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Communicating With Alzheimer’s Patients At Different Stages

Communicating with Alzheimer’s Patients at Different Stages

Alzheimer’s disease is the most common form of dementia. Over half a million Canadians suffer from the disease, and around 33,000 Montreal seniors live with dementia. This devastating disease lowers cognitive functions over time, affecting memory, basic motor skills, emotions, and normal daily activities. Read more below for tips on communicating with an elderly loved one affected by dementia.


What Are the Stages of Alzheimer’s?

Typically, the progression of Alzheimer’s is divided into three stages: Early stage, Middle stage, and Advanced/End of life stage. While very common, Alzheimer’s and dementia are not a part of the normal aging process.


Communicating with an Alzheimer’s Patient

Communicating in the Early Stage:


During the mild stage of Alzheimer’s, you may notice the senior’s ability to recall recent events start to diminish. Generally, more deeply ingrained memories, such as the ability to perform normal tasks like using utensils, aren’t affected at this stage. Limited short-term memory is often the main symptom. They may ask the same questions multiple times without realizing.

You may also notice a decreased fluency in their spoken and written language. Their vocabulary may begin to shrink, although basic tasks like writing and drawing are not likely to be noticeably affected. Complex tasks, such as math equations (in balancing checkbooks or doing other financial calculations) may be more difficult.

Changes in personality may also become apparent. Whether it’s an out-of-character irritability or seeming aloof in social situations, a senior with Alzheimer’s may show a change in emotional behaviour at this stage.

This stage usually doesn’t encompass a significant loss of autonomy, and early diagnosees can normally have a say in the future of their own senior care plan.


When a senior family member has early Alzheimer’s, they may show the following symptoms in normal conversation:


  • Repeating questions without realizing;


  • Having difficulty describing things, and using alternative words;


  • Losing their train of thought;


  • Avoiding speaking altogether;


  • Using gestures more than verbal communication.


Remember to ask them what they are comfortable doing on their own; do not assume they can do everything just because they may not seem fully dependent on a caregiver yet. They may not want to communicate with others directly, over the phone, or via email, and you may have to do so for them. Reassure them, and be positive; they can still appreciate laughter and good humor, and it’s a positive way to combat the difficulty of the disease.


Communicating in the Middle Stage:


The middle stage of Alzheimer’s is usually the longest, sometimes lasting for several years. In this stage, seniors with Alzheimer’s will likely be incapable of performing most normal daily activities.


  • Speaking will be more difficult, and the elderly person will often replace words incorrectly, due to an inability to recall vocabulary.


  • Coordination may be hindered, increasing the risk of falling.


  • Short-term memory is greatly impacted. Long-term memory, which was unaffected at the previous stage, will now also become impaired.


  • Behavioral changes will become more apparent, possibly leading to aggression, emotional outbursts, crying, and possibly delusion.



  • He or she may have difficulty orienting themselves and navigating familiar places, such as their own home. This can lead to confusion, and a phenomenon known as wandering. They may have trouble remember the day of the week, or even the season. They may also mistake friends for family, or vice-versa.



  • Incontinence may develop at this stage.


All of these changes can cause significant stress, both on the patient and their family. Hiring a personal caregiver for the senior, or having them moved to a retirement home or long-term care facility, are options to help remove some burden of care from the family.

Along with functional capabilities, cognitive function will be reduced further in this stage. Therefore, keeping meaningful communication can become a challenge, but there are some steps you can take to minimize the barrier:


  • Avoid open ended questions: For example, ask “would you like to wear your red shirt today?” as opposed to, “what would you like to wear today?”;


  • Always speak clearly and slowly enough to be understood, but try not to speak in an infantilizing tone;


  • Give them as much time as needed to respond, as they may need to think over the question for longer than normal;


  • Speak to them in an appropriate setting. Turn off the TV and other distractions, go into a quiet room, and maintain eye contact while speaking;


  • Remember that sometimes, listening means more than speaking. If the senior says something wrong, don’t argue with or correct them;


  • Pay attention to visual clues. Sometimes, if an elderly person is struggling to find words, they may use body language to express themselves;


  • Often times, their memory will be incorrect, and they may remember memories that never occurred. If their concept of reality has become muddled, sometimes, it’s best not to try and convince them of the truth. What they believe is real to them, and their feelings are real as well. Always respond with comfort and reassurance.


Communicating in the Advanced Stage:


During the final stage, the senior will be entirely dependent on a caregiver. They will require 24/7 care, as their mental and physical capacities will be extremely reduced. The goal at this stage of the disease is to make the affected person’s final weeks or months as comfortable and enjoyable as possible.

In the advanced stage, your elderly loved one may show the following symptoms:


  • They will have severe loss of memory and difficulty understanding the world around them;


  • Assistance with eating, bathing, dressing, and other physical tasks will be necessary;


  • They may have trouble swallowing and require a feeding tube;


  • Walking on their own may be difficult or impossible;


  • Muscles may become rigid, and the brain will be entirely unable to control what the body does.


Communicating with an Alzheimer’s patient at this stage is much harder, as they will have lost most of their ability to recognize speech and form words. If they do speak, it will likely be incoherent. Non-verbal communication is crucial. Use other senses as a form of communication, in ways such as:


  • Using pleasant scents that may trigger happy memories from their past;


  • Using calming visuals, such as a TV or laptop screen displaying nature scenery, or placing them in front of a window facing outside;


  • Playing soothing music, especially songs that the senior with Alzheimer’s enjoyed listening to during their younger years. Music therapy is becoming an increasingly popular method of mental care for the elderly;


  • Holding their hand, giving them a soft fabric to hold, and brushing their hair;


  • Take them outside, whether for a walk or in a wheelchair, and find a green area to spend time. This can be a nearby park, or the neighborhood they grew up in.


Remember: While communicating with an Alzheimer’s patient through verbal speech may seem fruitless, especially in the late stage, they can still be comforted by your voice. Speak to them calmly, reassuringly, and tell them stories from past memories. Read them their favourite story or poem. Even if they may no longer seem to recognize you, your presence is the most important thing you can offer to make the end of their journey peaceful and happy.


As always, if you need home care assistance for a family member affected by Alzheimer’s disease, Complete Care Coordination is here to help. Please feel free to contact us today for a free consultation if you need a qualified caregiver for an elderly loved one.

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