Communication With Alzheimer’s Patients

By learning to improve communication with your loved one who has Alzheimer’s you can reduce stress in your life and improve the quality of the relationship with your family member. A good place to begin is by remembering that communication is always a two-way street. You are sending information signals to another person while at the same time receiving signals from the other person. Improving communication means not only changing what you say and how you behave but also doing a better job of translating the sometimes confusing signals sent by patients with Alzheimer’s, for whom language skills have declined. It is also useful to remember that the quality of an exchange with an Alzheimer’s patient is influenced by the context and by the emotions that come into play on your part as well and as on the part of your loved one. They will not only hear what you say, they will also read your face and when the signals do not match you may elevate the confusion level. So it is essential that we set a positive mood or any communication. You need to know what you are feeling so that you can in ensure that your body language and facial expression as well as your tone of voice send the right message. In this course you will learn how to improve your communication, based on the vast experience of many professionals who have worked with Alzheimer’s patients over many years.

Early versus Late Onset Alzheimer’s

There are some important differences between early onset and late onset dementia of the Alzheimer’s type, that influences the likely results of improving communication. With early onset, disorientation begins between the ages of 50 and 70 years of age. With late onset disorientation begins usually past the age of 80. In early onset, the disease is progressive and in the end leads to death. In late onset the pattern is not always progressive and does not always end in death. Speech declines in an early onset while in late onset speech remains largely intact. Walking is often stiff and robot like in early onset and is more dance like and purposeful in late onset. In late onset, facial expression and overall emotional expression is highly varied. Whereas in early onset, there is a mask like expression and very little emotion. More importantly with in early onset there is less and less expression of emotions while in late onset, the patient expresses a full range of both positive and negative emotions. Improvement in our knowledge of communication styles and methods are more likely to achieve positive results with late onset than with early onset. However it is important to keep in mind that, although many of these methods were developed with Alzheimer’s patients, they can be of benefit with other types of dementia. Trying to improve communication patterns with early onset patients can be beneficial but will require greater patience.

Naomi Feil and Validation Therapy

Naomi Feil was the creator of a unique approach to working with patients with Alzheimer’s and other related disorders. Her approach has come to be called Validation Therapy. She is the Executive Director of the Validation Training Institute in Cleveland, Ohio. She earned her MSW from Columbia University and has studied at the new school for Social Research, Case Western Reserve University and the University of Michigan. Early in her work as a gerontologist she became dissatisfied with traditional methods and thus began to develop methods of her own to improve success. Her book the Validation Breakthrough: Techniques for Communicating with People with Alzheimer’s type Dementia was a major development in improving care for these patients. She is now internationally recognized and more than 7000 facilities in Europe, the United States, Canada and Australia have adopted her methods. Those methods now are being taught to families and we will introduce those methods in this course. The best way to begin is by defining validation, which is acknowledging and accepting the emotional reality of another person in a nonjudgmental way. We are not requiring that they adopt our reality, rather we are trying to better understand their view, even if that view is influenced by illness. The two active words in the definition are acknowledging and accepting. Acknowledgment is required in order to communicate understanding and acceptance is required in order to avoid being judgmental.

Quality of Life in Long Term Care

The overriding goal in long term care should be to improve the quality of life for residents and a major feature of quality living is psychological well-being. There are two sets of factors that must work hand-in-hand to produce psychological well-being. One is the quality of care provided. These are the processes of care that are the focus of most quality programs. Another set of factors, however, too often ignored are the quality-of-life factors that take into account what the residents actually bring to the equation. For example, coping patterns help residents preserve their individuality and spite of declining health. We will apply a developmental theory called selective optimization and compensation and discuss how a greater understanding of how older people adapt to the changes of aging can serve to refine quality of care strategies. Research in Positive Psychology suggests at least 16 specific factors that seem to influence a resident’s is subjective sense of well-being.

Quality Care and Quality of Life

In many cases quality care patterns have a direct impact on resident quality of living. A safe and timely pattern of care with can lead to a sense of security. Technically proficient healthcare can lead to optimal health and increased levels of functioning. Personal attention and individualized care programs that engage the individual in their own care lead to a sense of autonomy and self-determination. Patterns of care which are respectful of individual needs and values into affirm personhood and reinforce the continuity of the self concept. A higher-quality life comes from recognition by caregivers of individuality as does respect by caregivers to the right to privacy. Even for dementia patients there needs to be continuity with the past and respect for the continuation of social roles important to the individual earlier in life. People are not constituted in a way that allows them to lie in bed hour after hour, day after day, week after week, month after month as the months turn into years. An environment must provide opportunities for activities appropriate to age and skills no matter what the disability.

Preservation of the Self

Sheldon Tobin in his book Preservation of the Self in the Oldest Years points out that those who design and long-term care must take into account the way older people, particularly those over the age of 85, strive to cope with the stress of changes that threaten their sense of self. He divides the coping methods into two classes: rational coping techniques in less than rational coping techniques. The preservation of the sense of self is served by ensuring residents are involved in affirming meaningful activities. They need to have at least a measure of control over daily activities and over social interactions. In too many nursing homes neither of these is the case. He points out that successful coping with the challenges of advanced age involves a contraction of one’s personal space, sense of time and the numbers of people with whom one has significant relationships. However contraction cannot mean elimination and providers of care in LTC must realize this. For example, a couple may have traveled widely and sailed all along the East Coast in earlier years but now must confine their travel to radius 60 miles from their assisted living facility. But travel they can. At the age of 30 that are decades of future ahead at the age of 85 the future is a matter of years at best. In earlier years a person may associate with hundreds or even thousands of people but in the older years associations may be restricted to family and only the closest of friends. Such constrictions are appropriate ways to cope. However, Tobin also points out that are less rational coping techniques. The older person may deny reality completely. Is as an example they may continue to believe in their driving ability well beyond the point at which they should recognize this limitation. Under stress the older person may become more aggressive because this gives them the illusion of continued control. When that is the case punishment of the aggression only leads to more aggression. The older person may blame others for things other than admit to themselves that they are vulnerable. There’s no better example of this in the dementia patient who blames thievery by staff for items they have misplaced or lost. In short older people will go to great lengths to protect their sense of self.

Psychological Well-being in Long Term Care

Psychological well-being is a subjective point of view defined as person’s cognitive and affective evaluation of life. The dimensions of well-being include a balance between positive and negative affect. Affect is a psychological term for emotions. Negative affect involves such emotions as anger, fear and depression. On the other hand positive emotions include such things as joy and happiness. How much time in any given day we spend feeling depressed needs to be balanced with time feeling happy. If more of our day is filled with positive emotions than with negative we have a sense of subjective well-being. Well-being is also dependent on how well we meet our fundamental human needs. That includes basic needs like food, shelter and safety. There can be no sense of positive well-being if we feel hungry or fear for our safety. However, given that those needs are met higher level needs like autonomy and self-esteem become important to our sense of well-being. It also seems very important to our sense of well-being that we have a purpose. For the oldest among us it is just as important to have goals even though it may be necessary to limit those goals as we age. Careers are behind and there is increasing limitation on the pursuit of wealth. However, those with a sense of positive well-being continue to set goals and pursue those goals. Activities also seem very important as dimensions of psychological well-being. There may be some constriction in the options available; however, activities within the framework of current skills can make a great difference. For example, one patient of mine in a nursing home and only the use of his upper body. However, to help of his family he arranged an entire world all within the reach of his own arms. Finally, optimism and hope are essential elements for a positive sense of well-being.

Paul Baltes of the Max Plank Institute for Human Development in Berlin and his wife Margaret Baltes of the Free University of Berlin have conducted extensive research on what they characterize as ‘Successful Aging’ and they have proposed that success is in part dependent on the selection process in which strengths are optimize in older people learn to compensate for losses in appropriate ways. For example, they become more discriminating in the choice of activities while which to spend their time and energy. Interactions with family become increasingly important in that may restrict themselves to a few real friends other than a large number of acquaintances. Optimization involves building resources needed to cope through self-education and continued learning. For example memory skills training can help in compensating for some of the losses that are associated with aging. Compensation involves doing whatever is needed to mitigate limitations and losses. Visually impaired older people use reading machines which magnify the written word. If they cannot read that can begin to listen to audio books. To avoid falls they can learn to use a walker, a wheelchair or a cane. To the extent that quality care processes facilitate selective optimization and compensation residents in long term care are more likely to experience a positive sense of well-being in spite of losses.