May 3, 2016

How to Connect With A Person Living with Alzheimer's Looking for Meaning Behind the Words

We encourage caregivers to look for the meaning behind the words to try and discover what people with dementia are trying to say.

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We were working in a memory clinic when we met Ed. He was a tall, well -built man in excellent physical health but beginning to show worsening signs of dementia.

Ed would often wander through the center stopping people and asking them to take him to see his wife. Ed’s wife was not well and was living in a care home attached to the memory care center.

By Tom and Karen Brenner
Alzheimer's Reading Room

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The staff would take him every day to visit with his wife. As soon as he returned, Ed would begin his ceaseless request to be taken to see his wife.

The staff asked us if we could help Ed and help them: his constant demands to see his wife were wearing very thin.

We encourage caregivers (whether family members or professional) to look for the meaning behind the words to try and discover what people with dementia are trying to convey.

One of the techniques we use to decipher actions or conversations that we don’t understand is to look carefully at body language: Is the person frowning, are they standing or sitting in a defensive mode (arms folded in front of the body), are they slumped over, are their hands relaxed or clenched?

We also encourage care givers to look for patterns; is there a specific time of day or a particular event that tends to cause a person to become upset, agitated, sad or angry.

Finally, we find that engaging people in the moment can be very effective in helping them overcome feelings of anger, fear and confusion.

Some of the techniques we use to connect is giving a person something meaningful to hold in their hands. We try and find objects that have a special meaning for that person or we might bring in something from nature for them to hold.

Once the person is holding this object, then we can begin a conversation using open ended questions, such as: “Ed, you look really at home holding that baseball glove. Can you tell me which position you played?”

Having an object to hold helps the person with dementia feel grounded. It is often very difficult for people living with dementia to begin conversations out of thin air, so we really encourage this simple but very effective technique.

We also use music (especially singing) to reach people. We start singing an old hymn or popular song from an earlier era and 99% of the time, the person who was fearful, agitated or sad will begin singing with us and their emotions will lift. We know we’ve reached them when we see them smile!

We noticed early on that the staff took Ed to see his wife whenever there was a moment that someone could spare. We talked with the staff about the possibility of taking Ed to see his wife at the same time every day; perhaps right after lunch or just before dinner. It was our belief that if the visits to his wife became regimented and part of his daily routine, it might help Ed remember that he visited his wife at this specific time of the day.

Routine and the Importance of the First Action of the Day in Dementia Care

Once the staff agreed that Ed would visit his wife just before supper, we created a “memory wallet” for Ed. In this wallet, we placed a card (written in large font) that read, “I will go see Shirley at 4:30 today.” 

When Ed would become agitated and demand that someone take him to see his wife, the staff would ask Ed to take out his wallet and look at the card in there. Ed would read the card and be reassured that he would see his wife that day.

During our meetings with the staff, we encouraged them to try and understand what emotions Ed was trying to express by his demands to see his wife. Of course, one of the most obvious emotions was loneliness; Ed simply missed being with his wife. Could there be another emotion there as well?

Some of the staff thought that Ed needed more attention and asking about visiting his wife was his way of getting that attention. We brainstormed some exercises and activities that would appeal to Ed.

The staff reported that the techniques we encouraged them to use did help Ed have happier days as well as helping preserve the sanity of the staff. When they saw Ed begin to wander and demanding to see his wife, the staff knew now to ask him to look at his memory wallet and to engage him in one of the activities they knew that he enjoyed.

It is one of the most difficult parts of caregiving; finding the way to comfort someone who is living with unfounded fears, inexplicable anger or overwhelming loneliness.

We cannot do anything to change the diagnosis of dementia but we can try and help the people we care for and make sure they are safe, they are loved and they are understood.

It isn’t easy but it is possible to achieve this if we stay in the moment, look for the meaning behind the words and give people with dementia some way to communicate their feeling to us, whether through stories, music, or simply giving them something interesting and meaningful to hold in their hands.

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Publisher Alzheimer's Reading Room
Author Tom and Karen Brenner
May, 2016
Title: How to Connect With A Person Living with Alzheimer's Looking for Meaning Behind the Words