When your loved one is living with the challenges of any type of cognitive impairment, he or she may have trouble understanding or being understood by you. It helps to know the obstacles you both face, and what can be done to overcome them.
A well-trained caregiver will have the awareness and empathy to make the difference.
“Cognitive impairment” is a loss of intellectual function, memory, thinking and behavior. It can be caused by a number of diseases or conditions, such as Alzheimer’s disease; multi-infarct dementia (a series of strokes); or head injury. It causes difficulty in communication, either in forming thoughts, finding the words to express them, or understanding what others are saying.
The caregiver may be able to help you understand more about the specific limitations you are dealing with.
Here are some factors that our caregivers are able to consider:
Short-term memory may be more severely affected than long-term memory. A person with Alzheimer’s disease, for example, may be able to converse about things that happened in the past, yet may not be able to recall things that happened or were said moments earlier. Memory loss may also cause a person to forget where they are or even who they are with.
The person may appear to be hallucinating or having delusions. This is a time to follow the recommendations of professionals involved in caring for the person. Often, it is best not to try to correct the person’s ideas or perceptions. Instead, focus on the associated feelings the person is experiencing. For example, a person sitting in the doctor’s office reception area may think she is at the airport; rather than repeatedly correcting her, you might say, “It’s getting to be a long wait, isn’t it?”
People with dementia may retain some communicating abilities. For example, someone who is unable to carry on a conversation may nevertheless be able to sing a song. Help the person discover and use his or her unique talents.
Emotions, which often play a big part in communicating, may produce unpredictable or inappropriate responses. If you are facing emotional or behaviour obstacles, discuss the situation with the person’s care professionals or other counsellor or support group.
The Role of Body Language
In advanced stages of cognitive impairment, when verbal skills become severely limited, body language becomes a more important tool for communicating. You or the caregiver may be able to read the other person’s emotions and reactions through body language. Watch the person’s face and body for changes and reactions. Is he happy, sad, calm, agitated? Can you pick up positive or negative reactions to a particular topic or activity?
Your own body language is important, too. Without saying a word, you can project your love and caring, and convey a sense of comfort and security. Here are some suggestions:
- To appear relaxed and at ease, sit in an open posture, with neither arms nor legs crossed.
- To show interest and involvement, lean forward a bit to show that you are listening.
- To avoid showing frustration or agitation, remember your own gestures and facial expressions.
What are some of the practical steps you or the caregiver can take to improve your visits or caregiving involving a person who is cognitively impaired? Here are five suggestions:
- Begin each visit or conversation by calling the person by name. Sit at their level, at a distance that seems comfortable, moving slowly to avoid startling them. Try to make eye contact before speaking.
- Speak slowly, clearly, and at a volume appropriate for the person’s hearing ability. Avoid shouting and overstimulation. Keep your messages short enough to fit the person’s attention span; use short, simple sentences.
- Give the person time to organize a thought and respond. Choose open-ended questions that allow a range of appropriate responses—ones that don’t have to be answered “yes” or “no” or with a specific fact. For example, “What did you do today?” is better than “Did you go out in the garden today?”
- If you have to repeat yourself, watch to see if it’s best to say the same words exactly as before (so there is only one message to process) or whether it is more helpful to paraphrase or simplify. Similarly, if the person is struggling for a word, is it helpful or frustrating to have you supply it?
- Sometimes it may be appropriate for you to just talk, gauging reactions through visual clues, even if your companion is unable to organize a response. Just listening to you speak can be a pleasure.
What it Means to Communicate
Think of “communicating” in broad terms. Conversation is not the only—or even necessarily the best—form of communication. A cognitively impaired person may derive enjoyment and a sense of connection just by listening to music or to someone reading, or by looking at books, photo albums, movies, or home videos.
And don’t overlook the power of touch. Reinforcing pleasant emotions with a touch to the hand or a hug can help the person you are visiting or caring for feel calm, happy, and loved. But again, watch the body language of the person to learn whether a hug or other form of physical contact is welcome and appropriate at a particular time.
Finally, don’t judge the success or value of your communicating in conventional terms. You can’t expect a person with Alzheimer’s disease or other cognitive impairment to follow the usual patterns of conversation. The person may not recall your last visit or even know who you are. But the time and effort you spend connecting with the person in the way that works for them and expressing your love in this patient way can provide important moments of comfort and enhanced well-being. After all, love and a commitment to caring are the ultimate messages you want to get across.