Eye to Eye Communication

All eyes were on fathers last Sunday as we celebrated Fathers Day. During Sunday worship which naturally focused on fathers, our pastor talked about what a great father his son is to Lake. When Lake misbehaves, his dad gets on eye level to talk to him. That eye-to-eye contact is key to dealing with inappropriate behavior.

Communication is a problem in any relationship, and can become a major challenge when your loved one has dementia. To keep the lines of communication open, you can develop a strategy to focus on the feelings and not the words.

Jim sometimes said just the opposite of what he meant. If he said, “It’s cold in here!” and he was sweating, I knew he meant “hot.” As the disease progressed, and aphasia silenced Jim, I learned to read his body language and facial expressions to communicate with him. If he cried, I didn’t assume he was sad, I knew he might be hurting.

Some strategies to help keep the lines of communication open with your loved one:

• Keep good eye contact as you speak.
  
  
• Use short simple words and sentences, but don’t use Elderspeak or baby talk. You are communicating with an adult who has a disease that affects his or her ability to process information.



• Pause to give your loved one time to process what you have said. Don’t expect a quick response, or even an appropriate one.



• Use gestures to reinforce your words. Early in the disease when Jim was still able to drive I learned to point left, rather than say “Turn left.”



• Tone of voice matters. When you speak in a sharp tone, the person may become anxious or combative. If you speak too rapidly or softly, they may not catch what you are saying.



• Validate the person’s concerns.

One night at the nursing home, I observed a perfect example of how a visitor helped calm a resident by validating his concerns.

The resident, Frank, fidgeted and his brow was wrinkled with worry. He wore his heavy winter coat and paced the hallway. “I need to find a way out of here,” he said. “I have to tend to my cows and put the horses up.”

A man who was leaving after a visit with another resident passed Frank in the hallway and apparently knew what worried Frank and made him restless in the evenings. He stopped and made eye contact with Frank, and patted Frank on the arm as he spoke, “Frank, I’m going to go by your house and feed your cattle and put the horses in the barn.”

Frank turned and headed back to his room. Relief made his walk lighter. “Whew!” he said, “I’m sure glad that is taken care of.”

Just like the father who used eye level communication to get his point across, you show respect by giving the conversation your full attention. You are not talking down to your loved one, but have opened up a line of communication that goes beyond words.

Copyright(c) June 2010 L.S. Fisher
http://earlyonset.blogspot.com

News from ICAD: Elderspeak Increases Resistance to Care

Researchers are not only trying to find a cure for Alzheimer’s, they want to improve quality of life and improve the standard of care for people with dementia. The results of an ongoing study released at the 2008 Alzheimer’s Association International Conference on Alzheimer’s Disease (ICAD) involves communication. Researchers used “Elderspeak” to define a communication method similar to a parent using baby-talk phrases such as, “Sweetie pie, it’s time for us to get up now” or “That’s a no-no!” This study validates what we caregivers knew all along: Our loved ones with dementia are adults and need to be treated with respect.

During the study, resistance to care was measured in relationship to dementia care unit staff’s communication with the residents. The communication styles were broken down into normal talk, elderspeak, and silence. The study shows that it is significantly more effective to talk to residents in normal conversation than elderspeak. Silence was neutral.

Jim developed aphasia early in his disease and we learned to cope with his diminishing grasp of spoken and written communication. In effect, my unscientific study spanned ten years. I never used baby talk, but it was perfectly acceptable for me to call Jim by endearments because I always had. In fact, one time when I addressed him as “Jim” in front of our kids, they both giggled because they had NEVER heard either one of us call the other by name. Yet, I know that once Jim was in the nursing home, he had to cringe when staff called him by an intimate endearment reserved for use by people who loved him.

When a person’s spoken language is limited, and they are ordered to do something in an unkind tone, or treated like a child, they will react in the only way they can—by resisting. This resistance is looked upon as “behavior” and reflects upon the resident rather than the staff.

Some states require dementia specific training with communication as one of the elements. The results of this study should be reason enough for long term care facilities to go above and beyond any state laws in improving communication between staff and residents. When a resident resists care, it is stressful for staff and increases the time required to complete a task.

Using respectful communication methods is a win-win situation whether your loved one is at home or in long term care. Proper training allows staff to perform at an efficient level, and residents will be more cooperative. Family caregivers can benefit from the knowledge that their communication style can greatly impact their caregiving success.


Source: Respectful Adult Communications Improves Quality of Care in Alzheimer’s at http://www.alz.org/. The study conducted by Kristine N. Williams, RN, PhD, and the University of Kansas School of Nursing was funded by the National Institute of Health.