Techniques Demonstrated : Miami Nursing School Makes Video on Alzheimer’s
Victims of Alzheimer’s disease suffer from the inability to communicate, making it difficult for families trying to care for them, but one research project has come up with a few communication techniques that may ease the burden for everyone.
The University of Miami School of Nursing has produced a 25-minute videotape, “Communication With the Cognitively Impaired Older Adult,” designed to help nurses and families communicate with elderly people whose thought processes are impaired by Alzheimer’s disease.
The tape demonstrates techniques that proved effective during a 2-year research project at a North Miami nursing home.
“We know many people don’t know how to communicate with these people. The aim of the tape is to try to convince people that there is something they can do,” said Ruth Tappen, dean of the School of Nursing.
The physiology of memory and thinking is not well understood. It is believed that the brain translates the words it receives into concepts, stores the concepts in the memory, then translates the ideas back into words when they are needed again.
Translating Process Impaired
Alzheimer’s disease somehow impairs that translating process. Victims have trouble receiving, storing and retrieving ideas. They may retain the mechanical ability to hear, speak and read words, but lose the meaning of them.
They forget quickly, cannot process new information in a normal way, and usually suffer impairment in judgment, reasoning and logic.
In conversations, they tend to use short, repetitive phrases, often interrupting another speaker or stopping in the middle of a sentence. They may change the subject abruptly, seem to ignore the speaker or give answers that make no sense.
“These people have, specifically, problems with cognition, the thinking process. They are not mentally ill or emotionally disturbed,” Tappen said.
It is estimated that 5% to 15% of those over 65 suffer some degree of cognitive impairment, and that 50% of nursing home patients are cognitively impaired.
In the tape, nurses and aides demonstrate techniques that they used during a “revitalization” project aimed at finding out whether Alzheimer’s victims could be taught to become more independent.
They worked with 20 Alzheimer’s patients aged 60 to 103 in groups of six to eight, helping them perform such tasks as walking, and grooming and feeding themselves.
It should be noted that communicating with these patients requires an extreme amount of patience. “It is draining. You are working all the time,” Tappen said.
Some techniques recommended are:
* Speak slowly and allow ample time for a reply. Rapid stimuli are confusing to the cognitively impaired. Because they have trouble processing thoughts, it takes them a long time to formulate answers.
* Be repetitive. You may have to repeat yourself five or six times before they grasp the meaning of your words. Phrase your message several different ways, using simple synonyms. Use the same words they have used--it indicates that they may have retained some recognition of that word.
* Ask simple yes-or-no questions. A therapist on the tape gets no reply when she asks a woman to “Tell me something about yourself.” But the woman is able to answer such questions as “Are you married?” and “Do you have children?”
* Avoid pronouns such as he, she and it. Repeating the name of the person or thing may help them remember what you were talking about.
* Do things one step at a time. Instead of telling a patient to “Eat your breakfast,” nurses and aides got better results when they broke down their instructions into separate steps such as “Pick up your glass” and “Drink your juice.”
* Be concrete. Talk about things you can see, feel, point to or show pictures of. Attempts to discuss philosophical, hypothetical or abstract topics will probably compound their confusion.
* Be supportive and keep criticism to a minimum. Alzheimer’s victims may become frustrated, embarrassed or frightened by their failure to communicate. Show respect and understand that they may be very much aware of what’s going on around them.
“They’re impaired adults. They shouldn’t be treated like children,” Tappen said. “Would you want to be treated like a child again?”
* Use gestures and nonverbal cues. Demonstrate or act out your words when possible. Many cognitively impaired people seem adept at reading nonverbal cues. Pay attention to their nonverbal cues, too. Their voice tone, gestures and facial expression may provide clues to what they are trying to communicate even if the words don’t make sense.
* Maintain eye contact. It helps hold their attention and can help you measure whether they comprehend what you are saying. Watch your spatial relationship. If they are sitting and you are standing, you may literally be talking over their heads. If they can see or hear better on one side, sit on that side.
* Use touch. A light pat or touch on the arm can reassure them, get their attention and prepare them to receive information. Approach them from the front and don’t touch them without speaking first or you may startle them.
* Understand that it may be easier for them to talk about the past than about current events because those old memories have been “stored” and can be retrieved.
