Creative Solutions for Communicating with Care Recipients with Dementia

By Megan Carnarius

When your care recipient has memory loss issues, dementia, or an Alzheimer's diagnosis, it will quickly become apparent that using logical thinking and rational problem solving is not usually the best approach for communication. A little creativity can become a useful tool as you learn to listen in new ways, pause to see more layers of influence in a situation, and bring your compassion to the forefront. This creative exchange can make the difference between a peaceful day and a challenging day.

In family situations when these approaches are not incorporated into the daily routine, greater frustration and stress ensues. Artful redirection can make a huge difference in the moment-to-moment experiences you share, sustaining an up-lift, and capturing that elusive "quality of life."

The History of Approaches in Dementia Care

In the late 1970s and early '80s, it was standard practice to correct a confused person by using reality orientation. The conversation with a 90 year-old who is looking for her mother might go something like this: "Your mother is dead, it's Monday, and we are now serving lunch." This is a shocking response for someone who does not have short term memory and may only be able to remember things in the distant past. This person may respond with disbelief or great sadness.

This approach also does not take into account the stages of the disease progression. In early stages of Alzheimer's, it is very appropriate to provide reality orientation for someone who is still aware of life events and is seeking insight and reassurance. Many persons in early stages are still using notes, clocks, and calendars. In this case, they may have a sense that their mother is no longer living but needs help piecing facts together. Taking the recollection far enough back in time where you feel this person can recall things is helpful. Ask questions such as "Did your mother live near you or with you when she was older? Was she ill for any time?" Sometimes this can jog the person's own recollection and the person will realize the answer to their own question. "Oh yes, she was ill for some time, and then she passed away." Instead of reacting with shock and grief at the news, often the person is calmed by knowing they do not need to "look" for this missing person anymore.

Naomi Feil, a social worker during this era, realized that there had to be a more compassionate approach for elders with memory loss than trying to jar them out of their world into ours. She wrote a book called Validation Therapy, and the more recent edition, Validation Breakthrough. Her approach changed how many professionals approach this population in the field and provided great insights for families working with loved ones in their homes. Validation Therapy has grown to a world-wide movement that includes training programs and an institute designed to hone this philosophy. The basic tenet is that although memory may be impaired, each adult has many emotions and life experiences that should be taken into consideration. By "validating" the person's feelings and working with their perceptions in an affirming way, caregivers can become more skillful at redirecting in an artful way and helping their care recipient have a more succesful day.

What to Do Now.....

If you are currently caring for someone with memory loss, and the confusion at times causes increased tension, here are some helpful techniques:

• Assess the rhythm of the day
  • Is there a predictable structure?
  • Are there times of rest and passive activity as well as stimulation and physical activity?
  • Is the environment confusing and loud, or is it calm and peaceful?
  • Does your care recipient have excess energy that needs to be expended?
  • Is your care recipient under-stimulated, exhibited by being too lethargic and sleepy, even bored?
• Create a clear rhythm and routine for each day
  • Observe body language, facial expression, and tone of voice—both yours and that of your care recipient
  • Use a lilt, a pause, change an accent, or use a song to change the mood or lift a spirit
• Use your communication to minimize the losses and highlight the strengths of your care recipient
• Experiment with therapeutic fibs—using stories that make life easier for the care recipient

Example of Using communication to minimize loss:

If your care recipient is asking for a knife while sitting in front of a bowl of ice cream, do not correct them. Rejoice in their ability to use free association and that they were able to find the right family of words. Bring the utensil and say as you give it to them, "here is your spoon." The goal is to create comfort, rather than insisting on use of the right word.

Example of using therapeutic fibs:

Your care recipient wants to leave your home and walk home. Their "home" is likely the home of their childhood memories and their current home does not feel like the safe place they are seeking. Rather than arguing that they are home, it can be much more succesful to agree that it would be nice to go home and take them for a ride, or go for a walk together. Responding to the urge to leave rather than the specifics of where they are going validates what they are feeling. This is not considered lying in the dementia world; rather it is about using creativity to maintain the peace in the confusing world that the person with dementia is experiencing.

Megan Carnarius is a registered nurse, licensed nursing home administrator, and the executive director of Balfour Cherrywood Village in Louisville, Colorado.

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