Successful Communication

Look for this article written by Diane Hischke, in the March 2010 issue of "The American Senior Gazette", published in West Bloomfield, MI.

The Heart Remains

It is likely that an individual with Alzheimer’s disease often understands more than he/she is able to make known to others. It is also proven that he/she is aware of and experiences feelings elicited by others or events, even when he/she cannot articulate those feelings or describe what is happening. In other words, even if the mind is not there, the heart is. This is so important to remember and to celebrate. My mother could not always tell others my name, or that I was her daughter. However, I never doubted that when she looked at me, she knew I was someone she loved and who loved her.

Coping with the Alzheimer’s Victim’s Anger, Anxiety, and Paranoia

This professional geriatric care manager (GCM) and daughter of an Alzheimer’s victim well knows that coping with an Alzheimer’s patient’s overwhelming feelings, such as anger, anxiety, and paranoia, is difficult in many ways for the caregiver.

It is still fresh in my mind how I felt when my mother’s anger was inappropriately directed at me. And that was more than 15 years ago! I felt shocked, hurt, and confused. And, those personal feelings made it difficult for me to respond in a helpful way.

When responding to the ANGER of an Alzheimer’s victim:

DO NOT take the emotion and associated behavior personally. It is a symptom of the illness being “played out” in your loved one. He/she has little control of the feeling or action. In fact, he or she will, afterwards, probably not even recall the incident.

DO validate or state in a calm manner and in simple words the feeling you think your loved one is experiencing. For example, state, “You must be feeling angry right now. I understand that.” Surprisingly, this may quickly dissipate the feeling the person is having–like you’ve suddenly stuck a pin in a balloon and the air deflates!

DO then reassure the person with a kind touch on the arm or shoulder and a statement such as, “I’m here to take care of you” or “There are many people here who care about you.”

DO remove the person from the stressful place or situation while guiding him/her in a calm and reassuring way.

DO then offer a distraction he/she is likely to accept, e.g. offer to sit with the person and read a book, look at pictures of their grandchildren, or go for a walk and smell the flowers.

DO NOT ask if he/she wants to do this distracting activity, but suggest, in a very kind and encouraging manner that they do it with you.

DO look for early signs of frustration in activities such as bathing, dressing, or directing movement from one location to another. If evident, delay the activity temporarily.

I can still recall the embarrassment and anxiety I felt when my mother became anxious about the ringing telephone in my kitchen (which she didn’t recognize as a phone any longer). She began trying to take the phone receiver apart, while the caller (one of my nursing students) was on the other end!

When responding to the ANXIETY of an Alzheimer’s victim:

DO scan the environment to determine what may be triggering the anxiety. Can this be eliminated or can the person be gently removed from the environment?

DO maintain a calm and pleasant facial expression and tone of voice.

DO make reassuring comments, such as,“It’s okay” or “I’m here to help you.”

DO know that anxiety is most common in the early stages of dementia when the person still has a fair amount of awareness of his/her surroundings, but may misinterpret them as a danger to himself/herself, e.g. the ringing phone.

DO avoid situations and places where there are loud noises, many activities, and many people.

DO know that the stage where this is most common is usually temporary.

DO consult your doctor if the anxiety is unrelenting; interferes with necessary activities of daily living, such as bathing; or prevents adequate sleep of either the Alzheimer’s victim or the caregiver. Anti-anxiety medication may be ordered temporarily to ease the distress.

When responding to the PARANOIA of an Alzheimer’s victim:

DO NOT argue with the person or try to convince him/her the paranoid belief is untrue. He/she has lost the ability to be rational.

DO look for lost articles or assist in looking.

DO acknowledge the feelings the person is having in relation to the object of their paranoia. If he/she thinks someone is coming into the house and taking belongings, state, “I know how important your things are to you.”

DO tell the person where their valuables are stored for safekeeping.

DO tell the person all of the precautions which are being taken to keep him/her safe.

DO consult a geropsychiatrist for medication management if the paranoia is severe, very disturbing, and unrelenting. Antipsychotic medication may very well be helpful and be required only temporarily.

Effective Communication Techniques

Effective communication techniques with persons with dementia are often the opposite of how one might speak with a well person. This professional GCM believes this is why it “does not come naturally” to many people. It may be totally foreign to what a caregiver is accustomed. However, it can be learned if the caregiver is open to change and learning.

DO always approach the person slowly and from the front.

DO make direct eye contact before speaking.

DO eliminate distracting noises. Turn off the radio or TV. Guide him/her to a quiet area.

DO remember that how you look and sound, i.e. facial expression, body language, tone of voice, calmness or tenseness, is more important than even what you say.

DO point or demonstrate where you want the person to go or what you want the person to do. Repeat this if necessary.

DO give one instruction at a time, e.g. “Please sit down here” and then, “Now you can eat your lunch.”

DON’T ask questions he/she is unlikely to be able to answer. For example, don’t ask if he/she recalls a daughter’s name or where he/she had lunch with his family.


DO use short, simple sentences and concrete, familiar words.

DO pause between sentences to give the person time to respond.

DO use another word with the same meaning if the person doesn’t seem to understand your first word.

DO always speak to the person in a respectful manner.

DON’T speak in front of the person as if he/she is not there.

This writer believes that the dementia patient’s anger, anxiety, paranoia, and difficulty speaking and understanding language are tremendous barriers to quality of life for both the Alzheimer’s victim and his/her caregivers. This mental and emotional distress can be diminished or eliminated through the caregiver’s acceptance, understanding, and knowledge of effective ways to communicate and intervene.