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Learning Activity: Alzheimers Disease - Effective Communication
Module: Awareness and Sensitivity
Competency 4 and 5:
4. Explain how different diseases can influence the functioning, behaviors, and
attitudes of individuals including dementia/Alzheimer’s Disease.
5. Describe selected client service strategies, including customer service, their
impact on quality client care and the importance of client participation in
group/family activities.
Recommended Resources:
Act on Alzheimer’s, Curriculum website
Alzheimer’s disease Curriculum - Module IV: Effective Interactions
Act on Alzheimer’s, Communication
Power Point Alzheimer’s - Effective Communication
GUIDELINES FOR AND RESTRICTIONS ON USE OF CURRICULUM MODULES
This curriculum was created for faculty across multiple disciplines to use in
existing coursework and/or to develop a stand-alone course in dementia. Due to
the fact that not all modules will be used for all disciplines, topics have been
divided into ten modules that can be used alone or in combination with other
modules. Users may reproduce, combine, and/or customize any module text and
accompanying teaching slides to meet course needs. Our only restriction on reuse is that the modules not be sold in their current or modified form.
Potential Uses: Written paper, Group work, Discussion, Online
Activity: Alzheimer’s Disease - Effective Communication
1. Review the PowerPoint Alzheimer’s Disease - Effective Communication
2. Read the following Case Study:
Case Study:
Mr. Johnson, a 71 year-old man with a history of diabetes who currently lives
alone, is brought into the clinic by his son, Dave. Mr. Johnson does not believe
he has any significant memory problems, yet Dave describes 2.5 years of
progressive memory deficits characterized by increasing late fees while paying
bills and difficulty maintaining the household. Over the past three months, Dave
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has received repeated phone calls from his father in which he complains
repeatedly about losing items around the household. At one point, he wondered
whether somebody was stealing his keys and reading glasses. Originally, Dave
suspected that his father was fixated on this topic but, over time, it became clear
that he had forgotten about the original conversations. His cognitive review of
systems is remarkable for forgetting appointments and becoming lost while
driving in familiar neighborhoods. Dave mentions that he is worried about his dad
driving as well. He denied any specific symptoms for depression.
Mr. Johnson is a retired janitor with a high school education. No active smoking
or drinking. There is a family history of Alzheimer’s disease in his father who
developed symptoms at age 81.
Mr. Johnson was diagnosed by his primary provider with probable Alzheimer’s
disease. Dave inquired about any interventions that can possibly slow or treat the
disease process. It is clear that Dave is distressed about his father’s new
diagnosis. He has many questions about his father’s safety and how he can
proactively take steps to ensure his dads well-being.
QUESTIONS
1. Explain how Alzheimer’s disease has affected Dave.
Dementia Care Overview
Providing care for a person with dementia presents its own set of unique
challenges. At the core of effective care is honoring the humanity of the person
dealing with dementia. This module also provides suggestions for effective
communication, appropriate physical interaction, and assessment and
understanding of behaviors exhibited by an individual with dementia.
Before addressing specific suggestions, there are basic understandings that are
important for formal and informal caregivers to consider. First, it is critical to
acknowledge that the individual with dementia is a human being and one must
respect that person’s humanity. Second, the changes in this person are the result
of a disease in the brain over which the individual has no control. Last, the
person may exhibit strange or difficult behaviors, which are best viewed as
expressions of needs, desires, and distress. This is especially true when
traditional modes of communication are no longer viable.
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This module includes tips and suggestions for positive interactions with persons
with dementia. Three core principles guide interactions with person with dementia.
First, always affirm the person’s feelings and show empathy. This advice can be
applied in many caregiving settings and is very important in dementia care.
Second, bring curiosity to challenging situations and solve problems whenever
possible. A lack of problem identification and resolution can lead to anxiety for
people with dementia. Third, if other strategies are not working, examine one’s own
actions and, if needed, distract the individual, and/or relocate him/her in order to
shift the circumstances that may be creating the problem (Alzheimer’s Association,
2011).
A model for caregivers to consider is person-centered care. The idea behind
person-centered care is that each person is unique and the care of that person
should be tailored to the unique personal attributes of that individual. This tailored
care can be more challenging in a person with dementia because it may be more
difficult for the caregiver to interpret what characteristics are core to the persons
personality and what the underlying needs and desires may be (Spencer, et al.),
(Michigan Dementia Coalition, 2006).
To provide person-centered care, a caregiver needs to understand the following
personal characteristics of the individual. The questions include (Spencer,
Robinson & Curtin):
 What makes this person unique?
 What is his or her personality?
 What core qualities define this person?
Once the caregiver answers these questions, s/he may develop care that is more
appropriate for this individual. For example, if the individual has a great love for
music and the arts, it would be appropriate to include these passions into the
care plan for this individual. The Michigan Dementia Coalition (2006) states:
Providing person-centered care means taking the time and making the effort
needed to know the person as an individual so that her unique individuality is
honored (p. 8).
As one begins the process of gathering individual-specific information, one can
consider the following sources. One can interview staff members who have
worked with the individual in the past. One can develop a family questionnaire
that provides details on the person’s life as well as family stories that might be
relevant. A caregiver can also utilize photographs or biographical information to
better understand details about the individual’s life.
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Effective Communication
Effective communication with a person with dementia can be a challenge for
family members and caregivers. To complicate matters, the individual’s
communication patterns may change as the disease progresses. Caregivers
need to be aware of these changing communication patterns and adjust their
own communication methods to meet the needs of individuals. Regardless of the
stage of the disease, developing a healthy and productive relationship with an
individual will greatly enhance one’s ability to effectively communicate with a
person with dementia (Spencer, Robinson & Curtin).
The following is a list of communication challenges faced by individuals with
dementia. The intensity of these challenges will vary by individual and the stage
of the disease. Frequent communication challenges may include (Alzheimer’s
Association, 2011):
 Difficulty in finding or remembering words
 Repetition
 Loss of reading or writing ability
 Reversion to a native language
 Loss of ability to speak in clear sentences
 Loss of ability to understand oral communication
 Inability to use words effectively
In response to the communication challenges listed above, a family member or
caregiver should keep the following communications guidelines in mind. Utilizing
these tips may enable a caregiver to improve his/her communication with an
individual which will allow for improved and more personalized care (Robinson et
al., 2007):
 Eliminate potential distractions when speaking with a person with dementia
(no TV, music, etc.);
 Provide orienting information at the beginning of a conversation (name,
relationship, etc.);
 Look directly at the person when speaking and ensure that you have the
person’s attention;
 Position oneself at eye level with the individual;
 Speak clearly and slowly;
 Use short, simple sentences;
 Ask simple yes/no or either/or type questions;
 Use concrete terms and familiar words;
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 Talk in an easy-going, pleasant manner;
 Allow sufficient time for the person to respond; and/or
 When discussing tasks, break the task up into smaller, easier steps.
There will be times when the tips listed above will be utilized, but the person with
dementia is still not understanding or being understood. This can be a difficult
and frustrating situation. While there is no cure-all, the following suggestions may
help (Robinson et al., 2007):
 Be sure that you are allowing sufficient time for the individual to process
what you are saying and to respond.
 Demonstrate visually (using non-verbal communication) what you are trying
to say.
 Think about the complexity of what you are saying and rephrase in a more
simplistic manner if possible.
 If all else fails, give the person a reassurance cue such as a hug, pat on the
knee or back, and then change the subject.
Another communication challenge for a caregiver is the inability to understand
what the individual is expressing. This is a particularly difficult circumstance
because it can lead to frustration for the individual. The following are suggestions
to help the caregiver manage this situation (Robinson et al., 2007):
 Listen actively and carefully;
 Try to focus on a word or phrase that makes sense;
 Respond to the emotional, or non-verbal, tone of the statement;
 Always stay calm; and/or
 Ask family members about possible meanings of what is being said.
Regardless of what challenges a caregiver faces, there are certain actions that
should always be avoided. The following list will hopefully help the caregiver
avoid a negative interaction with an individual (Robinson et al., 2007):
 Do not argue with the person.
 Do not order the person around.
 Do not tell people what they can’t do.
 Do not be condescending.
 Do not ask lots of questions that rely on good memory.
 Do not talk about people in front of them.
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Lastly, there are other forms of communication besides verbal communication. It
is important for a caregiver to consider other forms of communication, particularly
when verbal communication has not produced the desired results. The following
is a list of suggestions when verbal communication fails (Robinson et al., 2007):
 Try distracting the person.
 Ignore a verbal outburst if you can’t think of a positive response.
 Try other non-verbal forms of communication.
 Learn your own body language and identify whether it is triggering negative
responses.
 Learn the body language of the other person to better understand his/her
needs and desires.
Physical Interaction
As outlined above, developing a meaningful and trusting relationship is critical to
effective care for persons with dementia. One important element of developing
that relationship is to determine how to approach the individual physically in a
way that does not create anxiety. All of the communication skills discussed
earlier can be far less effective if the individual has become scared or anxious
based on the physical approach of the caregiver. The following is a list of actions
for a positive physical approach (Alzheimer’s Association, 2011):
 Approach the individual from the front so that he/she can see you coming.
 Move slowly; a rapid approach might alarm the individual.
 Once you have approached the individual, assume a position at the
individual’s side.
 Position yourself at the same level as the individual; talking down to an
individual can be intimidating.
 Offer your hand with your palm facing up, this is a non-threatening motion.
 Use the person’s preferred name.
 Wait for a response before moving into a conversation or into direct care.
Reframing, Assessing, and Managing Actions
A person with dementia may exhibit many actions that may cause concern for
family members and caregivers which can include (Alzheimer’s Association, 2011):
 Wandering
 Exiting or trying to leave
 Wanting to go home
 Showing fatigue as the day progresses
 Sleep disturbances
 Looking or searching for things
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 Gathering or hoarding
 Expressing discomfort
 Having hallucinations or delusions
 Being suspicious or paranoid
 Repetitive actions
 Loud verbalizations that may not be coherent
A unique but effective approach to view and address a person’s actions is to
reframe the actions not as problem behaviors to manage, but as expressions or
communications of needs, desires, or distress. Reframing in this manner allows
one to be curious and observe a person’s actions to discover the root cause of a
person’s actions. An individual may be unable to communicate frustration verbally,
so he/she may resort to other means of expression. For example, a new home, a
new room, furniture changes, temperature changes, and changes in lighting could
all trigger expressions of need, desires, or distress. Past behavior patterns of an
individual or a new task or an unpopular task may trigger expressions or
communication of need, desires, or distress (Spencer, Robinson & Curtin).
Reframing may enable a caregiver to respond more productively to that behavior
in the future. For example, one might view wandering as a demonstration of
mobility rather than simply aimless movement. Hoarding, a common behavior
among person with dementias, could instead be viewed as shopping, a daily
activity of life (Alzheimer’s Association, 2011). Reframing also allows for
opportunities to explore new approaches to meeting needs.
There are times when certain expressions, communications, or acts become a
problem for the caregiver, the individual, or other people living in proximity to the
individual. A caregiver needs to understand when a behavior has crossed the line
and needs to be addressed or modified. If an action violates the rights of others,
then caregivers must intervene. The individual may not be able to properly assess
their own actions, so it is important for the caregiver to provide such oversight. A
second circumstance that should lead to intervention is if the health of the
individual, or someone else, is at risk as a result of a certain action (Alzheimer’s
Association, 2011).
Research has also developed strategies for addressing actions, expressions, and
communication often seen in persons with Alzheimer’s disease. Guerriero, et al.,
(2004) provides protocols to manage the common actions associated with
Alzheimer’s disease. The integration of behavioral interventions and primary care
has been successful. The behavioral disturbances addressed by Guerriero are:
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 Epression/anxiety
 Aggression/agitation
 Repetitive behavior
 Delusions and hallucinations
 Managing personal care
 Mobility
 Sleep disturbances
Brauner, Muir, and Sachs (2000) address the common challenge of providing
primary care for individuals with Alzheimer’s disease. Traditional primary care
management techniques may not apply to individuals with Alzheimer’s disease.
As a result, the primary care provider needs to consider the cognitive abilities of
the person with dementia as well as the common actions demonstrated by people
with Alzheimer’s disease before suggesting primary care treatment. Even basic
concerns of adherence to therapy need to be addressed: Any time clinicians
consider adding a new drug or performing a procedure for an individual with
dementia, they need to appreciate the potential difficulties individuals may have in
correctly following instructions (Brauner, 2000, p. 3231). Brauner, Muir, and Sachs
(2000) summarize that primary care treatment decisions need to consider all of
the following factors: decision-making capacity of the individual, altered benefits
and burdens of treatment, the ability of the individual to adhere to a treatment
regimen, the ability of caregivers, and mechanisms to compensate for
communication and other deficits.
Case Study Continued:
The primary provider has a Family Meeting where he counsels Mr. Johnson and
Dave about healthy lifestyle, safety concerns, maximizing his function,
socialization, and ongoing education and support of Mr. Johnson and Dave, his
care partner. This is the first time that Dave realizes that he is a care partner.
Physical activity is the priority, given Mr. Johnson’s diabetes and literature
supporting favorable impact of this intervention upon cognition. The patient was
recommended to use his home exercise bike for 30 minutes at a time for 3 days
weekly. After discussing options for increasing cognitive activity, the patient
decides to meet friends to play cards at the senior center twice a week in addition
to daily reading. He is also enrolled in a Brain & Body Wellness Program. He is
provided a calendar to write down his appointments and activities. At the Brain
and Body Wellness program, the health educators stress the importance of a
daily routine.
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The primary provider has numerous safety concerns about Mr. Johnson’s living
situation. In the setting of newly diagnosed Alzheimer’s disease, Mr. Johnson
has an increased risk for mediation non-adherence. The primary provider
recommends that he utilize a pillbox with daily reminders from his son.
Dave feels he is able to visit his father once a week and set up two pillboxes
indicating the days of the week, one marked morning and one marked evening;
when he makes reminder calls, he can tell his father to take the pills from the
appropriate box and indicate the day of the week so that the correct medications
are taken. When Dave calls to remind Mr. Johnson about his medication, he will
also review the day’s activities with him and write them on a white board on the
back of his front door.
Mr. Johnson and his son get along well. The primary provider discusses the
importance of the care partner; Dave will accompany his father to follow-up
appointments so that he will also hear the treatment plan, when the next
appointment should be, and symptoms and signs to look for that would indicate a
need for a more urgent visit.
A home care nurse is arranged to go to the home to assess Mr. Johnson’s home
situation for safety, assess if he is able to follow phone instructions from his son
accurately, ensure that he is eating regularly, and ensure adequate
housekeeping.
Mr. Johnson and Dave decide that it might be a good idea to try putting a small
table by the front door where he can leave his keys and a stand up glasses case
can be placed next to his favorite reading chair. They will put a white board on
the back of the front door indicating where the keys and reading glasses might
be. If this does not work, they will try another plan.
In addition, it is suggested that Dave and his father discuss the possibility of
Dave obtaining power of attorney and beginning to manage the patient’s
finances. All bills are subsequently placed on autopay.
Mr. Johnson has been responsible for his own meals. There have been no
problems thus far with forgetting to shut off stove burners. The family is
counseled about other options that include prepared meals and microwave meals
as well as Meals on Wheels.
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Mr. Johnson’s primary provider shares Dave’s concerns about Mr. Johnson’s
driving safety. Due to symptoms of disorientation in familiar places, the primary
provider recommends a formal driving evaluation through occupational therapy.
Mr. Johnson is instructed not to drive until this evaluation has been completed.
Dave sets up transportation to and from the Senior Center for the card game
sessions. They will find out if this senior center has meals, and if so, he may eat
a warm lunch with his friends on card game days.
The primary provider makes a referral to the Alzheimer’s Association to provide
additional education regarding Alzheimer’s disease and information relating to
community resources. Mr. Johnson and Dave begin care consultation to learn
about the disease, what they might expect as a course of progression, and how to
prepare to manage at later stages of the disease. The primary provider sees Mr.
Johnson and Dave in follow-up appointments to see how they are coping at home
with the new diagnosis. He is tolerating the donepezil without difficulty and
adjusting well to his new schedule. His primary provider uses the opportunity to
discuss Mr. Johnson’s overall healthcare goals, hopes, and fears about the future.
Mr. Johnson would like both of his sons to be his joint health care proxies. He
mentions his fears about losing his independence and goal of staying in his own
home as long as possible. Given this information, they discuss the importance of
identifying a health care proxy and writing an advance directive. They make a plan
to see each other in three months for follow-up.
QUESTIONS
1. Which services were provided for Dave? What impact will these services have
on Dave’s care?
2. Why is it important for Dave to participate in group activities?
3. Describe in your own words, how healthcare workers can be aware and
sensitive to their clients’ needs/behaviors.
4. Behaviors associated with Alzheimer’s disease are most effectively managed
with medication therapy.
True or False
5. Disruptive behavior in patients with Alzheimer’s disease is best interpreted as:
A. A deliberate attempt to upset caregivers
B. Anger about the diagnosis of Alzheimer’s dementia
C. An attempt to communicate
D. A mechanism to control the environment
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6. Effective interactions with an Alzheimer’s patient are facilitated by
A. Speaking loudly
B. Recognizing the person as a unique individual
C. Avoiding physical contact
D. Giving detailed instructions about what you want the patient to do
7. Mrs. L is a 75-year-old woman living in a dementia care AL because she is no
longer able to perform her IADLs without help. She is often irritable with the
staff and threatens to call the police when they attempt to help her shower.
She can become physically aggressive especially with male caregivers. When
staff ask her why she is upset she consistently replies: none of your damn
business.
To provide the most effective care to this patient, the AL staff should first:
A. Insist Mrs. L take a shower or bath at least weekly
B. Provide only female aides to help Mrs. L in the shower
C. Avoid showers in this resident as it is too upsetting
D. Review the life history of Mrs. L with family/friends to determine if
there is a reason why she is fearful of the shower and particularly
male caregivers
8. Breakfast in the large dining room of the nursing home is interrupted when Mr.
B accidentally knocks his plate off the table and it breaks on the floor. Three
staff members quickly move to his side, pull his wheelchair out to clean up the
mess, and have a discussion about how frequently he needs more
supervision at meals. Mr. B begins to shout loudly and shake his fist. He
strikes out at the person seated next to him and needs to be removed from
the dining room without finishing breakfast.
What mistake did staff make in managing this care situation?
A. Not demonstrating empathy
B. Rapidly approaching him
C. Discussing his faults in his presence
D. All the above.
9. The Unites States is training adequate number of professional health care
workers to take care of the growing aging population
True or False
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References
Alzheimer’s Association. (2011). Understanding memory loss: A personal and public
Imperative.
Brauner, D.J., Muir, J.C., Sachs, G.A. (2000).Treating nondementia illnesses in
Individuals with dementia. JAMA, 283, 3230-3235.
Guerriero Austrom, M., Damush, T.M., Hartwell, C.W., Perkins, T., Unverzagt, F.,
Boustani, M., Hendrie, H.C., & Callahan, C.M., (2004). Development and
implementation of Nonpharmacologic protocols for the management of
individuals with Alzheimer's disease and their families in a multiracial primary
care setting. Gerontologist. 44(4), 548-553.
Michigan Dementia Coalition. (2006). Knowledge and skills needed for dementia care.
Robinson, A., Spencer, B., & White, L. (2007). Understanding Difficult Behaviors: Some
Practical Suggestions for Coping With Alzheimer's Disease and Related
Illnesses. Ypsilanti, Michigan: Eastern Michigan University.
Spencer, B., Robinson, A., & Curtin, C. (n.d.). Developing Meaningful Connections with
People with Dementia: A Training Manual. Retrieved from
http://www.dementiacoalition.org/resources/
Developed by: ACT on Alzheimer’s
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