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  1. #1

    Compassionate Communication with the Memory Impaired

    The following piece was posted a while ago on TP and made a big impression on me. It is something I have referred to time after time and tried hard to follow.

    We have many new members who may not have seen it before. Yesterday I posted it on another Thread but thought it might be helpful if it had a Thread of it`s own.

    It`s a tall order but an excellent guideline.


    Compassionate Communication with the Memory Impaired

    by Liz Ayres
    A Volunteer of the Alzheimer's Association and Former Caregiver

    DON'T
    Don’t reason.
    Don’t argue.
    Don’t confront.
    Don’t remind them they forget.
    Don’t question recent memory.
    Don’t take it personally.



    DO
    Give short, one sentence explanations.
    Allow plenty of time for comprehension, then triple it.
    Repeat instructions or sentences exactly the same way.
    Eliminate 'but' from your vocabulary; substitute 'nevertheless.'
    Avoid insistence. Try again later
    Agree with them or distract them to a different subject or activity
    Accept blame when something’s wrong (even if it’s fantasy).
    Leave the room, if necessary, to avoid confrontations.
    Respond to feelings rather than words
    Be patient and cheerful and reassuring. Do go with the flow.
    Practice 100% forgiveness. Memory loss progresses daily.
    My appeal to you: Please.elevate your level of generosity and graciousness.



    Remember

    You can’t control memory loss, only your reaction to it. Compassionate communication will significantly heighten quality of life.

    They are not crazy or lazy. They say normal things, and do normal things, for a memory impaired, dementia individual. If they were deliberately trying to exasperate you, they would have a different diagnosis. Forgive them ... always. For example: they don’t hide things; they protect them in safe places... And then forget. Don’t take ‘stealing’ accusations personally.

    Their disability is memory loss. Asking them to remember is like asking a blind person to read. (“Did you take your pills?” “What did you do today?”) Don’t ask and don’t test memory! A loss of this magnitude reduces the capacity to reason. Expecting them to be reasonable or to accept your conclusion is unrealistic. (“You need a shower.” “Day care will be fun.” “You can’t live alone.”) Don’t try to reason or convince them. Give a one sentence explanation or search for creative solutions. Memory loss produces unpredictable emotions, thought, and behavior, which you can alleviate by resolving all issues peacefully. Don’t argue, correct, contradict, confront, blame, or insist.

    Reminders are rarely kind. They tell the patient how disabled they are – over and over again. Reminders of the recent past imply, “I remember, I’m okay; you don’t, you’re not. ”Ouch! Refer to the present or the future. (If they’re hungry, don’t inform them they ate an hour ago, offer a snack or set a time to eat soon.) They may ask the same question repeatedly, believing each time is the first. Graciously respond as if it’s the first time. Some days may seem normal, but they are not. They live in a different reality. Reminders won’t bring them into yours. Note: For vascular dementia, giving clues may help their recall. If it doesn’t work, be kind ... don’t remind.

    Ethical dilemmas may occur. If, for instance, the patient thinks a dead spouse is alive, and truthful reminders will create sadness, what should you do? To avoid distress, try these ways of kindness: 1) distract to another topic, or 2) start a fun activity, or 3) reminisce about their spouse, “I was just thinking about ______. How did you two meet?” You might even try, “He’s gone for a while. Let’s take our walk now.”

    Open-ended questions (“Where shall we go?” “What do you want to eat/wear/do?”) are surprisingly complex and create anxiety. Give them a simple choice between two items or direct their choice, “You look great in the red blouse.”

    They are scared all the time. Each patient reacts differently to fear. They may become passive, uncooperative, hostile, angry, agitated, verbally abusive, or physically combative. They may even do them all at different times, or alternate between them. Anxiety may compel them to shadow you (follow everywhere). Anxiety compels them to resist changes in routine, even pleasant ones. Your goal is to reduce anxiety whenever possible. Also, they can’t remember your reassurances. Keep saying them.

    Examples

    Don’t reason

    Patient What doctor’s appointment? There’s nothing wrong with me.”
    Don’t (reason) “You’ve been seeing the doctor every three months for the last two years. It’s written on the calendar and I told you about it yesterday and this morning.”
    DO (short explanation) “It’s just a regular check-up.”
    (accept blame) “I’m sorry if I forgot to tell you.”

    Don’t argue

    Patient “I didn’t write this check for $500. Someone at the bank is forging my signature.”
    Don’t (argue) “What? Don’t be silly! The bank wouldn’t be forging your signature.”
    DO (respond to feelings) “That’s a scary thought.”
    (reassure) “I’ll make sure they don’t do that.”
    (distract) “Would you help me fold the towels?”

    Don’t confront
    Patient “Nobody’s going to make decisions for me. You can go now ... and don’t come back!”
    Don’t (confront) I’m not going anywhere and you can’t remember enough to make your own decisions.”
    DO (accept blame or respond to feelings) “I’m sorry this is a tough time.”
    (reassure) “I love you and we’re going to get through this together.”
    (distract) “You know what? Don has a new job. He’s really excited about it.


    Don’t remind them they forget
    Patient: “Joe hasn’t called for a long time. I hope he’s okay.”
    Don’t (remind) “Joe called yesterday and you talked to him for 15 minutes.”
    DO (reassure) “You really like talking to Joe, don’t you?”
    (distract) “Let’s call him when we get back from our walk.”



    Don’t question recent memory

    Patient “Hello, Mary. I see you’ve brought a friend with you.”
    Don’t (question memory) “Hi, Mom. You remember Eric, don’t you? What did you do today?”
    DO (short explanation) “Hi, Mom. You look wonderful! This is Eric. We work together.”



    Don’t take it personally!

    Patient “Who are you? Where’s my husband?”
    Don’t (take it personally) “What do you mean – who’s your husband? I am!”
    DO (go with the flow, reassure) “He’ll be here for dinner.”
    (distract) “How about some milk and cookies?” .. Would you like chocolate chip or oatmeal?



    Do repeat exactly

    Patient "I'm going to the store for a newspaper."
    Don’t (repeat differently) "Please put you shoes on."
    "You'll need to put your shoes on."
    DO (repeat exactly) "Please put your shoes on."
    "Please put your shoes on."



    Do eliminate "but", substitute "nevertheless"
    Patient "I'm not eating this. I hate chicken."
    Don’t (say "but") "I know chicken's not your favorite food, but it's what we're having for dinner."
    DO (say "nevertheless") "I know chicken's not your favorite food, (smile) nevertheless I'd appreciate it if you'd eat a little bit."

    Used with permission from Ellen Warner at Ageless Design
    __________________
    __________________

    As per requests from members: the original source of this information is here

    http://www.agelessdesign.com/Library/InfoManage/Zoom.asp?InfoID=296&RedirectPath=Add1&FolderID=104 &SessionID={F6D6DF4E-D924-452C-9E03-21D0E8CA0183}&InfoGroup=Main&InfoType=Article&SP=2

    Last edited by jenniferpa; 22-04-2011 at 12:15 AM. Reason: Adding link to source.

    Sylvia

    Former Carer and Volunteer Moderator .

    I cried because I had no shoes until I met a man who had no feet

    About me

  2. #2
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    Cool Thanks Sylvia

    Here is the link & reference

    http://www.agelessdesign.com/Library/InfoManage/Zoom.asp?InfoID=296&RedirectPath=Add1&FolderID=104 &SessionID={279A307F-4B93-4B0C-ACDD-0FC25BB149FD}&InfoGroup=Main&InfoType=Article&SP=2

    Won't come up as hypertext - you'll have to cut & paste the linkto see the original

    Ayres, Liz, (2001) Compassionate Communication with the Memory Impaired. Alzheimer's Daily News (2001) Summer, Volume 16.

    Last accessed Today!

    Thank you Liz Ayres where ever you are: volunteer with the US Alzheimer's Association and former caregiver
    Sue, wife and carer
    "one knows that there is still a self to be called upon, even if music, and only music, can do the calling"
    Oliver Sacks (2007)

  3. #3
    Thanks Sue. xx

    Sylvia

    Former Carer and Volunteer Moderator .

    I cried because I had no shoes until I met a man who had no feet

    About me

  4. #4
    Volunteer Moderator
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    I'v has a quick look and will print it out later. I think there are many lessons there for me. Thanks. x
    Izzy
    Carer and Volunteer Moderator

    ABOUT ME.

    'The best things in life are nearest: Breath in your nostrils, light in your eyes, flowers at your feet, duties at your hand, the path of right just before you. Then do not grasp at the stars, but do life's plain, common work as it comes, certain that daily duties and daily bread are the sweetest things in life.'
    Robert Louis Stevenson

  5. #5
    So well written, not only for the person with memory impairment but also for the carer.

  6. #6
    I wish I had seen that when David was alive and living at home
    I think I must have done all the 'DON'Ts'
    Sue
    Wife and former Carer


    You don't appreciate what you had until it's gone!

  7. #7
    Sorry Sue.

    It`s so hard to remember to re-post this kind of information. I have no idea when it was last posted. I tried a Search but couldn`t find it.
    It really should be posted at least once a year.

    Sylvia

    Former Carer and Volunteer Moderator .

    I cried because I had no shoes until I met a man who had no feet

    About me

  8. #8
    I haven't seen it before and it make me realise that I am breaking almost all the rules.

    I do have an issue that this would work with certain types of dementia, namely Vascular. Some days Mum won't know who I am or how old she is, other days she is 75% there and got very aggressive when I tried these answers.

    Lemony xx


    When life gives you lemons make lemonade.

  9. #9
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    Thanks for that. Am printing it, will try and act it. I know I fall far short of it, over and over: losing patience with Mother, asking her to remember things, complaining when she asks the same question I answered 2 minutes ago, etc. Pam

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    Cool

    Hi Syvia that was so good to read, you are spot on with it all. you have such understanding about haw it feals to have this illness. i have a big white bourd in my frount room sating " please dont be angry if i forget." no one reads it but if i feel anger fron someone i tell them to read the bord. if everyone who cares for people were more like you it would be a perfect world. love miss cool.xxxxxxxxxxxxx

  11. #11
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    Thank you for this.I have printed it off for my husband and I to refer to.I think we so far have managed all the don'ts
    Reading the bit about being scared all the time has made sense of something for me. My Mum has a lot of tummy upsets these days. Before she had dementia she always got a tummy upset if worried or afraid about something. It explains why we are having so many upsets now if she is always feeling scared. I shall mention it to the CH next time I visit as they won't know about the connection between her nervy disposition and the tummy troubles.

  12. #12

    Dear miss cool

    Thank you for the compliment but I am not the author of Compassionate Communication, just the messenger. xx

    Sylvia

    Former Carer and Volunteer Moderator .

    I cried because I had no shoes until I met a man who had no feet

    About me

  13. #13
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    Quote Originally Posted by miss cool View Post
    Hi Syvia that was so good to read, you are spot on with it all. you have such understanding about haw it feals to have this illness. i have a big white bourd in my frount room sating " please dont be angry if i forget." no one reads it but if i feel anger fron someone i tell them to read the bord. if everyone who cares for people were more like you it would be a perfect world. love miss cool.xxxxxxxxxxxxx
    What a brilliant idea miss cool! We all need reminding to be more patient with each other.

  14. #14
    I must say a lot of the compassionate communication is also in the Specal book.

  15. #15
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    Personally, given Mum's back history of depression and chronic fatigue, I have found Compassionate Communication a lot more useful than SPECAL.

 

 

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