How to talk to a loved one with dementia: Never say ‘no’

This is part of the story The mystery of the brainCNET dives deep into the infinite complexity of the human brain.

I will never forget the last real conversation I had with my late mother-in-law Grace. He had been suffering from Alzheimer’s disease for several years, and it was becoming difficult for him to make calls on his smartphone. So I was surprised to see his name pop up on my screen, a random Thursday night in the fall of 2021 called me.

“Are you watching 60 Minutes?” she asked.

I paused. I hadn’t seen the news-magazine program in decades, but I knew it aired on Sunday nights, not Thursdays. I also knew how much Alzheimer’s confused my mother-in-law.

Before his illness, he kept up with the news and had strong opinions on politics — even campaigning for John F. Kennedy when he ran for president in the 1960s. He kept his mind active well into his 80s by doing daily crossword puzzles in his favorite newspaper, The Los Angeles Times, and he loved discussing new books with me.

But Alzheimer’s took away his attention, and often his words. I knew how hard it was for her, she was frustrated to the point of tears when she couldn’t make herself understood. If he thought he was watching 60 Minutes a night it wasn’t on, I wasn’t going to agree with him.

“Yeah, I’m watching 60 Minutes!” I said immediately.

It was the correct answer. “They’re a nice couple, aren’t they?” she said in a happy, satisfied voice.

Couple? Who was the couple? Mike Wallace and Morley safe? Didn’t they die? It doesn’t matter.

“Yes!” said.

“Okay, I’ll let you go now,” she said, and the call ended. About a month later, Grace died at the age of 85. She had moved from her two-bedroom California condominium into a nice assisted-living residence just eight months earlier, barely enjoying its hair salon, field trips and other amenities.

His health rapidly deteriorated and he soon needed 24-hour care. We transferred him from the hospital to a board-and-care home run by a sympathetic Russian doctor, and he lived there only a week before he died.

Every day, I am grateful that I agreed with him during that phone call. In her world, she was watching a “beautiful couple” on 60 Minutes on Thursday nights, and I knew enough about her dementia to try to enter the world she lived in.

‘I got your back’

Diana Waugh knows how difficult it can be to talk with cognitive loss, no matter what Alzheimer’s disease, Lewy body dementia or other conditions. Waugh is an experienced nurse and a certified dementia practitioner. his business, Wow ConsultingFocuses on giving caregivers and family members tools to communicate with loved ones suffering from dementia.

But Waugh didn’t always know how to do that. His own mother, Iona Kiser, suffered from dementia and died in 2008 at the age of 95.

“I did it all wrong,” Waugh said. “I was less than successful with him.”

Since then, Waugh has published a short book, I was wondering: Opening the door to successful conversations with loved ones with cognitive impairment. He spoke to countless caregivers, and Has produced numerous videos explaining his method.

Waugh says he can sum up his philosophy about talking to them in one phrase: “I’ve got your back.” She also feels strongly about the word “no” — saying caregivers shouldn’t use it. And she encourages caregivers to deflect potentially boring conversations to focus on old memories their loved ones can easily discuss, as opposed to trying to quiz them on new information their brains simply can’t access.

His work won’t give him back that time with his mother, but he’s helped many other people along the way.

Sheila Qualls’ 86-year-old mother has dementia, and Qualls has been working with Waugh on how to better communicate with her mother.

“I miss my mother, but Diana taught me how to ‘access’ her,” says Qualls. “His techniques made a huge difference in how we responded to my mother and changed our lives.”

The short-term-memory drawer has no bottom

Waugh explains that your loved one’s memory has two “file drawers” — short-term and long-term memory. Items in long-term memory are usually still accessible. But there is no bottom in the file drawer that should collect short-term memory. Memories can no longer be kept.

“So if you ask [a person with memory loss] To go to lunch with you tomorrow, they put it in the short-term drawer [and it’s forgotten],” Waugh said. “You see, they’re still in their pajamas A wise man says, ‘Whatever.’

A person with dementia can’t tell you how they’re feeling today, Waugh explains, because short-term memory is involved. But they can tell you “how it felt when they hurt their knee at 40.”

Tap into long-term memory

That’s exactly why Waugh encourages caregivers to tap into their loved one’s long-term memories whenever possible. Her slim book has many workbook pages where she encourages people to write down memories with their loved ones Did they like the taste? hear? To touch?

Always have three stories at the ready, Woah tells clients, and then use them to keep affected loved ones in the conversation. Bring up those old memories and encourage talking about them.

Qualls says this strategy works.

“My mom might not remember who I am, but when I start talking about her childhood or my childhood experiences, she can relate right away,” she says.

It can also be helpful to show your loved ones photos, but “make sure they’re old photos,” Waugh warns A new great-granddaughter might be cute, but it’s unlikely that a cognitively impaired person will have any idea who that child is.

Divert and redirect

Waugh tells the story of a woman who moved her elderly father from Nashville to Houston and worried he would return to the barn he knew, which was now several states away.

In such situations, instead of not telling him that his beloved barn is gone, Waugh says caregivers should calmly use the barn as a jumping off point for the man to talk.

“Say, ‘I was thinking about that one racehorse you had,'” says Waugh. “And once they start [talking]Let them go.”

Qualls also found this approach valuable.

“Diana taught me how to answer questions when my mom wondered where my dad was,” Qualls said. “Divert and redirect. Works like a charm. Diana taught me to enter my mother’s world without trying to bring it back to my reality.”

Taking the car keys

Many people first contact cognitive impairment when they realize their loved one can no longer drive safely. But how to give up their keys? You might be tempted to lie and say their car broke down.

It doesn’t work, says Waugh. If a loved one is in the early stages of cognitive loss, “they’ll call AAA to fix that ‘broken’ car.”

Instead, she suggests telling them about a scary incident you recently experienced on the road or claim you recently got lost while driving. Stories like these can hit home with someone who is almost certainly starting to notice problems. You might be able to convince them that a family member needs to use their car for a while, to have an excuse as to why it’s suddenly inaccessible.

Here’s what to never say

Wah encourages caregivers to avoid one word: no.

“‘No’ doesn’t work very well,” she says, adding that the word only angers loved ones. If you can divert the conversation instead, the person will likely forget about the diversion within five minutes and happily move on. But if you make them mad by saying “no,” they’ll stay mad for the rest of the day, she says.

Waugh understands why frustrated caregivers might be tempted to say no. Their loved ones may be insisting that they go to work when they haven’t had a job in years.

By saying “no,” the caregiver hopes, she says, to bring the person back to reality by denying them their “wrong thinking.” But the person they love lives in their own reality and the caregiver has to say “no” over and over again, putting pressure on the relationship.

Avoiding “no” makes sense, but Waugh says caregivers shouldn’t say, “Do you remember?” What may seem like a gentle prompt may be seen as a demanding quiz to make them lose their memory.

“It’s like waving a red flag in front of a bull,” Waugh said. “The person probably doesn’t remember whatever it was and asking them to do it puts them under stress they don’t know how to handle anymore.”

What should I say instead?

Instead, Waugh encourages using a phrase from the title of his book, “I was thinking…” as a starter to encourage memory. If a loved one tells you they need to work, even though they haven’t had a job in years, calmly say, “I was thinking…” and then start giving them some details about a job.

If it suddenly occurs to them that they’ve lost a loved one — even if it happened years ago, you might start with “I was thinking…” and then recount a happy memory of that loved one’s pie-baking skills. .

Communicating successfully with a loved one who has dementia can be very difficult. Wow know this very well.

“We have to stop looking [our loved ones] As we always have,” Waugh writes in his book. “When we change our expectations, we can find them as they are. We can have meaningful conversations. Our relationship will be different, but much more fulfilling. It will give us happy memories of the last part of their lives.”