Setting Communication Goals By Stage

As a loved one’s Alzheimer’s progresses, it’s important to reassess care. When a person enters mid- or late-stage Alzheimer’s, the way you communicate with her/him will need to change. More skill may be needed to convey messages clearly and establish mutual understanding. It’s important to remain flexible and aware of how effective different techniques work, or not, in different situations.

A key part of this is assessing where your loved one is in terms of communication ability and setting goals.

In the early stages, the goals of communication are: 1) to maintain as near to normal communication and interactions as possible, and 2) keep the person socially engaged. In some ways, these are relatively easy goals to achieve, because the main communication problem involves word finding.

When you start noticing changes in communication or are supporting a person with a new diagnosis in early stages, here are a few tips to keep in mind around communication:

  • Maintain eye contact.
  • Don’t speak as if the person wasn’t there.
  • Ask questions, especially if your loved one is frustrated trying to find the right words.
  • Mirror their words back or use observations such as “You seem thirsty.” or “It seems like you’re anxious.”

In the middle stages, a person with Alzheimer’s may be unable to remember the right word, repeat themselves, or forget what you are talking about. So, your goals are likely to be: 1) maintain a shared pattern of communication through turn-taking and other social norms, and 2) keep a two-way flow of communication going.

As disease progresses, a person with Alzheimer’s may have greater trouble expressing themselves, forget recent events, or talk less. Here are a few tips to reinforce your connection and help your loved one navigate these changes to communications during mid-stage Alzheimer’s.

  • Face your loved one and stand or sit at their level.
  • Reduce noise and distractions when having a conversation or giving directions.
  • Use simple phrases and reinforce with hand gestures. Stay focused on a single topic and when giving directions, communicate one at a time.
  • Repeat nouns instead of using pronouns.
  • Give the person time to comprehend and respond.
  • Try to ask easy questions, e.g., “Would you like a sandwich?” instead of “What would you like for lunch?” If there are choices, limit the number of choices to two if possible.

In late stages, the goal is to maintain communication by emphasizing non-verbal techniques. It can be frustrating or sad to see your loved one struggle with understanding words or appear to live in the past.

In late-stage Alzheimer’s, your loved one will likely face serious challenges communicating verbally. Here are several tips to help you adjust your communication style to provide comfort and reassurance:

  • Face your loved one and stand or sit at their level.
  • Try to reduce nearby distractions and noise
  • Use pleasant facial expressions and tone of voice, pictures, hand signals, and pantomime to convey your message.
  • Acknowledge their emotions with words matching the emotional expressions that the care recipient displays — e.g. “You look worried”.
  • Reminisce about memories to distract the care recipient to reduce her/his distress.

Learn more communications tips and strategies in the Alzheimer’s Caregiver Guide.

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