Seven Steps to Better Communication
by Lynn Ritter, Ph.D. Adapted by Debra Sorensen, LISW
From presentation at Heartland of Browning, October 22,
1998
One of our goals at ElderCare Advocates, Inc., is to provide
supportive services and information to caregivers. Information
we obtain through our continuing education process which
may be helpful to caregivers will be passed along, as much
as possible, through our newsletter.
Recently, I attended a brief seminar on Alzheimer's Disease,
which included "Seven Steps to Better Communication." Our
thanks and credit to Lynn Ritter, Ph.D., Coordinator of
the Dementia Specific Training Institute, Alzheimer's Association,
Northwest Ohio Chapter, for her contributions and editorial
assistance with this article.
Most of us dealing with elderly parents and loved ones
are also learning to cope with some degree of dementia or
loss of memory, whether or not this is Alzheimer's related.
That is why I felt this information on communication could
be applied to communicating with any elder, whether dementia
plays a role in their diagnoses or not. Many times, elderly
persons are resistant to intervention, no matter how loving
and caring that intervention is meant to be. Any help we
can obtain in communicating with that loved one should be
utilized in our interactions with them. With that in mind,
I pass along these "Seven Steps to Better Communication:"
1. Always address as an adult
So often, loving caregivers begin to speak to impaired
elders as children. It is a natural human process to speak
"down" to those whose understanding does not match our own.
However, just because an elder is beginning to be a bit
more dependent on others, does not mean that elder sees
him/herself as a child. Any perceived loss of respect from
their younger family members can contribute to further loss
of cooperation. Watch your tone of voice inflection, and
make sure you are not "sing-songing" to the person.
2. Keep communication conversational, not inquisitional
Sometimes we don't know quite what to say to someone we
visit who is cognitively impaired, so we begin to ask questions
about their lives or their families. Too many questions,
especially if the elder is unable to readily answer them,
puts a person on the defensive and increases their confusion.
Instead, talk about yourself, the weather, or the activity
in which you are engaged with the elder. In other words,
make statements instead of asking questions which the elder
is expected to answer. Leave room between your statements
for the person to speak if s/he wishes, even if communication
is difficult or improbable -- allow the information you
have given to be processed and considered by the person
to whom you are speaking.
3. Always presume the individual is able to hear/understand
conversation
One of the things I have learned in working with seniors
is that even those with hearing impairments often do not
hear a louder voice better, but a deeper tone of voice.
Also, never talk "around" the individual, asking questions
of others in the room about the elder as if s/he were not
in the room. Whether the elder can understand and hear or
not, this type of behavior contributes to our own degree
of separating ourselves and keeping from becoming personally
involved with the individual.
4. Provide accurate as well as descriptive cues
When dealing with a cognitively impaired individual, directions
such as, "Here you are," as a glass of juice is placed in
front of that person may not be adequate information. It
is better to give concrete instructions and descriptions.
A more helpful approach may be to say, "Mrs. Franklin, here
is your glass of orange juice to drink." This approach identified
Mrs. Franklin by name at the beginning of the sentence to
capture her attention. Then the object was described as
the glass of orange juice. Finally, Mrs. Franklin received
the cue that the item was for her to drink. With this type
of statement, Mrs. Franklin is provided a great deal of
information about the situation, yet it is presented without
extraneous, confusing thoughts.
5. Provide multiple cues to the individual
Tell, show, touch, invite, offer. Dr. Ritter gave the
example of a person with impaired memory whose caregiver
asked if she needed to use the toilet. "No," she replied,
then ten minutes later she had an accident. People with
impaired cognition may not be able to comprehend the question
asked. Instead, take her by the hand, lead her to the bathroom,
and show her the commode. This type of cueing may prompt
the person to realize her bladder is full.
6. Simplify tasks by breaking them down into achievable
parts
Another example, a person for whom it is time to brush
his teeth: Taking the person to the bathroom and handing
him the toothbrush may not be enough. Minutes later, you
may still find him standing in the bathroom with the toothbrush
in hand and not a clue as to its purpose. Instead, tell
him the steps involved: "Put some toothpaste on the brush
and brush your teeth like this," (demonstrate with gestures
to your own mouth). Each individual situation calls for
differing degrees of "cueing." Your experience will tell
you what is involved with your elder.
7. Eliminate competing stimulation
As a home health social worker, I often found myself competing
with the television set in the room. Seniors sometimes do
not hear the competing stimuli, or are simply unwilling
to stop what they are doing to give you their full attention.
Depending on the situation, it was usually appropriate for
me to politely ask if we could turn the volume down (I would
sometimes use myself as the excuse, "I have difficulty hearing
you with the TV on"). More often than not, the person then
would say, "Go ahead and turn it off, I didn't even realize
it was on."
Other golden tidbits of communication include:
* "Invite" the elder to participate or partake of the
next necessary activity, rather than informing him/her that
it is now time to do such-and-such.
* SMILE -- show positive emotions and attitudes -- the
last thing your loved one needs is to see how depressed
or stressed out you are about whatever is going on in your
own life, but on the other hand....
* Key into the emotion of the moment -- if the person
you are addressing is already engaged in an emotional fixation
of some sort, try to relate to what they are feeling and
address their fears and concerns. Don't ignore them as irrelevant
or idiosyncratic (even if they don't make sense to you).
* Also, be sure to check the individual's comfort level
regarding touch -- some people don't want to be touched
by strangers (remember, even loved ones can seem like strangers
to a person with encroaching dementia). And don't touch
their belongings without permission -- picking up photographs
on their mantelpiece may be your idea of engaging them in
conversation, but the elder may construe that as an invasion
of privacy.
