10 ways to promote self-expression in Alzheimer’s patients
Like Madonna once said, “you know, you know you’ve got to make him express how he feels.” Or help her express how she feels too. The following pieces of advice may help caregivers help Alzheimer’s disease patients to express themselves.
- Be a good listener. You can’t tell people with dementia “don’t bore us, get to the chorus;” you have to listen to the whole song – which may involve a repetitive refrain – to get to what you really need to hear. Just like when you listen patiently to all of Cheap Trick’s Surrender to get to the “we’re all alright” part. Be patient and go one step at a time, listen without interrupting, and nod in agreement and say things to signify that you’re interested and paying attention.
- Everyone’s a critic (not you, though). When someone makes a preposterous statement – for instance, that vaccines cause autism or that homeopathy works – you swiftly correct them and/or slap them in the face. Unless they happen to have Alzheimer’s disease, in which case you don’t tell them they’re wrong or try to reason with them. Instead, listen to what they say and read between the lines to try and make sense of what they’re saying. If necessary, repeat back what they said. Be flexible, and if all else fails, attempt to distract or redirect the person.
- No need to argue. There’s no profit in arguing with a person with dementia; you can’t win and yet they can still lose. Especially if they become upset and agitated to the point of experiencing the dreaded “catastrophic reaction.” Remember that you’re not arguing with the person but with the disease; it’s like Monty Python’s Argument Clinic without the hilarious consequences. It’s best to agree, validate, distract, or redirect.
- 3xx Redirection. Redirecting an argument involves agreeing first and then changing the subject. One of the few advantages of Alzheimer’s disease is that the patient will soon forget what the previous subject was. Diversions like TV, music, or food can also help.
- A penny (or two, or more) for your thoughts. You may have to invest a lot more than the proverbial penny to encourage the patient to continue to express their thoughts, but it’s worth it. Repeat back to them the last words that have spoken to get them back on track, use reassuring expressions, and praise even the smallest accomplishments.
- Buy a vowel. Suggests words when the person with Alzheimer’s disease cannot find them or if they use the wrong one – unless you understand what they’re trying to say regardless, in which you may choose not to supply the right word in order to spare them unnecessary frustration.
- Nobody expects the Spanish Inquisition. Speaking of avoiding frustration, it’s best to ask general questions as opposed to specific ones. For example, “how was your day?” instead of “what did you do today.” Likewise, though it is important to help Alzheimer patients jog their memory do not ask them to remember something specific, like names or places. Additionally, abstain from asking rhetorical questions.
- Eye Spy. The eyes are very expressive – especially when the person finds it increasingly difficult to express themselves orally – and can let caregivers know if the patient is hurting, angry, or afraid. In addition to keeping eye contact, pay attention to facial expressions and body language, and ask the person to point, touch, and gesture to as means of conveying what they’re trying to say.
- Embrace feelings and emotions. People with Alzheimer’s disease still have feelings as well as a need to have those feelings acknowledged. Thus, neither tell them how to feel nor disregard their emotions. Welcome and promote conversations about tough subjects like death.
- No sense makes sense. Sometimes when you try to communicate with a person with dementia it’s like you’re speaking two different languages. But consider this: just because you don’t speak Chinese that doesn’t mean the people in China talk gibberish all the time. Similarly, when people with Alzheimer speak it may sound like Mumbles from Dick Tracy or Boomhauer from King of the Hill to you, but it may make sense to them. Moreover, they could even be bilingual; not only can their non sequiturs be meaningful to them, but there’s the possibility that they can still understand what you’re saying. You may not be able to learn their own particular language, but keep your ears open for patterns and keywords – or as the French would say, le mot juste – that may clue you in on what the patient really is trying to say.