Caring for the cognitively declined individual

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An excerpt from A Caregiver’s Love Story.

My husband was diagnosed with cognitive decline in the last three years of his life. I was desperate for understanding and help and referred to the following source.

Here are ten tips for communicating with the cognitively declined individual from the website that I found very helpful:

Set a positive mood for the interaction. Speak in a positive, pleasant, and respectful manner. Use facial expressions, tone of voice, and physical touch to help convey your message and show affection.

Get the person’s attention. Limit distractions and noise. Turn off the TV and move to quiet surroundings, if necessary. Sit next to the person, make eye contact, and use non-verbal cues like touch to help keep the person focused.

State your message clearly. Use simple words and sentences. Speak slowly and in a reassuring tone. Don’t raise your voice. Lower it instead. If the person doesn’t understand, repeat the message in the exact words, and speak distinctly. If there is still no understanding, rephrase the question.

Ask simple questions. Ask one question at a time, those with a yes or no answer work best. Refrain from asking questions that give too many choices. Use visual prompts and cues to help clarify the question and guide the response.

Listen with your eyes, ears, and heart. Be patient while waiting for a reply. Give the person time to think of the answer, and then suggest words if you think you can help them find the word they are looking for. Always listen for meaning and feelings that might underlie the words.

Break down activities into a series of steps. Encourage your loved ones to do what they can. Gently remind them of steps they might have forgotten and assist with the steps they can no longer accomplish. Use visual clues to help the person remember.
Use distraction or redirect the person if they get upset. Change the subject or the environment if the person is distracted or upset. Let them know you are aware of their feelings. “I see you are a little distracted, I’m sorry, let’s go do something else.” Make it something they enjoy, like TV, music, or reading.

Always respond with affection and reassurance. A person with dementia may feel confused, anxious, and unsure of themselves, getting reality confused with the past. They may recall things that never occurred. Don’t correct them. Stay focused on the feelings they are expressing. Sometimes touching, hugging, and praise can reassure the person and help them respond appropriately.

Remembering the good old days. Remembering the past is often soothing to the patient, the times when they were the happiest.
Remembering what happened forty-five minutes ago will be hard, but remembering what happened forty- five years ago is much easier for them. Try and avoid questions that rely on short-term memory.

Maintain a sense of humor. Use humor when you can, but don’t make fun of the person or use humor at their expense. People with dementia often are delighted to laugh along with you.

I’d like to add one more personal item to this list.

Don’t take offense at some of the things that are said by someone suffering from cognitive decline. Sometimes things come out of their mouth without any thought. These can be rude, thoughtless things they would never have said in the past, like my husband’s comment to the doctor that I didn’t want to take him home because I wanted to have my boyfriend over.

My husband constantly lived in the past. He had a great career and a great time growing up, and much of what he remembers is of his childhood, life with his mother, law school, and his work. Very few memories were of our life together, and I don’t seem to be a part of any his memories. I mentioned this to him one day, “Your memories don’t seem to include any of the wonderful things we have done in our life together.” He looked at me in total shock, “What, I don’t? Maybe it’s because you are still here and take care of me.” I had no response, but it did make him think. It didn’t change anything. He still only talked about the old memories before I knew him, unless it was our anniversary and we talked about the arch in the backyard swaying in the wind. At least he still has good memories of that special day.

Another odd thing that has happened with Bill’s memory failing is he didn’t turn out any lights anymore. If I left my office to check on him while he was resting, I would find the kitchen, dining room, and living room lights were left on after he was in those rooms. This happens a lot during the day, the lights don’t even need to be on, but he seems to turn them on every time he walks into a room. I would walk through the house and turn them off and go back to what I was doing. If I mentioned this to him, he wouldn’t remember he had turned them on, and it just wasn’t necessary to bother him with the issue.

Nancie Wiseman Attwater is the author of A Caregiver’s Love Story.


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