Tips for Caregivers – Communication Techniques

“It’s not always what you say but how you say it.”

• Speak slowly and clearly
• Be aware of body language
• Use visual cues
• Approach from front
• Address by name
• Meet at eye level
• Short questions, one at a time
• Break down tasks into one step at a time
• Repeat using same wording, if that doesn’t work, rephrase
• Avoid negative statements (don’t use “don’t”)
• Allow adequate time for response
• Utilize humor
• Keep talking even if nonverbal

Communication is hard because person cannot remember things, can’t find words, difficulty understanding what is said, difficulty paying attention, remembering steps, blocking out background noise, being sensitive to touch, or tone or loudness of voice.

To Help Make Communication Easier:

• Make eye contact
• Call the person by name
• Be aware of your tone and how loud your voice is
• How you look at the person
• Body language
• Encourage 2-way communication as long as possible
• Gentle touching
• Try distracting/redirecting if communication creates problems
• Be open and agreeable even if the person is difficult to understand
• Let them make some decisions and stay involved
• Speak at eye level
• Offer simple step-by-step instructions
• Repeat instructions and allow more time for response
• Don’t talk about the person as if he or she isn’t there
• Don’t use “baby talk” or a “baby voice”
• Ask yes or no questions
• If they make a mistake say, “let’s try it this way”
• Say “please do this” instead of “don’t”
• Limit choices – do you want chicken or beef?
• Instead of asking if they’re hungry say, “dinner is ready”
• Try not to say “don’t you remember?” or “remember when”
• Use visual cues

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Coping with Dementia After A Stroke

When your loved one suffered a stroke, you probably knew that they would face challenges in their life. One of the most common challenges after a stroke is the onset of dementia. In essence, dementia is a chronic mental decline that affects the memory, cognitive and social skills, and sometimes emotional stability. It is common after a stroke because many of the neurons in the brain required to process memory and thinking are damaged from the stroke and this leaves a deficit in your loved one’s way of thinking.

Dealing with someone who has dementia can sometimes be challenging, and dementia can come in various forms and severity. For some, they merely become forgetful or repetitive, but for others, they may become completely unable to care for themselves. Most stroke rehabilitation focus on the physical deficits that arise from an insult, but it takes just as much compassion and patience to help your loved one travel the road of cognitive impairment.

Conversation Strategies

Although it can sometimes seem impossible, the best way to speak with someone with dementia is with patience. If you feel yourself becoming impatient and want to lash out at your loved one, you should remove yourself from the situation until you calm down. It is important to remember that your loved one is not doing this on purpose. You may think that they know what you are talking about, but the simple reality is that they do not understand what you are trying to communicate. Try speaking slowly, carefully, and softly to get through to your loved one. Use short words and sentences, and try to direct them with purposeful, simple commands.

If your loved one suffers from memory loss, give gentle cues and reminders to help them through their memory difficulty. Do not get frustrated that they ask repetitive questions, but realize that they don’t know they are repeating themselves. It is helpful to ask targeted questions when speaking to someone with dementia. For instance, do not ask, “What would you like for lunch?” Ask instead, “Would you like a sandwich or soup for lunch?” This is an example of a simple, directed question. Open ended questions are often not processed well by the cognitively impaired.

Navigating the Physical World

The key to helping someone with dementia navigate the physical environment is to keep it simple. Have a bed and a dresser in a bedroom. There is no need for a chair, nightstand, light fixture, and so on. A simple layout will help your loved one navigate the room and keep them from falling. Do not put down throw rugs anywhere in the house, as this is a primary reason for falls in the home.

You may want to put large labels on different important items in the home. For instance, labeling the refrigerator, stove, and pantry will help your loved one remember what things are and what to do with them. This also comes in handy in the bedroom, because you can label drawers with their contents to aide memory. Remember that patience and encouragement will get you further than agitation. People with dementia tend to do things more slowly, but they are very capable of completing small tasks. Give praise when they are able to zip their own pants, pull on their own shirt, or tie their own shoes. Your job is to be a totally biased cheerleader. Even when they do not do something that well, it helps to be encouraging anyway.

Emotional Struggles

Both you and your loved one are likely struggling emotionally. For your loved one, they may experience anxiety as the night comes on. This is a common symptom known as “sundowning.” Gently reorient your loved one to the place and time and attempt to help them understand their surroundings. They may ask for your help, but not know what to tell you to do. Ask them short, direct questions aimed at primary needs. For instance, ask if they are in pain, hungry, thirsty, or need the toilet. Any of these needs may be lacking, and they don’t know how to ask for the help they need.

For your own emotional struggles, it is important to take frequent breaks. It is quite difficult to deal with someone with dementia around the clock, and you should not expect yourself to. If your loved one is at home, see about getting other family members to come in and stay with your loved one for a few hours. If that is not an option, getting a hired professional to come in is a necessary expense to maintain your own mental health. Respite care is often the name that social services assign to this type of care. If your loved one is in a nursing home and they frustrate you during visits, take a break from them. You can also visit less frequently or keep your visits short. Your frustration will only lead to making them feel sad and confused about their condition.

In the end, calm, patient care is necessary for someone with post-stroke dementia. If you can calmly redirect your loved one, provide simple reminders, and ask directed questions, you will go a long way towards making life with your loved one as enjoyable as possible.

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Dealing With Hearing Impairment Issues at the Doctor

In the waiting room

If you have trouble hearing, tell the receptionist that calling your name isn't the best way to tell you that the doctor is ready to see you. Ask him or her to come and get you or get your attention visually when the doctor is ready for you.

If you are deaf and use sign language

Good communication with your doctor is important. If you prefer to have a sign language interpreter, ask for one when you make your appointment.

• Ask a friend or relative to be your interpreter. However, you should ask someone that you are comfortable with because your doctor may need to ask you personal questions.
• You can help your doctor find the right interpreter by explaining the type of sign language you use (American Sign Language, Signed English, Pidgin Signed English, Visual-Gestural Communication, or the sign language of another country). If the interpreter is certified by the Registry of Interpreters for the Deaf, you can feel sure about confidentiality.

If you are hard-of-hearing, or if you are deaf and rely on spoken language

• If you are hard-of-hearing you may feel embarrassed sometimes. You may feel awkward saying that you didn't understand what was said. Sometimes you might pretend to hear something you didn't. You may feel that it isn't right to interrupt your doctor. But to get good medical care, try not to be shy about your communication needs when you visit your doctor.
• Ask for a quiet, well-lit room, without glare. It will also help if the room has curtains and carpets. Ask the doctor to speak clearly, to face you, to keep his or her mouth visible, and to repeat and rephrase as needed.
• If you need a procedure or exam, complete your conversation in a quieter room before moving to the exam room.
• If your doctor will be wearing a face mask for a procedure, ask to be told what you need to know ahead of time, because you can't read lips through a face mask.
• If your speech is difficult for others to understand, ask the doctor to be patient. Take your time. Feel free to write or to type on a computer or other keyboard if you prefer.
• If you need a Cued Speech interpreter or an oral interpreter, request one when you make your appointment.

Understanding What Your Doctor Tells You

• You have a right to understand everything your doctor tells you about your health. You may want to ask the doctor to allow you to repeat sentences back. This way you can check to see if you heard correctly.
• If your doctor uses a word that you don't know, ask for the word to be written down and explained clearly. If you need it, ask for a drawing or a model.
• Don't be afraid that you're bothering the doctor with these questions. If it would help you, ask for written information about your condition, your medicines or your treatment choices.

Assistive Devices

If you wear hearing aids, take the time to adjust them for the best possible sound. If you use a personal amplification system, don't hesitate to ask your doctor to wear the microphone.

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