Below is a transcript of the podcast, “Communication Strategies for Family Members” with Laura Roberts.
Welcome to this special series, where the memory support program manager at Piedmont Gardens, Laura Roberts, will discuss topics of interest to family members of someone who is served by HumanGood's memory support program. Today, Laura is going to talk about communication changes with our loved ones and strategies for communicating that will help bridge the gap. Let's begin.
Hello and welcome to this resource for families. My name is Laura Roberts, and I'm the memory support program manager at Piedmont Gardens in Oakland, California. The focus of this session is communication. We will discuss how dementia can affect both expressive and receptive language for the person living with dementia and how we can create successful opportunities for communication as we engage with our residents and loved ones.
Our mission at HumanGood is to help older adults live their best lives — however they define it. The products and services we offer are designed to support those we serve, their families and our team members in the pursuit of an engaged, purposeful life. When it comes to our memory support program, the best way for us to embrace our mission is by immersing ourselves in the life of each person living with dementia, wherever they are in their journey.
We respect and honor each person living with dementia as they are now at this point in time, and we build on their strengths to provide them with their best lives. This philosophy is the reasoning behind the name immerse™, which is the name of our memory support program at HumanGood. Supporting a loved one living with dementia is not easy. Because we at HumanGood recognize this, we are pleased to provide this educational resource to assist you in immersing yourself in the life of your loved one.
To better understand today's topic of communication, we must first explore a little bit about how communication works. Many parts of the brain support language and communication, such as the cerebrum, the frontal lobe, the temporal lobe and the cerebellum. These parts of the brain control the many aspects of language. Examples include the production of language, which involves finding the appropriate words for a response and controlling the muscles needed to move the mouth to speak the words, and also the reception of language, which includes hearing and processing spoken words and interpreting body language.
As dementia progresses, the brain physically changes. As these parts of the brain change, so does the ability to communicate. Decline in communication is one of the most frustrating symptoms, not only for us but also for the person living with dementia. Knowing what the person living with dementia is experiencing can help us engage them more successfully.
Let's consider expressive communication, which includes the words we speak and the body language that we use. An important part of expressive communication is being able to access our full vocabulary within our brain. The person living with dementia might have difficulty finding the right words and organizing sentences. This is huge. You might witness your loved ones substituting words or using more descriptions instead of labeling an object. For example, instead of saying the phrase, "I want to eat a sandwich," they might say, "I want bread and meat." Imagine the frustration when you bring a dinner roll and a chicken breast instead of a sandwich.
We must often be detectives and gain more information about their wants and needs. We might notice that the person living with dementia will begin to speak less or more. They may realize that their vocabulary is not what it used to be, so they decide that it is better just not to speak, or they may use filler words and phrases on repeat in replacement of the lost words. "I just need help. I just need help."
The same can happen with their use of body language. Eye contact, facial expressions and other body movements may seem to disappear in some, while for others, it becomes more exaggerated. Some persons living with dementia may revert to their first language if they learned English later in life.
Now, let's consider the changes in receptive communication. This is the communication that the person living with dementia receives from the people around them. Some sources suggest that a person in the early stages of dementia might miss one out of every four words in a conversation. Imagine what your life would be like if you only understood three out of every four words spoken to you.
Here, I'll provide an example. This is what it might sound like for your loved one living with dementia when hearing a story about your day at work:
"I got blah in traffic for 30 blah, but I still blah to work on blah. The office was blah, so I blah a sweater. I blah out for lunch and I blah a sandwich with blah. The afternoon blah was informative, and I blah a new project. I'm blah to work with John."
Versus what I actually was intending to say:
"I got stuck in traffic for 30 minutes, but I still got to work on time. The office was cold, so I wore a sweater. I went out for lunch and ate a sandwich with Sarah. The afternoon meeting was informative, and I received a new project. I'm excited to work with John."
People with healthy brains will likely be able to fill in some of the missing words, but a person living with dementia requires more time to process information. Run through it again and take note of some of the ways we can speak differently:
"I got blah in traffic for 30 blah. I still blah to work on blah. The office was blah, so I blah a sweater. I blah out for lunch and I blah a sandwich, yum! The afternoon was blah, but informative. I blah a new project. I'm blah to work with my new partner."
Try speaking much more slowly, enunciating each word. Being more animated and eliminating some extraneous details can help the person living with dementia understand more of what you are trying to communicate. Additionally, a good rule of thumb is to allow 90 seconds before repeating or rephrasing. Even as the brain deteriorates, a person living with dementia can continue to be strong in certain ways of communication.
There are three common areas of strength for persons living with dementia:
Automatic chitchat: "Hey, how are you?” “I'm fine. How are you?" These little automatic phrases are still intact, and those living with dementia can engage in these surface-level conversations in some way throughout the process of dementia.
Forbidden words: These are words and phrases that we store in a part of the brain labeled “do not use.” This part of the brain has very little change; therefore, its contents are retained, so when other, more common vocabulary is lost, these words come out instead.
Rhythm, music, poetry and prayer: These are stored in a very special part of the brain that experiences very little change throughout the course of dementia. Even late in the disease process, people can sing every word to songs or say entire poems. They can tap their toes and sway their bodies in rhythm to music.
With this information, you can begin to assess some of your loved one's strengths and some of their challenges with communication. This is a difficult new reality, but it doesn't mean that you can no longer have meaningful interactions with your loved one.
Here are just a few tips that you might try during your next visit. Don't feel pressure to try all of these. Trying just one could make a positive impact on your next interaction.
Slow down the conversation. Give your loved one time to hear, process and interpret what you've said. (Remember: This may take up to 90 seconds.) Try using short sentences.
Enunciate and speak clearly.
Be patient when listening. Allow time for your loved one to respond.
Repeat what your loved one has said if needed.
Instead of correcting, ask for clarification.
Focus on feelings, not facts. Details can be challenging for your loved one. Instead of asking, “What did you do today?” ask, “How are you feeling today?” Or if your loved one is having difficulty remembering all the details of a past family trip, you might say, "It makes me happy to hear you talk about these memories. We had a lot of good times together."
Use appropriate body language to show that you care about what they are trying to say. Make eye contact. Sit closely. Nod your head.
Offer comfort as needed. If your loved one is becoming frustrated with trying to share something, let them know that it's OK and that you're there for them.
Limit distractions by focusing on one task or conversation at a time. If needed, redirect the topic of conversation.
Create a successful environment for a meaningful conversation. Move to a private area. Turn off the TV or music. Set newspapers or magazines aside.
Suggest taking a break from a frustrating topic. Take the lead, and tell a nice story while your loved one rests, or try nonverbal ways of connecting, such as holding hands, going for a walk or looking at photos.
Singing is a great way to take a break from spoken communication. It resets the brain and is a very successful activity for the person living with dementia. Sing a song that you both know and repeat it several times.
I hope these tips help you and your loved one engage in many more meaningful interactions.
Please remember, at HumanGood, we are here to support you as well as your loved one. Don't hesitate to ask questions or share anything you notice with a team member. We appreciate your partnership in providing the best life for your loved one. Thank you for your time. I hope you found this to be helpful to you in ensuring successful interactions with your loved one. If you have any questions or need more support engaging with a loved one, please reach out to your local HumanGood memory support program. Again, thank you for joining me.
The memory support team in your community is here to be your advocate. Reach out to them with questions or potential topics for which you would like further education. Thanks for listening, and we wish you peace on the journey with your loved ones.
This has been an educational resource developed by HumanGood's immerse™ program.