregiver acts or reacts to their behavior can make the difference between the elder being calm or agitated.

Whether they are resisting care or showing apathy or aggression, the person with dementia is attempting communication. Caregivers must try to "hear" their language and consider the person's environment, personality, history, likes, dislikes, and potential unmet needs. Caregiver actions which emphasize understanding and accommodate the persons' needs are much more successful than those which emphasize control. The overall goal should be to enhance self-respect by promoting comfort and dignity.

During the recent caregiver's conference, Gerontological Nurse Practitioner Merritt Andruss taught the following principles of dementia care:

1) The two golden rules of dementia care are as follows: Rule One: If the person is not doing anything to hurt themselves or others, let them do it. Rule Two: The person with dementia can't change; therefore, you (the caregiver) must change or change the environment.

2) The three "Cs" of communication (consistent, concise, calm) are very effective toward making a pleasant experience for both the elder and the caregiver. Consistency builds trust and comfort. Since it takes time together to understand someone, people with dementia should have consistent caregivers. A consistent routine and environment lessens confusion, anxiety and agitation. Speak in concise, short and clear sentences. Speak slowly and keep it simple, focusing on one subject at a time. Avoid commands that include the word "don't" and avoid asking questions, as these provoke feelings of being reprimanded or tested. Use a calm voice to reassure. Accept the person's reality to preserve their dignity. If they say something that isn't true, do not correct them. For example, a man may say he has to go to work (after having been retired for 20 years). If needed, redirect their attention to something else rather than confront them. Be tolerant of repetitive questions or behavior. Remember the two golden rules of dementia care.

3) Convey respect by talking directly to the person rather than their attendant or family member. Care and recreational activities should emphasize the individual's abilities, strengths, preferences, and stress their capability. Respect is also conveyed by not reminding the person of their disability. Focusing on the person's successes is likely to make them feel better and decrease challenging behaviors.

4) Nonverbal communication becomes more important since persons gain intuition as they lose their cognitive abilities. The caregivers should pay attention to their own tone of voice, facial expressions, gestures, feelings, touch-a gentle touch on the arm can be very comforting. The person with dementia can sense when one is angry or frustrated, so it may be best to take a break, if possible, until those feelings have subsided.

Observing the experience from the point of view of the elder is important. If the person seems upset, wonder: Is the environment noisy? Has there been a change in routine, caregiver or environment? Could there be a medical problem such as an infection causing discomfort? Acting as a detective and advocate on the person's behalf can prevent the challenging behaviors that result from ignoring the source of their discomfort.

• Marianne Mills is the program director of Southeast Senior Services, which offers home and community based services for older Alaskans throughout the region. SESS is a part of Catholic Community Service and assists all persons regardless of their faith.



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