Monday, June 24, 2013

Alzheimer's Translation Services


When I ask a question, I shoot those eyebrows up as high as they’ll climb. I keep them there until there’s an answer. I might ask, “Mom, do you want to get some coffee?” Up go the eyebrows and I wait. I hold her eye contact. I maintain a hopeful smile.

By Pamela R. Kelley
+Alzheimer's Reading Room

Alzheimer's Translation Services

Are you an Alzheimer’s translator? Do you have any techniques that have helped keep your loved one verbally connected?

Step One -- Learn the Language

A few years into caring for my mother, Audrey,  I have begun to think of myself as a translator.

A big part of my work involves interpreting the signals and messages from the ordinary world for my mother, Audrey. Then I translate messages from my mother to the rest of the world – care staff, family and friends. I’m the essential communications middleman. Both sides need the interpreter.

My mother’s need was the more obvious, and so I focused my efforts on satisfying her need from the start. But that meant I needed to learn to speak her language. Through lots and lots of trial and error, I learned to alter my speaking style to match Audrey’s ability to follow along.

Only when she can track my words can she participate in a dialogue. Early on, she had great frustration sorting through my cascade of words. My job before this one was as a professor. So I used big words. Lots of them.

No longer.

We have wonderful conversations now. I find great enjoyment in them and I know she does too. How do I know? We laugh more. Irrefutable evidence.

There are three simple rules I employ now to speak fluent Audrey.

Get rid of the “ands”.

Use more dots.

Emphasize with eyebrows.

In most of our daily dialogue, you and I use lots of extra words. We link up different thoughts with words like “and”, “but”, “or”. We don’t notice when we use them. These words allow us to convey information more efficiently. But efficiency isn’t particularly prized in conversation with Audrey.

Connection is our goal.

For my mother, the depths of her forgetful state are revealed in her relation to words. She can’t hold onto the start of my sentence until its end, unless that sentence is rather short.

A sentence that contains those conjunctions – and, but, or – turns into a long and winding road for her. She gets lost.

When Audrey gets lost, she gets frustrated and angry and upset. Such a state isn’t what I want to induce in her. What a revelation it was to me when I finally understood that sometimes how I said things was compounding her difficulty comprehending.

Realizing this, I also realized I had the power to eliminate the cause of the problem.

We have an acronym in modern usage: TMI, Too Much Information.

Audrey lives in the world of TMI. Too much, too fast. It’s not the content that offends her, it’s the sheer quantity and velocity. With every run-on sentence spoken at her, she feels the frustrating limitations of her disease. And Audrey makes plain her discomfort, often in her own words that are increasingly hostile, angry, mean-sounding and hurtful.

So an early thing I learned to do was to pay attention to my spoken sentences, in the same way that I’m careful with the words I write. When a conjunction was ready to be uttered, I stopped. I put a period on the sentence instead. I started to use more dots. The dots, periods, require a breath. If I’m not waiting a full beat, taking a full breath in-and-out, then I’m not using my dots correctly. Used properly, they create the space that slows down the message. That gives Audrey a chance to keep up.

With the space created by all of those dots, I found the time to consider what I was expressing non-verbally. I could question whether my body language and facial expression fit the message I was intending with my words. I was surprised to discover how often what I said and how I looked were mismatched. I set to work to correct that. I’ve learned to use my eyebrows more.

When I ask a question, I shoot those eyebrows up as high as they’ll climb. I keep them there until there’s an answer. I might ask, “Mom, do you want to get some coffee?” Up go the eyebrows and I wait. I hold her eye contact. I maintain a hopeful smile. It’s a signal – I’ve asked a question that she should answer. She has plenty of time to think. Eventually she’ll reply, “Now?” My smile widens and I say, “Sure”. Down go the eyebrows and out goes my hand, to assist her rising from her chair. My Cheshire grin stays on bright.

Those eyebrows and that smile manage to convey lots of reassuring emotion: they have positions for concern, for curiosity, for wonder, for affection, for happiness. I use them purposefully now; I never thought much about them before.

As my style of speech (and non-speech) improved, the quality of our conversations improved too. They were longer. There was more give and take. Audrey initiated more of the topics we addressed. Soon, I began to notice that my mother was looking to me to help her understanding as she experienced the speech of others.

When confronted with something a third person said that didn’t make sense to her, she looked to me to interpret. I came to understand that my mother understood the words, but that the method by which they were delivered sometimes created insurmountable barriers to communication. So my next challenge in this regard was to figure out how to provide some translation services without fostering too much dependence too soon.

I’ve picked up a couple of techniques along the way.

Just like every other family caregiver, I’m entirely self-taught. And I sure don’t think I’ve got it all figured out. So I was hoping that, by writing this, some of the readers here would share their hard-worn knowledge in the comments.

Are you an Alzheimer’s translator? Do you have any techniques that have helped keep your loved one verbally connected?

**This is part one in a three part series by Pamela R. Kelley

Also see--
Translating Alzheimer's for Others
Translating in Alzheimer's World


Pamela R. Kelley is the full-time caregiver for her mother, after serving as her long-distance caregiver for more than four years. Before her caregiving role took primacy, Ms. Kelley directed an American Bar Association-approved paralegal education program at the University of Alaska Anchorage from within UAA's Justice Center. As she transitioned to full-time caregiving, she prepared a resource manual and presented lectures on long-distance caregiving to her UAA colleagues. Ms. Kelley lives, works and writes in Anchorage, Alaska.

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