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    Dementia Symptoms & Caregiver Strategies: Connecting with Individuals Suffering from Memory Loss

    Memory difficulties resulting from cognitive impairment are generally progressive and over time affect a person's ability to remember and understand basic everyday facts, such as names, dates and places. Progressive memory loss gradually affects the way the person communicates and as a result, their ability to present rational ideas and to reason clearly will change.

    If you are looking after a person who has cognitive difficulties, you may find that you'll eventually have to start discussions in order to get the person to make conversation. This is common. Their ability to process information often gets progressively weaker and their responses can become delayed.

    Consider the following communication techniques when communicating with a person who is showing signs of cognitive impairment:

    • Approach the person from the front
    • Speak to the person at eye level
    • Use eye contact to look at the person, and encourage them to look at you when either of you are talking
    • Speak slowly, clearly and calmly, and use short, simple words
    • Allow enough time for the individual to respond (counting to five between phrases is helpful)
    • Try not to interrupt the person, even if you think you know what he or she is saying
    • If you're not sure what's being said, repeat what you heard back to the person and ask if it's accurate, or ask them to repeat what they said
    • Focus on the person’s feelings, not the facts
    • Use a comforting tone of voice
    • Be patient, flexible and understanding
    • Avoid interrupting people with who have memory loss; they may lose their train of thought
    • Allow them to interrupt you, or they may forget what they want to say
    • Limit distractions during communication (e.g. turn off the radio, move to a quiet place)
    • Increase the use of gestures and other non-verbal communication techniques
    • Carefully observe the individual to recognize non-verbal communication
    • A person with cognitive difficulties may sometimes require more time to process information and may take longer to respond to a question.
    • Short sentences, visual cues or pictures may help the person who is having trouble processing information better understand what they are hearing.
    • Sometimes the individual may feel unhappy that he or she can't communicate in the way they would like to – being able to express these feelings may be very important to the person. Just listening rather than trying to cheer them up may be reassuring.
    • Avoid arguing the facts. What the person is experiencing or believes is real to them. Try not to "correct" a person with cognitive difficulties but rather just try and validate their feelings.
    • Don't speak on behalf of the person during discussions about their welfare or health issues, as this can make the individual feel invisible and they may not speak up for themselves in other situations
    • Don't dismiss what the person you're looking after says if they don't answer your question or it seems out of context – instead, show that they've been heard and encourage him or her to say more about their answer
    • Avoid asking the individual to make complicated choices – keep it as simple as possible
    It's important that you encourage the person to communicate what they want however he or she can. Remember, we all find it frustrating when we can't communicate effectively, or are misunderstood because of language or cultural differences.

    Communication is a two-way process. Not only is it important that the person you're looking after is encouraged to use different skills to communicate, as a caregiver you will probably have to learn to 'listen' differently too. You may need to be more aware of non-verbal messages, such as facial expressions and body language. You may have to use more physical contact, such as reassuring pats on the arm, or smile as well as speaking.

    A diagnosis of cognitive impairment does not necessarily mean the person does not have the ability to make decisions; the person should be involved as much as possible in his or her own care planning. The ability of a person who has trouble processing information to understand their care choices and make decisions about their care varies with how impaired they are and the type of decision required. Whenever possible, a family member should be designated as the primary contact for all members of the home care team. People with memory loss will eventually have their care decisions made by others when they themselves cannot, so it is important to determine who the primary decision maker will be.

    Cognitive Impairment can have many causes. The patient’s doctor should be consulted to determine a specific diagnosis and treatment options. But whatever the cause, the symptoms are often alike, and the Caregiver Strategies are often similar.

    The information in the resources listed above was compiled by the Ray Dolby Brain Health Center through clinical experience and commonly available published materials. For information on additional Caregiver Strategies, go to: cpmc.org/brainhealth.