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A common comedy sketch has someone trying to communicate with a person who speaks another language. The joke is that they speak slowly or loudly. No matter how slowly or loudly you speak, you aren't going to get through to someone if they don't speak your
language!
Communicating with cognitively limited older adults (e.g. those who have suffered a stroke, have various forms of dementia, etc.) can be similar. It's often not a matter of just speaking loudly or slowly. It's learning the skills of how to speak in a way they can understand. I've learned this personally since my mother was diagnosed with Alzheimer's in 2007. I've worked on life course, learning, communication and aging issues for many years; now she is my greatest teacher, bringing a profound new level of understanding to my work.
Here are some tips for communicating with cognitively limited older adults:
Begin a conversation with orienting information. Identify yourself by name, if necessary, and call the other person by their name. Then say something like, "I'm here to visit with you." Reduce distractions to minimize the person's confusion – noise (e.g. phones ringing, people talking, even street traffic), crowding, glare, unrelated activity, etc. Even moderately impaired people can "overload" from too much distraction and may withdraw, have outbursts, or attempt to leave. Be aware of how you're presenting yourself. Are you angry, tense, or frowning? Older adults can be extremely sensitive to nonverbal signals like facial expression, body tension, and mood. If you make a point of being relaxed and smiling a lot, the other person is more likely to respond in the same way. Touch and emotional tone are important. Take a calm, gentle approach. Reach out and make physical contact at appropriate times during a conversation (e.g. touching a person's hand in a comforting way). It's important to be at eye level with the person you're talking with, especially if they also have physical impairments like hearing loss. Look directly at them when you speak, and make sure you have their full attention. Use your normal conversational tone, but take into account any hearing impairment (e.g. favor good ear). Speak slowly, articulating each word. Use simple, straightforward sentences. Be clear, but not patronizing. Take your cues from the other person to determine what they do and do not understand. If necessary, slowly and calmly repeat a statement. It may take several repetitions before the person understands you. Supplement words with nonverbal gestures to reinforce or explain your message. Be patient. You need to allow time for the older adult to absorb, understand, think, and respond. The capacity to understand is usually greater than an older person's ability to express themselves verbally. Don't put a lot of emphasis on expecting answers to your questions, like "Tell me about your day?" or "What did you have for lunch?" Instead, provide them with information. When you do ask questions, ask one at a time. Start by asking questions simply, in a way that requires only a "yes" or "no" answer. If a person is able to communicate more, they will, and you can adjust accordingly. Use statements that emphasize the "here and now" (e.g. "I like your sweater"). At the same time, linking to the past can evoke fond memories and help structure a visit (e.g. looking through old photos). Respectful, polite listening is often what people want most. They may seem to be rambling, but even the attempt to communicate with you is a good sign. Respond not only to their words, but also to their emotional tone. You can acknowledge a feeling by saying something like, "You sound very sad." If you don't understand something the person says, apologize and ask them to repeat it. Try to focus on a word or phrase you do understand and build on it. If you make a guess, phrase your guess as a question to help minimize frustration (e.g. "Are you saying that you like my ring?"). Be prepared that not everything the person does and says will "make sense." For example, a person may ask if you like the hat they're wearing when they're not wearing a hat. You can smile respectfully and move on to talking about something else. Be aware of changes in mood or behavior during a visit and adapt accordingly. If a person becomes upset or angry, don't try to reason or argue with them. It will only make the situation worse. The person may no longer have the ability to be logical or rational. Try cheerfulness, humor, or distraction to politely move on to something more positive. Ignore a verbal outburst if you can't think of any positive response. To minimize everyone's frustration, focus on what the person can do instead of what they can't do. For example, if a person wants to go outside and it's winter, suggest looking through a magazine together. You don't need to fill every moment with conversation. Just sitting and looking out the window can be enough. There are many ways to communicate – familiar songs, favorite foods, holding hands, walking. Respect the person for the adult individual they are. And remember that even someone with serious memory loss can still enjoy the moment. A compliment, shared joke, or caring smile makes everyone feel good.
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