Communicating with Someone Who is Cognitively Impaired

Staff Writer

Communicating with a senior who is cognitively impaired presents a special set of challenges. This person may have trouble understanding or being understood by you. Either way, it helps to understand the obstacles you face, and what can be done to overcome them.

"Cognitive impairment" is a loss of intellectual function, memory, thinking, and behavior. It can be caused by a number of diseases or conditions, such as: Alzheimer's disease; multi-infarct dementia (a series of strokes); or head injury. It causes difficulty in communication, either in forming thoughts, finding the words to express them, or understanding what others are saying.

The person's healthcare provider or a support group may be able to help you understand more about the specific limitations you are dealing with.

Here are some factors to consider:

• Short-term memory may be more severely affected than long-term memory. A person with Alzheimer's disease, for example, may be able to converse about things that happened in the past, yet may not be able to recall things that happened or were said moments earlier. Memory loss may also cause a person to forget where he is or even who he is with.
  
  
• The person may appear to be hallucinating or having delusions. This is a time to follow the recommendations of professionals involved in caring for the person. Often, it is best not to try to correct the person's ideas or perceptions. Instead, focus on the associated feelings the person is experiencing. For example, a person sitting in the doctor's office reception area may think she is at the airport; rather than repeatedly correcting her, you might say, "It's getting to be a long wait, isn't it?"
  
  
• A person may retain some communicating abilities. For example, someone who is unable to carry on a conversation may nevertheless be able to sing a song. Help the person discover and use his unique talents.
  
  
• Emotions, which often play a big part in communicating, may produce unpredictable or inappropriate responses. If you are facing emotional or behavior obstacles, discuss the situation with the person's care professionals or other counselor or support group.

The Role of Body Language   

In advanced stages of cognitive impairment, when verbal skills become severely limited, body language becomes a more important tool for communicating. You may be able to read the other person's emotions and reactions through body language. Watch the person's face and body for changes and reactions. Is he happy, sad, calm, agitated? Can you pick up positive or negative reactions to a particular topic or activity?

Your own body language is important, too. Without saying a word, you can project your love and caring, and convey a sense of comfort and security. Here are some suggestions:

• To appear relaxed and at ease, sit in an open posture, with neither arms nor legs crossed.
• To show interest and involvement, lean forward a bit to show that you are listening.
• To avoid showing frustration or agitation, remember your own gestures and facial expressions.

Practical Suggestions   

What are some of the practical steps you can take to improve your visits or caregiving involving a person who is cognitively impaired? Here are five suggestions:

1. Begin each visit or conversation by calling the person by name. Sit at his level, at a distance that seems comfortable, moving slowly to avoid startling him. Try to make eye contact before speaking.
   
   
2. Speak slowly, clearly, and at a volume appropriate for her hearing ability. Avoid shouting and overstimulation. Keep your messages short enough to fit her attention span; use short, simple sentences.
   
   
3. Give him time to organize a thought and respond. Choose open-ended questions that allow a range of appropriate responses—ones that don't have to be answered "yes" or "no" or with a specific fact. For example, "What did you do today?" is better than "Did you go out in the garden today?"
   
   
4. If you have to repeat yourself, watch to see if it's best to say the same words exactly as before (so there is only one message to process) or whether it is more helpful to paraphrase or simplify. Similarly, if she is struggling for a word, is it helpful or frustrating to have you supply it?
   
   
5. Sometimes it may be appropriate for you to just talk, gauging reactions through visual clues, even if he is unable to organize a response. Just listening to you speak can be a pleasure.

What it Means to Communicate

Think of "communicating" in broad terms. Conversation is not the only—or even necessarily the best—form of communication. A cognitively impaired person may derive enjoyment and a sense of connection just by listening to music or someone reading, or by looking at books, photo albums, movies, or home videos.

And don't overlook the power of touch. Reinforcing pleasant emotions with a touch to the hand or a hug can help the person you are visiting or caring for feel calm, happy, and loved. But again, watch the body language of the person to learn whether a hug or other form of physical contact is welcome and appropriate at a particular time.

Finally, don't judge the success or value of your communicating in conventional terms. You can't expect a person with Alzheimer's disease or other form of cognitive impairment to follow the usual patterns of conversation. She may not recall your last visit, or even know who you are. But the time and effort you spend helping the person express herself and perceive your love and support can provide important moments of comfort and enhanced well being. After all, love and a commitment to caring are the ultimate messages you want to get across.