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Communication Strategies When Working With Confused Persons/Patients

General Attitude and Approach

bulletStay calm
bulletBe flexible
bulletBe non-resistive
bulletBe guiding, not controlling

Verbal Approaches

bulletUse concrete, exact, positive phrases; repeat the same phrase.
bulletTrigger automatic responses.
bulletBreak tasks down into single task instructions like "walk forward", "stop", "turn around", and "sit down".
bulletMake a suggestion if the person is unable to make a choice.
bulletUse a calm, slow, soft voice pattern.
bulletAsk one question at a time and wait for a response.
bulletDo not argue or try to reason.
bulletUse distraction.
bulletKeep your promises, so promise only what you will be able to do.
bulletInclude the person in your conversation.
bulletIdentify the person's vocabulary and use it - if he likes the word "potty" for bathroom, then the staff should use that word.
bulletTreat the person as an elder or a peer, not as a child.
bulletAcknowledge the person's feelings and help her name it if she has difficulty, for example:  "You look sad.  Do you miss your daughter after she leaves?"
bulletGive directions within attention span.

Non-verbal Approaches

bulletPractice "looking friendly" - your attitude/mood is contagious, felt by all, even if you share it verbally only with the other staff.
bulletMake your verbal and non-verbal messages the same.
bulletStand in front and make eye contact.
bulletAssume and equal or lower position, especially if the person feels powerless.
bulletMove slowly.
bulletApproach from the front, not the side or behind.
bulletAvoid overwhelming the person physically or verbally (approaching an anxious person with three or more people may lead to a catastrophic reaction).
bulletUse lots of touch, if the person enjoys it.  Allow time for the person to touch you.
bulletIdentify symbolic behaviors and their meaning - the cup the person wishes to hang onto after meals may be symbolic for having coffee with friends and relatives and be a source of security and comfort.

Twelve Basics For Alzheimer's Care

bulletAlzheimer's is a disease, not a normal part of aging.
bulletAccept the disease.  Persons are not "misbehaving" or forgetting on purpose.  You can not change this reality, but you can manage the behavior.
bulletArguments are useless; in fact, they make matters worse.  Confusion, memory loss and frustration are making the person behave irrationally and you can't "argue" them out of it.
bulletAllow as much freedom and independence as possible while keeping safety and comfort in mind.
bulletActions help when verbal communication may fail.  Help the person by demonstrating what you mean, or sometimes, start them in the activity.
bulletAssume that the person may hear and understand what you say even if they are confused.   Do not say things to others in front of them as if they are deaf.
bulletAppreciate good moments or good days, even though the person's ability is not going to remain that way.
bulletAppropriate activities which help persons pass the time meaningfully and productively and reduce agitation, boredom, daytime sleeping, and depression.
bulletAgitation can be alleviated when the caregiver remains calm, reassuring and respectful of the person's feelings.
bulletAdults with disabilities are still adults.  Mental level is not always equal to social level.
bulletAdapt the task to fit the ability of the person.  Break down the activity into separate  steps, or simplify task by eliminating parts that could be frustrating.
bulletAssessment is ongoing.  What is safe and effective for now may not be so at a later time.  Keep watching and reevaluating.