How Can I Continue Communicating With Late-Stage Alzheimer’s Patients?

As Alzheimer’s disease progresses, patients are likely to have increased problems with speech and understanding language, which can make communication challenging for all parties involved. However, it’s very possible to continue to communicate with late-stage Alzheimer’s patients as the disease progresses—it simply requires patience, a new mindset, good listening skills, and different listening and speaking techniques. 

Continuing to listen, communicate, and connect is not only important for maintaining relationships with late-stage Alzheimer’s patients but also for understanding how their function is changing with time to effectively adjust treatment and care plans to meet their changing needs.

Below, we provide basic information on communicating with late-stage Alzheimer’s patients, including what sorts of changes in communication to expect, helpful tips, and how to monitor changes in function to enable the best care and quality of life possible for patients.

Understanding Changes in Communication Skills

First and foremost, it is important to understand that Alzheimer’s is a complex disease that affects each individual uniquely. It is essential to not make any assumptions regarding an Alzheimer’s patient’s ability to communicate. Communication with two patients in the late stages of Alzheimer’s disease may look completely different. Typically, in the late stages of Alzheimer’s disease, you may expect changes in communication abilities such as those detailed below:

• Difficulty finding the right word
• Substituting words or repeatedly using familiar words
• Repeating words, phrases, stories, or questions
• Speaking less often than before
• Describing familiar objects or gesturing towards them instead of referring to them by name
• Relying more on gestures than on speaking
• Difficulty organizing words, ideas, or phrases logically
• Reverting to speaking a native language
• More frequently losing a train of thought
• Mixing unrelated ideas or phrases

Helpful Tips for Communicating with Late-Stage Alzheimer’s Patients

To improve understanding for both the patient and yourself, there are several things you can do. Some patients may still have the ability and desire to communicate verbally, while others may not be able to communicate verbally but can show their thoughts, needs, and emotions in other ways. Keep in mind that it is okay to not know exactly what to say—what matters is your presence, comfort, and friendship. Below are some helpful tips for communicating with late-stage Alzheimer’s patients.

• Remove distractions: Prepare the room in which you will be communicating with the patient. Eliminate any background noise and visual distractions to make it easier for the patient to hear you and concentrate on the conversation.
• Identify yourself: Approach the individual from the front and identify yourself. Even if the patient’s family member, companion, caregiver, or support system is present, speak directly to the patient while maintaining eye contact. 
• Encourage non-verbal communication: Encourage and interpret non-verbal communication techniques, such as gestures, facial expressions, and body language. If it isn’t clear what they are trying to say, ask them to point or gesture. 
• Bring a comforting and respectful presence: Treat the patient with dignity and respect. Show a loving, warm, and matter-of-fact manner and be open to their concerns. Use appropriate physical contact, such as hand-holding, to offer reassurance and comfort. Speak calmly and slowly while making sure not to talk down to the patient. Be aware of the volume and tone of your voice and your body language, as the patient may rely heavily on non-verbal cues.
• Stay connected: Make eye contact and use appropriate physical contact, such as hand-holding, to offer reassurance and comfort. 
• Keep it simple: Try using simple, step-by-step instructions. Allow plenty of time for the patient to interpret and respond in their own way. If needed, repeat instructions and allow more time for a response. If this level of communication is not possible, try asking short and simple yes or no questions.
• Be creative: Try using senses of touch, sight, sound, smell, and taste as a way to communicate.
• Check for understanding: Be aware of how the patient is reacting verbally and non-verbally to what you are saying.

Monitoring Changes to Inform Proper Care Adjustments

Regularly interacting and communicating with late-stage Alzheimer’s patients can certainly give you a general understanding of how their brain function is changing over time to help inform proper adjustments to care and treatment. However, the ability to effectively update care plans in the most personalized manner possible requires routine testing of brain function to assess patients’ ability to complete Activities of Daily Living.