There’s no doubt dementia diminishes the ability for effective communication between the patient and caregiver. When people can’t comprehend what is being said, or can’t find the words to express their own thoughts, it can be painful, embarrassing and frustrating.
How a caregiver sets the tone for the conversation can make all the difference between being gratified and exasperated.
- Think about how you are presenting yourself. Are you frowning? Tense? Expecting the worst? Bossy or controlling? People with dementia are often extremely aware of nonverbal signals. In my book, My Dad My Dog, there’s a scene in the first chapter where Joe, Rachel’s Alzheimer’s-afflicted Dad, has had the “presence of mind” to answer a question posed by a resident of the care facility where he lives. Unbeknownst to him, this causes Rachel embarrassment. He looks at her, pleased that he was able to answer, but her reaction is not what he expected.
Told in the first person, this is how Rachel describes the resulting dynamic:
I brush at the non-existent lint on my pants and look over at Dad, who is smiling at me. He’s pleased he was able to answer Grady’s question. Then he looks at me, really looks at me, and his smile disappears. The corners of his mouth turn down and his eyes dull.
He’s aware of my distress. His shaky hand reaches for mine. He wouldn’t be able to describe what I’m feeling, but he senses it. He doesn’t think clearly, but he feels deeply; and at this moment, he wants to comfort his daughter.
- Sometimes things can be said to an Alzheimer’s patient that cause an unexpected shift in mood, and the patient can spiral down from there. A caregiver can just be physically and mentally tired, and might say no to a request, or order him to do something, but that often brings about a bad result, most often stubbornness or resistance or a bout of “shutting down.” There are ways to overcome a possible downward spiral, including humor, cajoling, or cheerfulness. Humor or gentle teasing often helps caregivers through difficult moments. Here’s a scene from the book that describes how Rachel deals with her dad’s response to her refusal to give him a beer.
“Can I get you anything, Dad?” I call from the kitchen.
“Too early in the day. Plus, it will make you have to go to the bathroom all afternoon.”
I hear him grumble, but I’m not going to put myself, or him, through the effects of a beer so early in the afternoon.
I wait to see if he says anything else, but when he doesn’t, I go back to peeling potatoes.
“Hey, Dad, remember what you told me about how I peeled potatoes?”
There’s no response, so I walk into the living room, holding a peeled potato. He won’t look at me. Is he being petulant over a beer? How aggravating. I just want to turn around and go back into the kitchen, but I don’t want his mood to descend any further.
So I cajole him. “You used to say I peeled them so much, they looked like marbles when I got through with them. Remember that?”
Still no response.
Standing directly in front of him, I show him the potato. “Now look at this one. If you hadn’t shown me how to peel a potato, we’d be having marbles for dinner.”
There’s a long pause before he responds. “I peeled enough of them in the Army.”
“And you learned to peel them perfectly. Thanks for passing that on to me.”
Mollified, he starts digging into the box of crackers again.
Being a caregiver requires learning on the job. One has to find out what works with her loved one, and build upon those skills that keep communication open.
In Part II, I cover more about approach and tone through using more excerpts from My Dad My Dog.