My grandmother, who is 92, recently reported that she’d seen three giraffes in her Midwest backyard. She is otherwise sharp (and also kind and funny), but the giraffe episode was further evidence of the mild cognitive impairment that has been slowly creeping into her life.
The question for my family has become: How should we respond?
Communicating with a family member who has cognitive impairment can be frustrating and disheartening, even downright depressing for patient and caregiver alike. And it’s a problem faced by a growing number of Americans. According to a recent report, about 1.4 million Americans have dementia. As baby boomers reach old age, these numbers are expected to increase dramatically.
A number of techniques can help reduce the frustration and also create new ways of connecting. Among the most effective and popular among experts is the “validation method,” a practice pioneered by geriatric social worker and researcher,Naomi Feil in the 1980s.
As its name suggests, the practice is based on the idea of validating a patient’s experience – to empathize, even if what the person is expressing doesn’t seem to make sense.
In my grandmother’s case, that might have been to ask how tall the giraffes were or how she felt upon seeing them.
“You match her emotions,” Feil says. You communicate that you “know that it’s real and meaningful for her, that she’s not psychotic or hallucinating.”
Strategies for talking to people with dementia are not so different from effective listening techniques. Jo McCord, a family consultant for the Family Caregiver Alliance in San Francisco, suggests imagining yourself in your loved one’s position. Using these strategies may help:
Don’t argue: “Arguing with them is very damaging to their self-esteem,” McCord says. “Depending on where someone is in the disease, use a different vocabulary. Adapt your behavior to accommodate theirs.”
Patients with dementia can sometimes experience angry outbursts. Center yourself, Feil suggests, and then look closely at the person: Observe her eyes, her facial muscles, anything to distract you from your own reaction. Then try to rephrase what the person has said. “Pick up their emotion,” Feil says. “Reflect it. Then you have some communication.”
Caregivers can be hurt and confused by accusations that they have stolen or hidden a patient’s belongings. Often, these items symbolize some other aspects of the person’s life. Feil suggests that, in these cases, patients are really saying, “‘I’ve lost my youth, my husband, my money, my power, my control.’ It’s a coping method, blaming others.”
Feil says the temptation is great to say anything just to get the person to stop, but doing so can be patronizing and at some level the patient will understand that this is what is happening.
Instead, Feil recommends listening and allowing emotions to be expressed. Try reminiscing about the object, the time or place or people it represented.
Calm yourself: If you are feeling frustrated with your loved one, take a minute, Feil says, and more. Just go up and down the stairs (if you can), or do something else physical to release your own tension. Feil advises family members to “center,” by focusing on their breathing. Breathe in through the nose, she says, count to eight, and then exhale. Repeat six times.
In addition, she recommends finding someone to talk to, perhaps by joining an Alzheimer’s support group. Not talking about what is happening, Feil says, can lead caregivers to “blow up and not be able to use any of these techniques.”
Reframe: In the case of the patient who repeatedly asks a question, Feil suggests you first “imagine the opposite.” If the patient keeps asking what time we’ll leave for an event, for instance, ask, “What will happen if we don’t? Are you worried? Do you think we’ll be late?” This may allow you to detect what’s causing the anxiety. Once you understand what the worries are, you can try to ease or dispel them.
If you are at a loss trying to respond to a patient who simply wants to “go home,” ask specific questions. “Where would you like to go?” Feil suggests. “Whom would you want to see the most? What would you do first?” If your loved one is disoriented about a long-dead loved one, ask, “When did you last see him? What did he say to you?”
Pick up on nonverbal cues: “Sometimes, as cognitive thinking abilities become compromised, the person becomes more attuned to body language and picks up on [your] stress or irritation,” says Lisa Snyder, a social worker at the Shiley-Marcos Alsheimer’s Disease Research Center at the University of California at San Diego and author of “Living Your Best With Early-Stage Alzheimer’s.”
In advance stages of the disease, when people have lost their ability to communicate, Feil urges families to turn to music and touch.
“It’s so important to know that people with dementia aren’t infants; they’re not their disease,” Snyder said. “They are people with needs, and you can communicate with them. You need to go where they are; they won’t come to you. Their world makes sense to them, and they often are very creative. The idea in validation is to keep communicating with the person, wherever they are. [pulled out by ARC from The Baltimore Sun. June 13, 2013]