Transcription:
Communication and Dementia

Deborah Howell (Host): Welcome to BayCare HealthChat. I'm Deborah Howell, and I invite you to listen as we discuss dementia and communication. Today, we'll find out more about how we can connect more effectively with our loved ones who have dementia, so they can better understand us. I'm joined today by Kim Saberi, the Coordinator of the Memory Disorder Center at St. Anthony's Hospital. Kim what a pleasure to have you with us today.

Kim Saberi, MSW (Guest): Thank you so much, Deborah. It's good to be here.

Host: Let's dive right in. Dementia makes it hard for your loved one to understand and be understood. Why is this so?

Kim: When someone has dementia, they live in a different reality than we do. Because of their brain disease, they are unable to come to our reality. But we can go to theirs. So, instead of trying to reason, rationalize or trying to get them to remember, join them in their world, comfort them in their world, solve the problems that exist in their world. Their feelings are real, even if their reality differs from yours.

Host: Yeah, it's a good thing to remember. Now you recommend following them perhaps when communicating with someone who has dementia, can you tell us the steps?

Kim: Number one, is to validate feelings. Number two, offer a quick solution if possible. And number three, distract and redirect. So, an example of this is the loved one with dementia moves their wallet, but they don't remember moving it because they have short-term memory loss. So, when you come in the room, they say you took my wallet and so, a normal human reaction would be to say, I didn't take your wallet. I haven't even been in this room. So, what this theory about joining them in their reality is saying is instead of trying to reason with them and bring them to your reality; instead, use the three steps, validate feelings, offer a quick solution if possible and distract and redirect.

So, when they say you took my wallet, say, I'm sorry, your wallet is missing. I can see you're frustrated. Come on, I'll help you find it. Hey, look at these birds out the window. So, in this way, we can join them in their reality and help them solve their problem in their reality. And this isn't easy to do, Deborah. People have been communicating with their loved one in the same way, probably for decades. So, to suddenly change it is hard to do. So, we suggest role-playing and kind of practicing, having a little self-talk, asking yourself, all right, what did I say when I was over there? How could I have said it better? All right let me say it out loud and practice what I should have said. All right. Let me say it out loud and practice of what I should have said instead.

Host: I love this. I love this idea rather than just going, no, I did not take your wallet and I have to be right. It doesn't matter if you're right. Just, it matters that they feel better and you know, that they find their wallet. If it was quote unquote lost and it just has to be right in their world as you said. Now, this brings us to the next thing, Kim, what are fiblets?

Kim: All right. Fiblets are minor adjustments to the way you explain things. It's also referred to as therapeutic fibbing and it's therapeutic because we use it to calm and reassure our loved one. It can reduce their anxiety and help promote their self esteem. And it's showing empathy and not being deceitful as long as you're using it for their benefit and not for your personal gain.

So, an example of this might be why we have an aide. So, the person with dementia probably doesn't have a full awareness of their cognitive deficits and therefore they think they're fine to be left home alone. However, in reality, they're unsafe. And they're wandering off and sometimes turning on the stove and you're concerned about their safety when you're not there.

So, instead of saying, well, we're getting this aide because you can't be left alone, you're incompetent, or, you know, you're unsafe instead, you can say, hey, we have some, someone who's coming over to do some housekeeping and they'll be here while I'm gone to the grocery store. Another example is when someone wants their mom and suppose they're you know, 80 years old. And so their mom has been passed away for some time. So, instead of telling the person that their mother is dead we can use a fiblet. And so what it could be is that person in their mind right now, because of the dementia, they're 10 years old. So, they're naturally looking for their mother. So, if you tell them that their mother is dead, then you're traumatizing them.

And if they ask repeatedly, you could be retraumatizing them over and over, cause they may not remember the last time you told them. So, instead you can use a fiblet and a little bit of creative communication and just say, your mom's not here right now. You miss your mom don't you? Remember how she used to make those paper dolls? Let's go, let's get the photo album and look at some pictures of her.

So in this way, you are not directly addressing that her mother has passed away, but you are trying to help her feel comforted and she's probably missing her mom. So, instead you can help her reminisce.

Host: That's beautiful. Kim, how can we say things in a way that preserves our loved one's dignity?

Kim: Well, we can simplify our statements and we can give one step at a time. Offering two choices is another great way. So, instead of asking an open ended question, like, what do you want to eat; we could ask, would you like an apple or a banana? Would you like to take your medicine before dessert or after dessert and use the word let's go to the bathroom before we have dinner. Let's take our medicine before we clear the table. So, you're saying things in a way to help promote your loved one's dignity.

Host: I like that as well. Now, what approach should we not take when speaking with a loved one?

Kim: So, a person with dementia, they live in the present moment. It is difficult, if not impossible for them to remember the recent past or to plan for the future. So, don't quiz them on what they did yesterday or what they had for breakfast. And if they say something incorrect, ask yourself, is this a safety issue? Does it really matter that mom got the name of her grandchild wrong or said the number of years she was married incorrectly? And if not, don't correct them. Help them to maintain their dignity and reduce their anxiety in the present moment. And also don't expect them to be able to plan for the future. Plan things for, or preferably with them. Make sure they're getting plenty of socialization, cognitive stimulation, exercise, and healthy food. Help them stay calm and content in the present moment by being present moment focused when you are with them. Remember you cannot change dementia. You can only change your reaction to it.

Host: It's a big job to be a caretaker for someone with dementia and Kim you've given us such great information. Where can our listeners go to find out more about your services?

Kim: You can contact the Memory Disorders Center in Clearwater at 727-298-6025. Or the Memory Disorder Center in St. Petersburg at 727-825-1595.

Host: Kim, it's been very, very enlightening talking to you today. Thanks for all the good information.

Kim: Thank you so much for having me.

Host: And that wraps up this episode of BayCare HealthChat. Head on over to our website at baycarememories.org for more information, and to get connected with one of our providers. Please remember to subscribe, rate and review this podcast and all the other BayCare podcasts, so we can share the wealth of information from our experts together. This is Deborah Howell. Have yourself a terrific day.