Sam Bauman: ‘Compassionate communication’ to dementia sufferers
October 28, 2012
Every so often the Retired Senior Volunteer Program joins with others to present lectures on dealing with respite and driver workers for problems of dementia and other aspects of volunteer work. The most recent took place late this month at Western Nevada Collage Tech Center with some 40 RSVP volunteers on hand.The subject was “Compassionate Communication and Challenging Behaviors,” largely presented by co-sponsor Alzheimer’s Association of Northern Nevada, with Dori Ward of the association the main speaker. This was a four-and-a-half hour meeting.Ward, a forceful, witty speaker, outlined the objectives: a better understanding of Alzheimer’s Disease, other dementia and their progressions; practical techniques in communicating and behavior management to better connect with memory-impaired people and how to better communicate with them..“What is dementia?” asked Ward. She explained: “A syndrome which describes a group of symptoms, some of which are irreversible, some of which are not.” She added dementia is itself not a disease or a specific diagnosis, “but it is not part of the normal aging process.”Dementia includes Alzheimer’s disease, Lewy Body disease, Vascular dementia, reversible dementia and frontal temporal dementia.“Some are irreversible, such as Alzheimer’s, Lewy, frontal or temporal, vascular or alcohol-related,” Ward said. “Others, such as depression, metabolic problems, adverse medication reactions, infections, brain tumors, sensor loss or nutritional shortages” can be treated.“Alzheimer’s is the most common dementia, accounting for 70 percent of dementia patients” Ward said, adding it is progressive, degenerative and neurological in nature and “It goes through phases of decline and requires caregiver flexibility.”Ward outlined the changes that come from Alzheimer’s: Loss of memory, and declines in language and communication skills, visual-spatial perceptions and behavior.“By 2050 it is expected that 60 million will be suffering from Alzheimer’s worldwide,” she said.What happens to the Alzheimer’s patient?“Confusion is the central problem of dementia,” Ward said. “It’s the source of emotional or behavioral problems. Those afflicted lose thinking powers to keep confusion at bay and bring up needs that the patient cannot meet.”The patient suffers from terror of being out of control, is self-protective. Confusion strikes without notice.Ward listed some of what caregivers need to understand: What is and isn’t possible to change. That caregivers’ actions impact the behavior of the person with dementia. That all behavior has meaning. That improving communication requires the commitment to remain connected.She listed challenges for the patient: Finding the right word, word repetition, comprehension difficulties, limited attention span, losing the train of thought.“Time is different for the patient. Five minutes can seem like five hours.“Communication problems can lead to frustration, anger, embarrassment, withdrawal or silence. The patient suffers.”Compassionate communication begins with “adjusting caregivers’ expectations and simplifying how to communicate. And it happens when you help the person with dementia to express their feelings and needs.“Caring communication fosters self-esteem for the patients, supports their need for meaning and to be useful. Reduces frustration, enhances independence and strengthens the relationship.”It’s important for the caregiver to be active — “to stop talking and listen. To express interest and maintain eye contact, be careful not to interrupt, focus on feelings, not fact, be patient, cheerful and reassuring.”Ward suggested some steps to make conversations easier. “Establish eye contact, always approach from the front, say your name and address to the person, speak in a calm, gentle relaxed voice, speak slowly and use short, simple questions. Take time to reach the patient.”Always avoid open-ended questions, offer praise and compliments, use humor and sometimes try other forms of communication such as music, massage, favorite foods, walks, Ward suggests.“Repeat instructions exactly the same way, don’t confuse, don’t insist on getting through, try again later. Accept blame when something goes wrong, and in a confrontation you might want to leave the room.”And don’t play the blame game, Ward warns. Don’t try reasoning, arguing, confronting, reminding the patient that they forgot, and don’t take anything personally.As far as reasoning goes, if a patient says, “What doctor’s appointment? There’s noting wrong with me,” don’t say, “You’ve been seeing the doctor regularly, I told you yesterday.” Instead, “It’s just a regular check up, sorry if I forgot to warn you.” Distract: “Would you like to help me set the table?”One thing to avoid is confrontation. “Nobody’s going to make decisions for me,” says the patient. Respond: “I’m sorry this is a rough time. I care about you — we’ll get through this together.” Or distract with a news snippet.There’s a lot more to compassionate communications and I’ll continue this next time. But perhaps the most important thing is to put yourself in the patient’s position, where logic is weak and memory fleeting. • Sam Bauman writes about senior affairs, among other things, for the Nevada Appeal.