alzheimer's disease (ad) final draft

Running head: HOW TO COMMUNICATE WITH ALZHEIMER’S PATIENTS 1

How to Communicate with Alzheimer’s Patients

Bianca Butler

Ferris State University

HOW TO COMMUNICATE WITH ALZHEIMER’S PATIENTS 2

How to Communicate with Alzheimer’s Patients

According to the National Institute of Health (2013), Alzheimer’s disease (AD) is a brain

disease that gradually affects the memory and thinking skills and, eventually, the ability to do

daily tasks. Alzheimer’s starts off slowly and then gradually gets worse over time.

As reported by NIH Senior Health (2013), “5.1 million people in the United States may

have Alzheimer’s disease.” The risks of developing the disease increase with age. After an

elderly person is diagnosed with Alzheimer’s disease, the time until death can vary. The person’s

age when he or she is first diagnosed will determine how long they will live, which may range

from 3 to 10 years after the diagnosis (NIH Senior Health, 2013).

Researchers still are not sure what causes a person to have Alzheimer’s disease. Studies

show that this disease can cause changes in the brain which may not show up for years. Some

risk factors for Alzheimer’s are age and genetics, which cannot be controlled. On the other hand,

lifestyle factors, like diet and exercise, which can reduce the risk of developing Alzheimer’s, can

be changed (NIH Senior Health, 2013).

According to the National Institute of Aging (2013), scientists think that if Alzheimer’s is

diagnosed during the early stages, treating the patient will be more successful. Today, scientists

have the technology to diagnose Alzheimer’s during the early stages of the disease. An article

by the National Institute of Aging (2013) discusses the goals doctors have when using this

technology:

These efforts are designed to determine who is at the highest risk for Alzheimer’s so that

possible treatments can be tested more rapidly and effectively, as well as to improve

diagnosis in clinical practice to better serve patients and their families.


Diagnosing

Symptoms

Doctors begin to look at a diagnosis of Alzheimer’s disease when a patient displays

enough symptoms of the illness. Not everyone with Alzheimer’s disease shows the same

symptoms. In some cases, this disease can progress more quickly in some older adults than in

others. Overall, it can take many years for Alzheimer’s to become severe. One early sign of

Alzheimer’s disease is memory loss. An elderly person who experiences the early signs of

Alzheimer’s disease possibly can get lost, lose things, find it harder and harder to remember

things, have mood and personality changes, and display other symptoms. In the later stages of

Alzheimer’s, elderly people have trouble remembering who their friends and family are and

wander away from home (NIH Senior Health, 2013).

Tests

Doctors perform standard medical tests to look for Alzheimer’s. For instance, a blood

and urine test can be done. Brain scans are performed to look for anything in the brain that does

not look normal. Doctors also ask the about the patient’s past medical problems, changes in

behavior and personality along with the ability to carry out daily activities (NIH Senior Health,

2013).

Genotyping and test of insulin resistance are essential tools that can help diagnose which

individuals are at risk for developing Alzheimer’s disease. As of today researchers are looking at

three main approaches to determine the early stages of Alzheimer’s disease. They are as follows:

measurements of biomarkers in cerebrospinal fluid (CSF), brain imaging and standard clinical


tests of memory and thinking abilities to determine cognitive health (National Institute on Aging,

2013).

Prevention

Unfortunately there are no medications or treatments that can prevent a person from

having Alzheimer’s, but researchers are trying to find possible solutions. Exercising can reduce

the risk for Alzheimer’s, and taking dietary supplements and following a good diet can help keep

the brain healthy. Chronic diseases such as vascular disease, high blood pressure, heart disease,

and diabetes can increase the risk for Alzheimer’s. Studies are trying to determine whether these

risks can be reduced by preventing and controlling these diseases (NIH Senior Health, 2013).

Treatments

Medication

Unfortunately, there is also no cure for Alzheimer’s disease, but on a positive note, there

are medications that can treat symptoms of this disease. The medicine works best if the patient is

in the mild or moderate stages of this disease. Donepezil (Aricept), Rivastigmine (Exelon), and

Galantamine (Razadyne) can help maintain his or her thinking, memory and speaking skills.

Memory aids can help elderly adults who have a mild case of Alzheimer’s with day-to-day living

(NIH Senior Health, 2013).

Music Therapy

According to Sambandham and Schirm (1995), music has been shown to serve as a

therapeutic activity for Alzheimer’s patients, but there is still much more research to be done in

this area. However, the data that have been collected show that music therapy has enough


promise that it is important that health care providers use music on Alzheimer’s patients because

this remedy can uplift the patient and help with his or her communication skills. There was a

study done on two Alzheimer’s patients’ who were in the last stage of the disease who chose

music therapy over other therapies. A researcher named Hamer did a study on “low-functioning”

dementia patients and found that these patients developed “adaptive behavioral strategies” when

they were introduced to music (Sambandham & Schirm, 1995).

Researchers have found proof that music can help Alzheimer’s patients with their

communication skills. They have also found out that some areas in the brain can still respond to

music and that this part of the brain will be the last to be affected by dementia (Sambandham &

Schirm, 1995). There was a case study done on an 82-year-old musician who suffered from AD.

This study showed that this individual was able to still play the piano from memory up until the

patient’s final stage of AD. According to a report by the U.S. Senate’s Special Committee on

Aging, music is a therapeutic way for Alzheimer’s patients to communicate past memories

(Sambandham & Schirm, 1995). In this report, Sacks (1991) commented on this phenomenon:

One sees that it is not an actual loss of memories but a loss of access to these – and

music, above all, can provide access once again, can constitute a key for opening the door

to the past, a door not only to specific moods and memories, but to the entire thought-

structure and personality of the past. (as cited in Sambandham & Schirm, 1995, p. 80)

When the study was done, the results indicated that the patients who suffered from severe

cognitive impairments had significantly showed improvement in their memory and reminiscence

capabilities verses the patients who had less severe cognitive impairments. However, some


researchers found that this information was a little bizarre and speculated that there may have

been a measurement error during the study (Sambandham & Schirm, 1995).

Walking Therapy

According to Gutfeld, Rao, and Sangiorgio (1993), researchers have found a strategy that

can help Alzheimer’s patients to communicate better, and that is by walking. Researchers did a

study where they monitored 30 Alzheimer’s patients who took a walk for 30 minutes three days

out of the week while communicating with a scientist. Each patient’s communication skills were

monitored before and after this experiment (Gutfeld, Rao, & Sangiorgio 1993).

As stated by Tappen, “Those who took part in the planned walking showed a significant

improvement in communication." Tappen is a professor at the school of nursing at the University

of Miami. Tappen also states that patients who could only say a couple of words were able to

communicate and say what they were feeling (Gutfeld, Rao, & Sangiorgio 1993).

Some people believe that giving any attention to an Alzheimer’s patient is great.

However, this belief does not seem to be supported by Dr. Tappen’s study. Rita Friedman, who

also worked on the study, stated that the group of non-walkers, despite receiving the same

amount of attention as patients in the walking group, did not significantly increase their

communication skills (Gutfeld, Rao, & Sangiorgio 1993).

No one really knows why walking can help improve Alzheimer’s patients’

communication skills. One theory that researchers believe is that “exercise may be stimulating


parts of the brain closely associated to areas handling communication,” as stated by Dr. Tappen

(as cited in Gutfeld, Rao, & Sangiorgio 1993).

Since Dr. Tappen has been closely working with Alzheimer’s patients, she has become

aware of how good the patients’ communication skills are while walking. When the disease

reaches the later stages, a patient’s communication skills will be problematic. Trying new

strategies that assist the patient in maintaining any amount of communication skills will greatly

benefit both the caregiver and patient (Gutfeld, Rao, & Sangiorgio 1993).

Dr. Tappen states that this research is still being studied and that more work will need to

be completed, but she feels that there will be good outcomes in the end (as cited in Gutfeld, Rao,

& Sangiorgio 1993).

Detrimental to communication

Physical process

A patient who suffers from Alzheimer’s will have a memory disorder which can affect a

patient’s ability to comprehend the meanings behind verbal and nonverbal communication. In

addition, patients with Alzheimer’s may not always understand what caregivers are trying to

communicate with them. Although a patient’s hearing and eyesight may not be affected, their


brain system can still be affected by the disease, which can affect all information that the patient

is receiving. This can lead to information not being processed correctly. Furthermore, a patient’s

senses can be affected by Alzheimer’s; sometimes he or she may not be able to hear, see or read

properly. Often important information can be misplaced. This can lead to chaos. Therefore, those

individuals who suffer from this disease will at times not be able to comprehend what is going

on. This may lead to the patient feeling lost (Prism Innovations, 2001).

Why is this important

According to Orange, Molloy, Lever, Darzins and Ganesan (1994), between “85 and 95

percent of individuals with Alzheimer’s Disease (AD) exhibit language and communication

disturbances.” Having all of these problems is not only difficult for the patient, but also for the

caregiver. Caregivers who communicate with Alzheimer’s patients can face some challenges,

which can eventually lead to having a breakdown and being frustrated (Mandel & Shulman,

1993). Overall, nonverbal communication is important in everyday life. Nonverbal messages can

be shown through different variations such as “gestures, body movements, facial expression,

touch, tone of voice and speed of words” (Prism Innovations, 2001). When one first learns that

their family member has Alzheimer’s disease, trying to communicate with the sufferer can be

challenging and even surreal. As the disease progresses, it can affect his or her communication

skills. At times caregivers may not even be able to understand what their family members are

trying to communicate with them. On the other hand, it can also be difficult for Alzheimer’s

patient’s to understand what anyone is trying to say to them. Overall, this can be a frustrating

time because communication will not always be a two-way street (Mayo clinic staff, 2013).


Strategies to cope/lessen communication barriers

Mandel and Shulman (1993) have participated in training programs designed to

maximize communication with the Alzheimer's patient. They believe that there are some

strategies that caregivers can use to better communicate with these patients while also decreasing

negative feelings on the parts of both caregiver and patient. This belief has been corroborated by

many other researchers. According to Mandel and Shulman (1993), caregivers who work with

patients that have dementia and Alzheimer’s know that they will have a hard time trying to

understand what the patient’s needs and wants are. As the disease worsens, so does the patient’s

communication skills. This could range from poor memory, “poor judgment, poor word finding

skills, poor comprehension of spoken and written material, poor expressive language skills,

verbal perseverations of words and ideas, poor topic maintenance, poor turn taking, poor

discourse skills, and general disorientation or confusion” (Mandel & Shulman, 1993). A patient

who has Alzheimer’s will need more time to take in information and to reply back to a caregiver

or loved one. Caregivers should try to speak loudly at times, not only because of the patients’

age, but also so the patients can understand what they are talking about. However, caregivers

should never yell at the patient because this can be considered insulting. It is important that the

caregiver not treat the patient as a child. The patient at times may not understand what the

caregiver is trying to communicate, but he or she can still understand the tone of voice a

caregiver uses. Talking in a condescending tone is considered disrespectful because it may seem

to the patient that they are not intelligent enough to understand what is being said. Additionally,

caregivers should never talk about the patients in front of them, as this is considered rude.

Although at times this can be somewhat hard to do, it is in the patients’ best interests (Mandel &

Shulman, 1993).


It is important for a caregiver to let the patient talk whenever they get the chance. This

can be hard on the caregiver, but allowing the patients to communicate more will give them a

better chance of expressing themselves. The patient may talk about their past; caregivers should

let the patient do so because it can help them to express themselves more and even lower their

anxiety (Mandel & Shulman, 1993).

It is a known fact that communication is the core of how individuals interact in the world.

When patients can no longer communicate properly, they are looked upon by other individuals as

“not normal.” Once Alzheimer’s patients can no longer communicate, they will eventually keep

to themselves; when a patient does this, it can lead to depression. If caregivers find that these

strategies are helpful, then they should use them. It is best to alter these strategies so that it will

best fit the caregiver and more importantly the patient. Once the caregiver can get the patient to

communicate, it can be easier on them later (Mandel & Shulman, 1993).

According to Small, Gutman, Makela and Hillhouse (2003), having an inadequate

amount of communication will cause problems for the caregiver and the patient. Some studies

have shown that caregivers find that communication is a huge problem for patients who have

Alzheimer’s disease. In addition, this lack of communication skills can affect both the caregiver

and the patient.

Small et al (2003) gave a survey to caregivers of Alzheimer’s patients to see where the

caregivers thought communication skills were lacking. All of the caregivers came to a conclusion

that there were six everyday activities that they found communication to be a problem in. These

include general conversation, talking on the phone, using the restroom, making an agenda,

looking for a particular item, and meal preparation.


One problem with having Alzheimer’s disease is that the patients’ functional abilities will

decrease over time and the patient will be faced with difficulty in communicating with

caregivers. The main cause behind this is that his or her daily living skills will have diminished

significantly. The main question is “what can be done to improve communication between

persons with AD and their caregivers?” (Small et al, 2003). There are some scientists who

believe that rehabilitation by helping assist with memory training can help the patient. However,

this strategy can only “help maintain certain functional and/or cognitive abilities” (Small et al,

2003). On the downside, this strategy only works for a short amount of time before the patient

returns to their original self.

Both nonverbal and verbal communication are important in everyday life, especially in

quality care. However, “the breakdown in communication between a person with Alzheimer’s

Disease and his or her caregiver leads to frustration” (Prism Innovations, 2001 ). It can

sometimes be stressful for a caregiver who is living with a patient who has Alzheimer’s because

at times the patient may not be able to recognize their caregiver. It is vital for a caregiver to

comprehend what the patient is trying to communicate so the caregiver can help them by all

means. All individuals are able to communicate verbally and nonverbally. Verbal

communication is defined as “an exchange of words or noises that express thoughts or emotions”

and nonverbal communication “consists of gestures, facial and body expressions, touch and tone

of voice” (Prism Innovations, 2001). A caregiver should be able to listen to what the patient has

to say because the patient will not always seem to make sense of what he or she is trying to

communicate. With this in mind, a caregiver should be able to identify key words and phrases

that do not seem logical to them. In the end the patient’s words can have more meaning than one

might realize. However, Alzheimer’s patients will at times not know how to use their


vocabulary; when this happens, communicating nonverbally becomes important. Furthermore,

patients who have this disease will not be able to understand what a caregiver or loved one is

trying to say to them verbally. For this reason, caregivers need to notice their own behavior and

what type of message it will send to the patient. It is also important that caregivers should be able

to analyze their patients’ body language (Prism Innovations, 2001).

To successfully communicate with an individual who has Alzheimer’s, one must have

“patience, understanding and good listening skills. There are many variations in the ways people

communicate when they are affected with Alzheimer’s. In the beginning, it might just be

repetition of words and forgetting or losing things. Later, as the disease progresses, it may be

more difficult to communicate and the patient will start communicating less due to the

frustrations. Many individuals who suffer from Alzheimer’s disease will end up struggling with

how they show the way they feel. These individuals will even have a hard time relating to other

people. There are many strategies that can help a patient who has Alzheimer’s to effectively

communicate with others. It is important to try to be compassionate to the patient and wait until

the patient is done with what they have to say. One may notice that the patient may have a hard

time communicating what they need or want. Reassuring them that everything will be fine can

help ease their worries. The best thing to do is to uplift the patients’ spirits and give them time to

gather what they are trying to say. A patient may state his or her opinion and the caregiver may

not agree with them; he or she should just switch to a different topic. Correcting a patient can

cause problems. What an individual should do instead is to listen and try to find out what the

patient is trying to communicate Sometimes repeating what the caregiver heard can also help the

situation(Alzheimer’s Association, 2014).


Next, when working with people who have dementia, caregivers should try eliminating

sufferers’ frustration through patience. If the caregivers know what the patients are talking about,

they should try to help them by paraphrasing. Sometimes caregivers or other individuals may not

be able to comprehend what the patient is trying to communicate. It is best to ask the patient to

give hints as to what they are talking about. It can also help to have the Alzheimer’s patients find

a nice, relaxing place where they can concentrate and gather their thoughts. Facial expressions

are key factors when dealing with Alzheimer’s patients because the words they are trying to

communicate are sometimes less important than the feelings such words are an expression of.

Caregivers should try finding out how their loved ones really feel when they start talking. There

are scenarios where the patients’ tone of voice and other non-verbal behaviors can give

caregivers or other individuals hints (Alzheimer’s Association, 2014).

According to the Alzheimer’s Foundation of America [AFA], n.d.), there are many

strategies that can help a patient who has Alzheimer’s interact with other individuals. Caregivers

or other individuals should notice Alzheimer’s patients’ body language and what they are trying

to express themselves. Patients can tell whether another individual is sad, happy, or angry by his

or her body language. Sometimes the patient may even copy what the other individual is doing.

For instance, a caregiver may seem agitated, and that negative energy may rub off on the patient.

The patient may copy what he or she sees and display the same emotion. For safety purposes it is

best that the patients are able to see and hear their caregivers when they are approaching them.

Caregivers should make sure that if the patients are required to wear glasses or hearing aids, they

are doing so. It may also be necessary that when patients communicate, it should be done in a

quiet atmosphere. When giving instructions to Alzheimer’s patients, one should make sure that

they can comprehend what they are being asked to do. It is best to give the patients one task at a


time. If one gives too many instructions to patients all at the same time, this may eventually

confuse them, which is a poor outcome. The patients may become irritable and not want to

continue doing the task. If this happens, it is okay to come back to it later on. It is important to

continue to talk to the patients even if they seem like they do not feel like talking. Caregivers

should try talking about subjects that are important to the patients and bring up familiar names of

their family and friends. Although it may seem like they are the only ones communicating, this

can show that they care about the patients enough to keep talking to them (Alzheimer’s

Foundation of America AFA, n.d.).

If healthcare workers can come up with solutions that can aid patients with their language

and communication skills, not only will the patients benefit, but so will their loved ones and

health care workers (Orange, Molloy, Lever, Darzins and Ganesan, 1994).

It is especially beneficial for patients who suffer from AD and their caregivers to have a

solid foundation of communication. The better the communication on the part of health care

staff, the happier the patients will be (Orange, Molloy, Lever, Darzins and Ganesan, 1994).

Bayles thinks that it is a good idea for Alzheimer’s patients and their loved ones to

complete a yearly assessment of communication, language, speech and hearing skills. This is

especially important for those individuals who communicate with Alzheimer’s patients on a

regular basis. She recommends that all caregivers need to allow Alzheimer’s patients and their

loved ones sufficient time to learn and understand certain materials and give written statements

for each strategy. It is best for caregivers to be allowed more time with the doctor and also

provided with printed material to go over later (Orange, Molloy, Lever, Darzins and Ganesan,

1994).


In conclusion, it is important for a caregiver to effectively communicate with

Alzheimer’s patients in an appropriate manner. A caregiver needs to be compassionate enough to

understand that the patient will have a difficult time communicating what he or she may need or

want. That is why it is important for a caregiver and patient to come up with certain strategies

that can help the patient successfully communicate with caregivers and loved ones. The

important thing is to enhance communication and reduce the occurrence of negative emotions.


References

AFA. (n.d.). Education and care: Comunication: Techniques. Retrieved from

http://www.alzfdn.org/EducationandCare/techniques_pr.html

Alzheimer’s Association. (2014). Retrieved from http://www.alz.org/care/dementia-

communication-tips.asp#ixzz35394cmr3

Darzins, P., Ganesan, R. P., Lever, A. J., Molloy, D. W., & Orange, J.B. (1994). Alzheimer’s

disease: Physician-patient communication. Canadian Family Physician 40, 1160-1168.

Gutfeld, G., Rao, L., & Sangiorgio, M. (1993, March). Speaking in steps: Walking may boost

communication in Alzheimer's patients. Prevention, 45(3), 24. Retrieved from Gale

Power Search Database.

Gutfeld, G., Rao, L., & Sangiorgio, M. (1993, March). Speaking in steps: Walking may boost

communication in Alzheimer's patients. Prevention, 45(3), 24. Retrieved from

http://go.galegroup.com/ps/i.do?id=GALE

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Gutman, G., Hillhouse, B., Makela, S., & Small, A.J. (2003). Effectiveness of communication

strategies used by caregivers of persons with Alzheimer’s disease during activities of

daily living. Journal of Speech, Language, and Hearing Research, 46, 353-367.

Mandel, E., & Shulman, M. D. (1993, September). Maximizing communication with the

Alzheimer's patient. Nursing Homes, 42(7), 36. Retrieved from Gale Power Search

Database.


Mayo clinic staff. (2013). Alzheimer’s: Tips for effective communication. Retrieved from

http://www.mayoclinic.org/healthy-living/caregivers/in-depth/alzheimers/art-20047540

National Institute on Aging. (2013). Advances in detecting Alzheimer’s disease. In 2011 – 2012

Alzheimer’s disease progress report. Retrieved from

http://www.nia.nih.gov/alzheimers/publication/2011-2012-alzheimers-disease-progress-

report/advances-detecting-alzheimers

NIH Senior Health. (2013). Alzheimer’s Disease. Retrieved from NIH Senior Health website:

http://nihseniorhealth.gov/alzheimersdisease/whatisalzheimersdisease/01.html

Prism Innovations. (2001). Chapter 2: Communication. In Coping with Alzheimer’s disease:

Learning resource guide. Retrieved from http://www.ec-online.net/CGE3/cad2.htm

Sambandham, M., & Schirm, V. (1995). Music as a nursing intervention for residents with

Alzheimer’s disease in long-term care. Geriatric Nursing, 16(2), 79-83.

http://nihseniorhealth.gov/alzheimersdisease/whatisalzheimersdisease/01.html

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