Compassionate Communication with the Memory Impaired

MaryH

Registered User
Jun 16, 2016
120
0
Ottawa, Canada
okay.. The link on page 1 does not work but have email the compassionate communication to myself. Being trained as an engineer, more on factual but they are in the don'ts..
 

elkmaster

New member
Dec 22, 2017
1
0
This is very helpful indeed. Me, the son and my mother's partner have made a lot of these mistakes...we have not meant to!
I am gonna print this off and hopefully change the way we communicate with my mum. She and her partner are always arguing and he always seems to start a sentence with a question and rambles on...they are both 80s.
I have tried talking to him gently about it and he says 'yeah yeah', but might not be able to change behaviour/adapt.
I get frustrated when I hear it but can't say much as it would cause a row and he would say I was bullying him.
My Mum says hurtful things sometimes and hard not to take it personally but most of the time I don't.
Will try the above cues/techniques to stear the conversation to another topic.
I am glad of this forum as want my mum to be in as much peace as possible throughout this dreadful illness.
Kind regards
elkmaster
 

Grannie G

Volunteer Moderator
Apr 3, 2006
81,443
0
Kent
Hello @elkmaster Welcome to the forum.

I'm pleased you've found something to help . Even though it will be difficult to follow at all times it is still good advice.

I think we sometimes realise how inappropriate attitudes are when we hear them from others rather than ourselves. It is a very steep learning curve and some of us only realise when it is too late.

Please start your own thread if you wish , on the sub forum I care for a person with dementia.

https://forum.alzheimers.org.uk/forums/i-care-for-a-person-with-dementia.70/

This way you will find it easy to access all your replies and support.
 

DaisyCat

Registered User
Dec 2, 2017
79
0
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: another source of this information is here

http://www.alz.org/greaterdallas/documents/CompassionateComm.pdf
Thank you for posting this! I really need to work on the DON'TS!
 

Grannie G

Volunteer Moderator
Apr 3, 2006
81,443
0
Kent
Thank you for posting this! I really need to work on the DON'TS!

Its a very tall order especially for 24/7 primary carers who need to be angelic to comply with the full piece. However it is a very good rule of thumb and something we can all aim for.
 

lena42

Registered User
Mar 9, 2015
3
0
Thank you for your reply,as a carer i am always being told by my daughter that my health is important as without me my husband would be lost. However things happened that i had no control over and i nearly died at xmas. This i guess is constantly on his mind,
 

karaokePete

Registered User
Jul 23, 2017
6,534
0
N Ireland
Thank you for your reply,as a carer i am always being told by my daughter that my health is important as without me my husband would be lost. However things happened that i had no control over and i nearly died at xmas. This i guess is constantly on his mind,
I'm glad you used the link as this is one of the first threads I came upon on the site and found it so useful that I make a point of passing on the link.
One of the things that I have noticed with my wife is that her short term memory no longer functions to any great extent unless some strong negative emotion is involved. Your illness probably caused fear and that may cause the event to be recalled often as the life of a PWD(person with dementia) can be ruled by confusion, fear and anxiety.
Good communication, reassurance and empathy can help greatly, even if it can get tiring to be repeating the same reassurances time and time again - the strong emotion of fear seems to me to be remembered, but the reassurance isn't!
 

Cazzita

Registered User
May 12, 2018
617
0
Oh, just reading this post has made me cry and made me realise how rubbish I am with my mum! We are always clashing and I get so exasperated but now I know I need to take a step back, have patience and much, much more understanding. Thank you
 

Cat27

Registered User
Feb 27, 2015
13,057
0
Merseyside
Oh, just reading this post has made me cry and made me realise how rubbish I am with my mum! We are always clashing and I get so exasperated but now I know I need to take a step back, have patience and much, much more understanding. Thank you

@Cazzita You are not rubbish. You are trying your hardest against a cruel, changeable disease. I wish you strength.
 

Grannie G

Volunteer Moderator
Apr 3, 2006
81,443
0
Kent
Hello @Cazzita

As @Cat27 you are not rubbish , you are doing the best you can.

Compassionate Communication is a guide only. It`s a very tall order and we would all be saints if we could stay with it all the time.

It`s just an aid to show us where we may be mistaken in our approach and if we can learn something and if it helps someone, it is doing it`s job.
 

Cazzita

Registered User
May 12, 2018
617
0
Hello @Cazzita

As @Cat27 you are not rubbish , you are doing the best you can.

Compassionate Communication is a guide only. It`s a very tall order and we would all be saints if we could stay with it all the time.

It`s just an aid to show us where we may be mistaken in our approach and if we can learn something and if it helps someone, it is doing it`s job.

Thank you Cat27 and Granny G for your reassurances. Today I have cried a fair bit about all this dementia stuff (and she isn't even diagnosed yet!) but yes, it is a cruel disease that is changing all of us involved. I am sad for my mum that she is changing so much. Why does life have to be this cruel? Bad day but tomorrow is a new day and I will try and approach things differently, try not to get so frustrated with her and be much more accepting. You are all bloody saints on here - you really are - and I have so much admiration for everything you and going through. I know I will be on here a lot in the years to come. Thanks again xx
 

Magnetic

Registered User
Apr 18, 2016
5
0
This advice has been so helpful..I think I have been repeating all the don'ts daily.I have sent it on to my adult children also.It has given me a goal to practice these new ways of responding to my husband.Thank you
 

canary

Registered User
Feb 25, 2014
25,018
0
South coast
Hello @Magnetic and welcome to Talking Point.

Im glad you have found this helpful. I think we all find it all too easy to do the "donts"! Please dont worry if you cant follow it all the time, its near impossible when you are tired and stressed!!

Do have a look around the forum, join in any of the conversations and do feel free to start a new topic if you wish to talk/ask about something specific
 

Lady M

Registered User
Sep 15, 2018
298
0
Essex
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: another source of this information is here

http://www.ocagingservicescollabora...te-Communication-with-the-Memory-Impaired.pdf
@Sylvia