Dementia and incessant talking

Effective communication requires you to tailor your message to your audience. When it comes to older adults, many of us tend to treat them like children, or invalids. Here are the most common mistakes we all make, and how you can avoid them.

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We Treat Them Differently Just Because They’re Old

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Age comes with a lot of stereotypes, and we often fall prey to them. For example, we have a tendency to address seniors with patronizing language, unnecessarily simplified words or voice modulations that we’d use with children. For example, we might use “sweetie” or “dear” or talk in a high-pitched voice. Such “elderspeak” is usually taken as an insult. It seems obvious, but you might not even realize you do it.

In its guide “Communicating With Older Adults“, The Gerontological Society of America (GSA) also says you don’t need to change your vocabulary to use simplified words:

As a general rule, older adults maintain their existing vocabulary or continue to improve it. They have no greater problem understanding complicated words than do members of other age groups, so there is no need to simplify the words you use.

Seniors also often complain that people talk to them loudly for no apparent reason. Not every old person suffers from hearing loss. So enunciate well and speak at your normal volume. If they ask you to repeat something you said, don’t think it’s an invitation to yell it out. My own grandmother put it best when she mildly scolded me for this:

Just because I ask you to repeat yourself, you don’t need to start talking at a louder volume. I can hear just fine, but just like you miss words sometimes, so do I.

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Most importantly, talk to them directly. When meeting an older adult, have you ever asked someone else in the room, “So how is he/she doing today?” Turns out, that’s one thing most elderly people take offense to (go figure), as the Aging & Communications: Engaging Older People guide points out:

“It is downright humiliating when the health care provider says to my daughter – “And what are “WE” here for today?” – ASK ME! You obviously see me sitting here.” – Emma, age 81.

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We Don’t Adapt To The Issues They Do Have

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Old age can bring some complications, of course, but you should know which ones are affecting the person in question. More importantly, know the fine line between being patronizing towards those and accommodating their issues respectfully.

A good example: many of us ignore changes in the environment. Just like background noises, harsh lighting or anything else affects you, it affects older adults too, and often to a larger degree. But the reason your grandma could hear you the last time and not this time is not “She’s just getting old!” That leap in logic is how you fall into the trap of talking loudly or patronizing them.

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Just be more sensitive towards changes. Seniors will adjust too, they just take a little longer, so don’t be an impatient jerk and jump to conclusions. You can also help with a few thoughtful gestures to make the transition easier and faster. For example, the Cleveland Clinic suggests that it’s a good idea to ensure they can see your lips clearly:

Avoid covering or changing the shape of your lips and mouth. Most listeners make use of lip-reading. Lip-reading helps improve recognition of some sounds and speech that are more difficult and especially in difficult listening situations.

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Similarly, if the person you’re talking to has a bad working memory, break down your sentences when conveying important information. The GSA gives an example of such rephrasing:

Original: You have arthritis of the hip which is making it painful for you to walk and may eventually require hip replacement surgery if we cannot control your pain with medications.

Broken Down: You have arthritis of the hip. The arthritis is causing pain when you walk. Taking medication should help to control your pain. If the pain continues, we might need to consider hip replacement surgery.

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With some people, it may also a good idea to use visual aids.Imagination can take a hit along with short-term memory as we get older. If they aren’t following your detailed descriptions of your trip, whip out that smartphone and show photos of your vacation. While those descriptions will still get your point across, why would you want to task someone when there’s a more effective way of communicating?

You should also be aware of any physical or mental disorders and act accordingly. For instance, with a patient suffering from dementia or any disorder that affects their thinking, make things easier by asking specific questions instead of open-ended ones. For example, “Would you like soup or sandwich for lunch?” narrows their answer than “What would you like for lunch?” Open-ended questions are fine in conversation, though—just avoid something that taps into episodic memory like, “What did you have for lunch yesterday?”

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We Forget They Are People—People We Can Learn From

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Somehow, we end up forgetting that the older person is, in fact, a person. They have the same thoughts and feelings that you do. Old people feel like eating their favorite food, old people can kick your butt at chess, and old people can have the same sexual desires as you. Yet we treat them differently because of our flawed notion of what age does to a person.

Realize that it’s just another person in an older body. Think of what you would feel like if you, right now, were put in an older body and people started treating you differently. Not a nice picture, is it? Treat a senior like how you would eventually like to be treated, and you will have a much better experience for the both of you.

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The more you realize that everyone’s “just another person” like you, the more easily you can connect with them. You’ll find that they too have been through all the experiences you have—and a lot more. Your grandfather got his heart broken, your grandmother struggled with finances, and they lived through it all to tell the tale. Tap into that wisdom they have gathered over the years, get them to share their stories, just talk! Our elders are like a Wikipedia of life lessons that you can learn from, so take advantage instead of writing them off.

Photos by Matthew Cole (), YODesigner, Kamyar Adl, Nathan O’Nions.

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There may be a reason grandparents repeat the same stories over and over again. According to a new study, older people are more likely than younger people to forget with whom they’ve shared information.

The study investigated two types of memory: source memory, or your recollection of who told you a piece of information; and destination memory, which is your recollection of which people you’ve informed. Not only were older people bad at remembering to whom they’d told information, they were very confident in their mistaken memories.

“Older adults are additionally highly confident, compared to younger adults, that they have never told people particular things when they actually had,” study co-author Nigel Gopie, a cognitive scientist at the Rotman Research Institute in Toronto, said in a statement. “This over-confidence presumably causes older adults to repeat information to people.”

To investigate the effects of aging on destination and source memory, researchers recruited 40 college students between the ages of 18 to 30, and 40 older adults between the ages of 60 to 83. In one experiment, participants read 50 facts aloud to the images of 50 celebrities on a computer screen. Next, they were asked to remember which fact they told to which person. For example, they might have told a picture of Oprah Winfrey that “A dime has 118 ridges around it.” This experiment measured destination memory: Whom did you tell what?

In the second study, the “celebrities” read the facts to the participants, who then had to remember which celebrity told them each fact. This experiment measured source memory: Who told you what?

The results suggested that aging has little effect on source memory. Young people scored about 60 percent when recalling who told them what, while old people scored 50 percent.

However, in the destination-memory experiment, older adults scored 21 percentage points lower than younger adults.

The researchers suspect that older adults are more prone to destination-memory failure because they lose the ability to focus and pay attention with age. In other words, older adults use so much of their attention sharing the information, they forget to take notice of whom they were talking to when they shared it.

But lack of focus can also boost memory: A study published in January in the journal Psychological Science showed older people have the unique ability to “hyper-bind” the irrelevant information gleaned when they get distracted, essentially tying it to other information that is appearing at the same time.

  • 7 Ways the Mind and Body Change with Age
  • 10 Things You Didn’t Know About the Brain
  • Top 10 Mysteries of the Mind

Overly Talkative Senior?

Q1. My father has always been a good talker, but as he’s aged (he’s now in his late 80s), he has become a compulsive talker, to the point that it seems like he literally cannot stop talking. Is there any help for such a compulsion? Have you seen this in other seniors?

Excessive talking, also known as garrulity, can be associated with dementia, or cognitive impairment. It is necessary that you take your father to a doctor who can recommend a neurologist and psychologist who can perform appropriate evaluations to determine if he might be suffering from some form of dementia. From there, you can find out if any treatment options are available to help your father with the garrulity, as well as any other dementia symptoms he might be exhibiting.

Q2. At my age (51), is there a vitamin or something I can take every day to give me energy without increasing my appetite? I have no energy at the end of my eight-hour workday. And I work at a desk all day, so I don’t get any exercise.

— Margie, Texas

Feeling a lack of energy or fatigue is understandably a disturbing symptom. You have not provided your full history, but if you are on a variety of medications, they can cause fatigue. First, you should put all your medications in a bag and take them to your doctor to find out whether there are any that you can eliminate or reduce in dosage. Even if the combination of medicine is not related to your fatigue, this is a valuable exercise.

Second, you should check with you doctor to be certain you do not have a metabolic condition such as thyroid disease. Third, you should review your diet to be sure it is balanced, with appropriate representation of carbohydrates, fats, and proteins. Finally, you indicate that you don’t get any exercise. I understand completely that you feel tired and not inclined to exercise; however, it always surprises people to find that adding exercise to their lives actually adds zest and energy. Try it and see.

Q3. My husband was recently diagnosed with vascular dementia by a neuropsychiatrist, based on tests run by the doctor. His neurologist, though, doesn’t think that he has vascular dementia but is unable to confirm it because my husband has a pacemaker and defibrillator combo in his chest. They both prescribed Aricept for him. I have been doing some research on this medication and have learned of its many side effects. My husband had been nauseated and dizzy for the past two days (he’s taken five pills so far, 5 mg. each). I read that these pills can slow down your heartbeat, and he has the pacemaker and defibrillator to keep his heart functioning well. Isn’t it detrimental to his health to take the medication? Sorry I wrote so much, but this is a new Illness in our lives. Thank you.

— Judy, Arizona

This can definitely be confusing. Whenever possible, it is important to provide a clear diagnosis of vascular dementia, which is the second most common type of the dementias next to Alzheimer’s disease. In general, vascular dementia is more “spotty” since it affects specific blood vessels in the brain; on the other hand, Alzheimer’s disease is more diffuse in its effects. For that reason, intellectual insight and awareness is more apt to be preserved in vascular dementia. This condition results from repeated small strokes, which cause the death of tissues surrounding the affected blood vessels. There are suggestions of interrelationships between Alzheimer’s disease and vascular dementia. That is important and means it’s essential to control hypertension, diabetes, and cholesterol levels — all of which contribute to the risk of stroke. Thus, while your doctors were unable to confirm or eliminate vascular dementia as a diagnosis, some of the same protective steps should be taken with either form of dementia.

You are correct that Aricept has significant side effects, as do similar medications that are used to treat Alzheimer’s disease. These drugs are cholinesterase inhibitors, the purpose of which is to promote increased levels of acetylcholine, the “memory chemical,” which is depleted in Alzheimer’s disease. However, these agents have limited effectiveness and then only work for short periods of time. Therefore, it is necessary to monitor the adverse affects. If your husband’s quality of life is too impaired by the drugs, you can consider reducing or stopping their use. In short, and most unfortunately, we do not yet have major drugs to ameliorate either Alzheimer’s disease or vascular dementia.

Q4. My 94-year-old mother weighs 90 pounds and is stooped over. She stays on a 900-calorie-a-day diet because she is afraid to gain weight. She tries to rely on nonfat diet foods with no sugar. Is it dangerous for an elderly woman to be restricting her diet like this? I don’t think it’s healthy.

I would encourage your mother to increase her calorie intake if she can, but in particular, she should be eating a balanced diet. The usual formula is 30 percent protein, 50 percent carbohydrate, and 20 percent fat.

A growing body of literature suggests that caloric restriction can extend life, but only when part of a healthy, well-balanced diet. The data suggest this is true in a wide variety of species, but it hasn’t been demonstrated in human beings. Others would argue that in the later years a little added weight may be protective. It sounds as if your mother is going overboard in her decision to avoid sugar and to eat low-fat diet foods. On the other hand, she is 94, and I assume she has been on this restricted diet for some time. Sometimes, of course, people lose weight because of depression or some underlying physical condition. I assume she has been carefully evaluated for such a problem — if not, I suggest that you look into it.

Q5. Is dried fruit a good solution for constipation as I age? If so, how much is a healthy amount to take on a daily basis?

— Intesair, United Arab Emirates

Constipation is not as easily defined as one might think. It refers either to the need to strain in order to defecate or indicates infrequent or incomplete bowel movements. Constipation increases with age and may be related to many medical and surgical conditions as well as many medications. It can also come as a result of low fiber, caloric, and fluid intake. There are dietary approaches to treat constipation, which include increasing fluids and fiber: eating more vegetables, fruits (especially prunes), whole-grain breads, and high-fiber cereals. Physical activity is an important element in the treatment. Laxatives are widely overused and should be a last resort.

Q6. What do you recommend for problems in finding words?

— Nancy, Texas

Difficulty finding words is not uncommon as people grow older. Vocabulary actually grows with age but words can become difficult to retrieve. Our reaction speed also slows as we grow older. Moreover, it is difficult to deal with large amounts of information, and, of course, with age comes an accumulation of knowledge. Verbal fluency is therefore diminished, an effect that can be measured by the number of words one can recite in a particular category (for example, types of vegetables) in a fixed amount of time. Again, as we age, speed becomes an obstacle.

For someone who has a problem finding words, patience is necessary from both the person affected and his or her audience. Of course, this problem can be embarrassing at times, but there is no simple means of treatment or prevention other than quietly taking one’s time before speaking.

Q7. After MRIs, a PET scan, and neurocognitive/movement testing, my father was recently diagnosed with corticobasal degeneration. After researching the diagnosis, I’m still not sure how the doctor can be certain that it’s not Parkinson’s, Alzheimer’s, or Pick’s disease. What makes CBD unique?

— Theresa, Maryland

Corticobasal degeneration is a progressive neurological disorder of unknown cause associated with atrophy of many areas of the brain, including the cerebral cortex. This degeneration progresses gradually. Symptoms typically begin around age 60 and may first appear to affect one side of the brain, then eventually both sides. It can have symptoms similar to those of Parkinson’s disease, such as poor coordination; in addition, there can be visual impairments, muscular jerks, and difficulty swallowing. The patient may be unable to walk. Unfortunately, there is currently no successful treatment. The disease progresses slowly over six to eight years. It can be difficult to separate from Parkinson’s, Alzheimer’s, and Lou Gehrig’s disease, but I think what makes it unique is that some of its symptoms are not characteristic of Parkinson’s or Alzheimer’s, including hesitant or “halting” speech, dysphagia (difficulty swallowing), and myoclonus (muscular jerks). If your father has any of these symptoms, it may be the reason he’s been diagnosed with CBD rather than one of the other degenerative diseases.

Q8. How can I ensure that my mother gets the right nutrients now that she has such a small appetite as a senior?

— Gwen, United Kingdom

Emphasize a balanced diet of foods she enjoys, and have her eat four to five smaller meals each day. A very useful beverage product called Ensure comes in a variety of flavors and is packed with necessary vitamins. It could be very useful for your mother if she is having trouble eating complete meals. I suggest sprucing it up with whole milk, some chocolate ice cream, and chocolate syrup mixed in a blender. Such a milkshake early in the morning or at night, along with a regular diet, adds both calories and essential nutrients.

Q9. My mother is 76 years old and is losing her eyesight to glaucoma. We had always been a very close family, but my mother has become distant since we came back from a family cruise in January and has not attended any family function since then. My siblings and I are having a hard time with this: We can’t get her to a doctor (she probably hasn’t been for at least ten years), she won’t let us do anything for her, and she says some very hateful things to us. All four of us plus our children are wondering if this is a mental problem. We are all open to any feedback that you might have.

— Sue, Indiana

Loss of vision has strong emotional effects in itself and it is a marker, perhaps in your mother’s case, of increasing age and her fears about it. It is useful when a family is concerned about an older member to have a family meeting and carefully evaluate the personality of the person that is in trouble and devise a thoughtful approach. This family approach is especially useful to avoid individual conflict in approaching the parent, in this case your mother.

Once you have a consistent and comprehensive plan, I would sit down with your mother and strongly insist (you cannot use force) that she accept your help. Arrange for her to see a primary care physician to undertake an overall evaluation of her physical and emotional state. Some times a social worker, psychologist or psychiatrist can also be helpful following the discussion with the primary care doctor. It would be very useful to put any medicines your mother might be taking in a brown bag and take them to the doctor to see if any of them are having adverse effects that may contribute to her behavior. It would also be wise to visit her regularly but also to encourage her to participate in outside activities at a church or temple, senior center, whatever to help draw her out.

There are many behavior patterns in the later years. It has been said that “aging is not for sissies” and your mother’s adjustment may test all of your family’s capacities. But you are right to want to intervene now and not let the issue percolate further.

Learn more in the Everyday Health Senior Health Center.

How Dementia / Alzheimer’s Affects Communication and Tips to Help Caregivers

Last Updated: September 27, 2019
“My sick father says the wrong words and can barely understand when I’m speaking, so we both get angry and I know I’ve failed another test for caregiving. It’s too difficult sometimes. How do we talk to each other?”

Communication is how we maintain our relationships, so when dementia robs the ability to speak and understand it can strain the bonds between caregivers and their loved ones.

If two people can’t talk, how do they get along? Here we will define and understand the problem, and explain some solutions. Planning a strategy to communicate is crucial in maintaining personal connections, and in becoming a better caregiver.

How Dementia Affects Communication

As Alzheimer’s disease and other related dementias destroy brain cells, a significant symptom, known as “aphasia,” is losing the ability to speak and to understand speech. Aphasia worsens as the disease progresses. It becomes harder to remember the right words and process what others are saying. Difficulty speaking is one of the first noticeable symptoms in people with dementia, particularly those with Fronto Temporal dementia.

Dementia takes years to advance over stages, the symptoms worsening in each subsequent stage. In early stages, someone can carry on normal conversations but will simply forget a word or use the wrong words. Resuming a conversation after an interruption becomes difficult. These communication hiccups happen all the time to most people, but dementia affects the brain so that language problems become more noticeable. Someone with Alzheimer’s, for instance, won’t remember phrases, or be able to learn new phrases. Slang and common expressions become hard or even impossible to remember. Someone with dementia may start confusing the meaning of words, like saying “I want worms for dinner” instead of asking for a favorite meal, or calling a computer “the picture.” It is also more difficult for people with dementia to hold multiple ideas in their heads at once, so they may jump from topic to topic without completing a coherent sentence.

Additionally, understanding is affected. The words coming into a brain with Alzheimer’s are as confusing as what’s coming out. If someone speaks quickly – or in a high-pitched voice, or has an accent, or uses complex speech – a person with dementia will probably struggle to follow along.

Did You Know? There are free resources available to persons with dementia and their family members.
Help finding memory care communities that meet your requirements.
Help finding in-home care with dementia training.
Medicaid eligibility test and free consult on qualifying.

Loss of Communication by Stages of the Disease

Loss of communication skills follows a different pattern for different types of dementia and varies by individual. Below is a general guideline of what to expect in the different stages of dementia:

Communication Skills Loss Through the Stages of Dementia
Early dementia / Alzheimer’s Some difficulty concentrating and following conversation; difficulty finding the right words when speaking or writing; losing train of thought when speaking; repeating oneself. Usually the person with dementia is aware of these problems and may try to hide or overcompensate for them.
Moderate or mid-stage dementia / Alzheimer’s Difficulty following along with group and one-on-one conversations; losing train of thought when speaking; increased difficulty finding the right words when speaking or writing; loss of vocabulary, like proper nouns and slang terms; substituting words that sound the same or inventing new words; difficulty following storylines in books, TV shows, or movies; difficulty following directions; poor recall when telling others about recent events; increased use of gestures to communicate.
Severe or late-stage dementia / Alzheimer’s Inability to follow along with anything other than simple conversations and instructions; increased loss of vocabulary, including personal information and loved ones’ names; inability to follow storylines in books, TV shows, or movies; tendency to talk about nothing, rambling, or babbling.
End-stage dementia / Alzheimer’s Inability to speak or otherwise respond verbally; difficulty or inability to understand when spoken to; all communication may be non-verbal.

Understanding Communication Problems

Communication is how we understand and how we are understood by others, and the loss of the ability to speak or process speech correctly is absolutely devastating for someone with dementia. Worse, the breakdown of speaking ability can strain the relationship between you, as caregiver, and your loved one. Caregiving is emotional and difficult, and caregiver stress is unfortunately a very real phenomenon.
Caring for a loved one with dementia requires patience, strong listening skills, planning, and the willingness to be flexible. Confusion and misunderstandings are unfortunately common and can lead to frustrations for you, as caregiver, but especially for your loved one. Understanding and positivity are vital in all facets of caregiving, but especially with communication.

What follows is tips and strategies for maintaining communication with your loved one, even as it becomes harder and harder over time. Try, above all, to be kind, and remember that they may not know what they’re saying, but you do.

Studies have shown that using pictures (on a mobile device or picture board) can help communication after speech becomes difficult. Letting your loved one point to pictures of common items – like a light bulb or cold drink or someone who is yawning so obviously sleepy – is an effective way to express needs.

Solutions to Communicate with Persons with Dementia

Coping with Speech Problems

Speak the Language
People with dementia have been known to revert to their first language as they lose the ability to speak. If your loved one grew up speaking a different language, prepare to speak as much of it as you can.

Sing Along
People with dementia remember songs, because music and melodies are stored in a part of their brain unaffected by the disease. Singing, therefore, is a way to connect. Listening to favorite albums together can also be useful. (For more on how music helps with Alzheimer’s disease, click here.)

Minimize Distractions
Turn the radio or television off, and remove things from sight that are distracting. If possible, sit down face-to-face in a quiet, calm place.

The Approach
If they don’t see you coming, engaging someone with dementia can elicit anxiety or aggression. Approach from the front to allow time to process.

Announce Yourself
Identify yourself before starting a conversation, and refer to the person by name. This gets attention and awareness, and reminds your loved one who you are.

Talking to Someone with Dementia

Anticipate Mix-Ups
As soon as your loved one starts speaking, listen carefully and anticipate which words may be mixed up, so you can help find the right word without overcorrecting.

Annunciate
Particularly in the early stages, problems understanding can be helped by simply speaking slowly, with proper pronunciation and grammar.

One at a Time
Because people with dementia have problems with multiple thoughts at once, focus on one idea or short story at a time.

Stay Simple
Use basic language and keep anecdotes and stories brief. Discuss one topic at a time. Avoid slang, nicknames, and idioms. Only use simple explanations, and avoid logic and reasoning beyond the very basic.

How you phrase a question can make a huge difference. Asking “Yes” or “No” questions or giving a simple choice is better than open-ended questions. “Do you want chicken for dinner?” or “Chicken or steak for dinner?” is better than “What would you like for dinner?”

No Tests
Reminiscing can be healthy, but avoid asking, “Do you remember when…?”

No Baby Talk
Don’t speak in cutesy voices, or in a way that could make your loved one feel minimized. “Baby talk” is for babies.

Positively Speaking
Use positive, rather than negative, expression. For example, instead of “Not like that” say “Try it this way.”

Relax
Stay relaxed to keep the person with dementia relaxed and comfortable. Use positive body language and gestures. Maintain good eye contact.

Listening to Someone with Dementia

Be Patient
Someone with dementia may need time to find the right word. Let your loved one think and speak without interrupting. Expressing impatience or frustration will cause more frustration.

Say Again
It’s okay to repeat information and questions. If your loved one doesn’t respond, wait a moment and ask again.

Embolden
Encouraging someone to take time could give a boost in confidence. Try saying, “It’s important to me to hear what you have to say. Just take your time.”

Be Agreeable
Arguing with someone who has dementia is pointless and counterproductive. Even if you disagree, be agreeable and just change the subject. Also, don’t point out when words or names are used incorrectly; just go with it.

Be Creative
If you don’t understand, try guessing what your loved one is saying, or ask them to point or gesture. Focus more on the overall message than the literal words being spoken. Reading body language and emotions can be useful.

Going Beyond Words

Communicating with hand gestures, body language, facial expressions, eye contact, and touch will be increasingly important as dementia progresses. Try the following:

Reinforcement
If you ask your loved one about eating something, point to the refrigerator or pantry to reinforce the message.

Nod For Yes
Express agreement or disagreement by nodding “Yes” or shaking your head “No,” even as you’re saying these words.

Better Than Words
If you can say something without actually saying it, do so. A warm smile or huge conveys a message just as strongly as words.

Tips for Dealing with Specific Dementia Problematic Behaviors

  • Agitation – Individuals with dementia frequently become restless, anxious, or upset (when filling out a behavior chart, it is helpful to use specific, concrete words that clearly describe what your loved one is doing so you can truly track whether your changes work to decrease the behavior). To decrease agitation, listen to the person as he or she expresses her frustration to get a clue about what kind of antecedent is a trigger; try to eliminate and/or decrease triggers as much as possible. Pain, discomfort (being too hot, too cold, hungry, needing to use the bathroom, etc.), frustration, and overstimulation are all common triggers of agitation. It is also very important to examine your behavior in response to the person. If you are not already doing so, reassure the person that you are there to provide assistance and comfort. If it seems like the person needs something to do, try redirection to an enjoyable activity.
  • Aggression – Aggressive behavior can include shouting, cornering someone, raising a hand to someone, or actually pushing or hitting. Unfortunately, aggression among people with dementia can happen suddenly and seemingly without warning. Try to identify what triggered the aggression so that the antecedent can be eliminated or modified as soon as possible. As difficult as it may be, react in a calm, reassuring way and focus on the person’s feelings. Reduce environmental distractions as much as possible, such as loud noises or potentially frightening shadows or movements. Redirecting an aggressive person to an enjoyable activity can be remarkably effective.
  • Repetition – People with dementia often repeat a word, question, or action over and over again (e.g., saying “What are we doing today?” repeatedly). This behavior is usually harmless, but it can be unnerving and annoying for those who are caring for the person. Repetitive behavior is usually a sign of insecurity, since people with dementia are often looking for something comfortable and familiar – something over which they have some degree of control. To address repetition, look for a specific antecedent or reason for the repetition as well as for the emotion behind it. This can reduce your chances of responding impatiently with the person. If the repetition is an action, try turning it into an activity that makes the person feel useful. For example, if the person is constantly fidgeting with his hands, try giving him some socks to sort or some knick knacks to clean.
  • Hallucinations – Hallucinations are sensory experiences that seem real, but are not. The most common hallucinations are visual (i.e., seeing something that is not really there) and auditory (i.e., hearing something that is not really there), but hallucinations can also occur in regard to taste, smell, and touch. Because hallucinations seem real to those with dementia, it is not helpful to try to convince the person that she is imagining things. Instead, recognize the person’s feelings, reassure the person that you are there to help, and redirect her to a pleasant activity. Also consider whether the hallucination is actually bothersome. If it is a “nice” hallucination (e.g., seeing a pretty orchard outside that is not really there), there may be no benefit in trying to discourage the behavior.
  • Suspicion – Memory loss and disorientation can cause individuals with dementia to perceive situations inaccurately. They may become suspicious of others – even those close to them – and accuse them of theft, infidelity, or other offenses. As hurtful as it may be to be accused of something you did not do, try not to become offended. Remember that the behavior is caused by a disease that is affecting the person’s brain. Try to imagine what it would be like to continuously think your possessions are being taken or hidden (because you cannot remember where you put them). Do not try to argue with the person or convince him or her of your innocence. Instead, share a simple response with the person (e.g., “I see that you’re upset that your purse is missing; I’ll do my best to find it for you.”) and avoid giving complicated explanations. Redirection to another activity can also be effective in these situations. Another option is to store “back-ups” of commonly misplaced items (e.g., hats, wallets).

  • Apathy – Apathy is a lack of interest in or motivation to engage in activities. While apathy may not seem like a serious behavior problem, it is not healthy for someone with dementia to simply sit around passively. Try to find out what may be triggering the apathy (e.g., being ignored or becoming overwhelmed with a task) as well as what kinds of consequences may be reinforcing it (again, being ignored, not having appropriate choices of pleasant activities). Even though the person is ill, it is important to keep him or her moving and as active as possible in order to maintain physical health and to prevent depression. Try adapting previously pleasurable activities so the person can participate at a level that is comfortable and not overwhelming. Even a small amount of activity is better than none at all.
  • Confusion – Dementia often causes confusion about person, place, and time. In other words, the person may still know who he or she is, but may not recognize others and/or the current location, time, date, or year. An individual with dementia may also become confused about the purpose of objects, such as forks or pens. As frustrating as this can be for caregivers, the best way to respond is to stay calm and provide simple, clear, positive answers when the person asks for help. For example, if the person seems confused about the purpose of a spoon, simply say, “Here’s your spoon for eating your soup.” You could also calmly show the person how to use the utensil (e.g., by saying “watch me”). Never scold the person or talk to him or her in a belittling way for becoming confused.
  • Sundowning – Sundowning is a term used to describe behaviors that intensify (e.g., increased confusion and agitation) in the late afternoon and early evening, and is most common with Alzheimer’s disease. There are several theories about why sundowning occurs, such as increased fatigue (and as a result, a reduced ability to tolerate stressful situations, such as a chaotic dinnertime or a rushed bedtime routine) or increasing confusion due to darkness and shadows. The best way to approach sundowning is to make late afternoons and evenings as simple and relaxing as possible. Reduce distractions, unscheduled activities, and behaviors that could be done at a different time of the day (e.g., switch to bathing in the morning) and keep rooms well-lit until bedtime.
  • Wandering – One of the more dangerous behaviors among individuals with dementia, wandering may be goal-directed (e.g., the person thinks that he or she is going to a job or going “home” to a childhood residence) or non-goal-directed (i.e., the person wanders aimlessly). To reduce the frequency of wandering, make sure the person has plenty of supervised activity to channel his or her energy. Redirecting the person to another activity can also work. Interestingly, dementia sometimes affects perception in such a way that environmental approaches can help reduce wandering. For instance, a black square painted on the floor in front of a doorway – or simply a black doormat – may be perceived as a hole, which can prevent the person from leaving the home.

6 Diseases Linked to Communication Disorders in Seniors

Last Updated: December 26, 2018

Because our parents and senior loved ones are especially prone to ailments that can negatively impact awareness, hearing and speech, it is important to understand these issues as well as how medical professionals can treat them.

Learn more about six diseases that are linked to communication disorders in seniors.

6 Diseases Linked to Communication Disorders in Senior Loved Ones

If your parent or senior loved one is experiencing difficulty in hearing, speech or understanding, it may be worth researching theses diseases and speaking about them with your parent’s physician:

1. Alzheimer’s Disease

Alzheimer’s and related dementias can greatly hinder communication and understanding when areas of the brain responsible for comprehension and speech are damaged. While Alzheimer’s and most other common kinds of dementia are incurable and progressive, sometimes therapies can improve communication skills among people with the disease. Because Alzheimer’s is irreversible, however, people who are speaking with a loved one with the disease must be prepared to adapt their communication patterns to the situation. A recent blog article has a list of tips to help communicate with someone who is suffering from Alzheimer’s. For instance, nonverbal cues such as maintaining eye contact and smiling can be helpful when talking with a loved one with the disease.

2. Amyotrophic Lateral Sclerosis (ALS)

ALS, also commonly referred to as Lou Gehrig’s Disease, is a disabling, progressive disease that can cause difficulty speaking and swallowing, muscle atrophy and weakness. There is currently no cure for ALS and as the disease progresses, communication can become labored. Loved ones with ALS can work with occupational therapists and speech language-pathologists to mitigate speech problems, although they can they lose their ability to speak altogether.

3. Hearing Loss

According to the National Institute of Health (NIH), one in three people over age 60 experience hearing problems, and that figure increases to 50% in seniors over 80. Hearing loss can be most problematic when it’s not recognized. Recent studies have linked hearing loss to Alzheimer’s and according to the American Academy of Audiology, untreated hearing loss is also linked to depression and social isolation in seniors, so it’s important to watch out for signs of hearing difficulties. Signs of hearing loss can include avoiding social interactions, frequently asking conversation partners to repeat themselves and listening to the radio or television at unusually loud volumes. If you think that a senior loved one may be experiencing hearing loss, arrange a doctor’s visit right away. Audiologists are adept at diagnosing hearing problems and in recent years, hearing aids and other adaptive devices have become more powerful while decreasing in price.

4. Multiple Sclerosis (MS)

Multiple sclerosis can cause difficulty with both speech and understanding. While MS is typically diagnosed before old age, it is a condition that many seniors live with. Problems with the swallowing reflex which are prevalent among people with MS can cause difficulty speaking, while cognitive problems associated with MS can impede understanding. According to a study published on the NIH website, half of the people with MS have communication difficulty. The National MS Society has published an excellent guide to speech problems for MS patients and their loved ones, which includes a number of practical tips. For example, it suggests that people with MS who are struggling with their speech use a recorder to help themselves learn to correct their speech. The document also reminds family members to keep an eye out for communication problems in loved ones: “A person with MS may not notice his or her own speech problems. Many times a family member or physician brings it up.”

5. Parkinson’s Disease

Parkinson’s disease affects about 1% of seniors over 60 in the U.S. In people with Parkinson’s, damage to a region of the brain called the “basal ganglia” often causes speech problems. These problems can manifest themselves as problems with articulation, reduced fluency and voice changes; although it’s usually not until the later stages of the illness that these problems can cause the sufferer to become unintelligible. An NIH document describes three general treatments strategies for the speech problems caused by Parkinson’s:

  • “Communication-oriented strategies” involve educating and empowering the listener to better understand the person with Parkinson’s. For example, family members of people with Parkinson’s are taught active listening to help them understand their loved one.
  • “Low-tech augmentative and alternative communication” (low-tech ACC) aims to help people with more advanced speech problems through a strategy known as alphabet supplementation, where “a speaker points to the first letter of each word on an alphabet soundboard as it is spoken.
  • “Speaker-oriented” treatments help the person with Parkinson’s compensate for speech problems independently through instruction and practice.

6. Stroke-Related Aphasia

Aphasia is a disorder that impairs one’s ability to use and understand language. The leading cause of aphasia is stroke and one in four people who have a stroke will develop aphasia, according to the National Stroke Association. There are several different categories of aphasia and no two person’s symptoms are completely the same. Many people do recover, at least somewhat, from aphasia, but the Stroke Association says that recovery is not likely when symptoms have persisted for more than six months after the stroke. Speech therapy is the primary treatment for aphasia, although other approaches have been tried as well. One interesting therapy is known as “melodic intonation therapy,” whereby patients are sometimes able to sing words and phrases that they cannot speak.

Does a parent or senior loved one in your family have communication disorders? How have you persevered and overcome the challenge? We would like to hear your stories in the comments below.

  • Communication Strategies for Dementia
  • Communicating With Your Parent’s Doctor
  • How to Better Advocate for Your Parent or Senior Loved One

How to Effectively Communicate with Seniors with Dementia

People with dementias don’t only have difficulty expressing thoughts and emotions, but also have trouble understanding others.

Dementia isn’t a specific disease. Instead, dementia describes a group of symptoms affecting memory, thinking, and social abilities severely enough to interfere with daily functioning.

Dementia indicates problems with at least two brain functions, such as memory loss and impaired judgment, and the inability to perform some daily activities such as paying bills or cooking meals. Alzheimer’s disease and other dementias also gradually diminish a person’s ability to communicate.

Difficulty with Senior Communication: Look for Clues

Changes in the ability to communicate are unique to each person with dementia. The family and/or caregiver may recognize changes such as:

  • Using familiar words repeatedly
  • Inventing new words to describe familiar objects
  • Easily losing his or her train of thought
  • Reverting back to a native language
  • Having difficulty organizing words in a logical way
  • Speaking less often

Communication With Elders During the Different Stages of Alzheimer’s and Other Dementias: What to Expect

In the mild (early) stage, an individual is still able to participate in give-and-take dialogue, have meaningful conversations, and engage in social activities. However, he or she may repeat stories, have difficulty finding the right word, or feel overwhelmed by excessive verbal stimulation.

The moderate (middle) stage is typically the longest and can last for many years. As the disease progresses, the person will have greater difficulty communicating and will require more direct care.

The severe (late) stage may last from several weeks to several years. As the disease advances, the person may rely on nonverbal communication such as facial expressions or vocal sounds. Around-the-clock care is usually required in this stage.

The Best Ways to Communicate to Seniors with Alzheimer’s or Dementia

People with Alzheimer’s and other dementias have more difficulty expressing thoughts and emotions; they also have more trouble understanding others. Here are some ways to help you be successful at communicating:

Before You Speak to Seniors with Alzheimer’s or Dementia:

  • Stay composed. Take a moment to calm yourself.
  • Remain focused. Consider what you are going to talk about, and what you want to achieve from the conversation.
  • Try to always be positive. Show it in your voice and body language.
  • Be the main focus. Make sure you have the person’s full attention, and that the person can see you clearly. Try to make eye contact, and If the person is seated or lying down, move down to that level.
  • Minimize distractions. Get rid of background noise, such as the TV, radio, or other people’s conversations.
  • Match your body language with your words. Make sure that your body language and facial expression convey what you are saying.
  • Never stand too close. It can feel intimidating. Instead, respect the person’s personal space, and allow the person to feel more in control of the situation.
  • Use physical contact. Show that you care by holding or patting the person’s hand or putting your arm around him or her.

How to Speak to Seniors with Alzheimer’s or Dementia:

  • Speak clearly, calmly, and without raising your voice. Be aware of speed and clarity. Use a gentle and relaxed tone—a lower pitch is more calming.
  • Speak at a slightly slower pace. Allow time between sentences for the person to process the information and to respond.
  • Include the person in conversations with others to help to reduce feelings of exclusion and isolation.
  • Avoid confusing and vague statements. If you tell the person to “hop in the shower”, he or she may interpret your instructions literally. Describe the action directly: “Please come here. Your shower is ready.” Instead of using “it” or “that,” name the object or place. Rather than “Here it is”, say “Here is your hat.”
  • Repeat information or questions as needed. If the person doesn’t respond, wait a moment. Then ask again.
  • Turn questions into answers. Provide the solution rather than the question. For example, say “Your dinner is right here,” instead of asking, “Are you ready for dinner?”
  • Turn negatives into positives. Instead of saying, “Don’t go there,” say, “Let’s go here.”
  • Try to laugh together about misunderstandings and mistakes. Humor can bring you closer together, and relieve the pressure.

What to Say to Seniors with Alzheimer’s or Dementia:

  • Identify yourself. Approach the person from the front and say who you are. Keep good eye contact.
  • Call the person by name. It helps orient the person and gets his or her attention.
  • Use short, simple words and sentences. Lengthy requests or stories can be overwhelming.
  • Offer a guess. If the person uses the wrong word or can’t find a word, try guessing the right one.
  • Avoid asking too many direct questions. People with dementia can become frustrated if they can’t find the answer. If you have to, ask questions one at a time, and phrase them in a way that allows for a ‘yes’ or ‘no’ answer.
  • Try not to ask the person to make complicated decisions. Give them a choice. Too many options can be confusing and frustrating.
  • Avoid criticizing or correcting. Don’t say he or she is incorrect. Instead, try to find the meaning in what is being said, and encourage him or her to communicate their thoughts.
  • Avoid arguing. If the person says something you don’t agree with, let it be. Arguing usually only makes things worse—often heightening the level of agitation for the person with dementia.

How to Listen to Seniors with Alzheimer’s or Dementia:

  • Listen carefully to what the person is saying.
  • Be patient and supportive. The person may need extra time to process what you said. Let the person know you’re listening and trying to understand.
  • Listen for clues. If the person has difficulty finding the right word or finishing a sentence, ask them to explain it in a different way.
  • Remain sympathetic while listening. If the person is feeling sad, let them express their feelings without rushing or dismissing them. This will show that you care.
  • After listening, get affirmation. When you haven’t understood fully, tell the person what you have understood and check with them to see if you are right. Repeat what was said if it helps to clarify the thought.
  • Use your best judgement. Some people won’t remember things such as their medical history, family, and friends. You will need to and act appropriately. For example, they might say that they have just eaten when you know they haven’t.

With Elders, Keep Communicating, and Be Respectful

Always remember to treat a person with dementia with dignity and respect. Don’t talk about them as if they are not there, or talk to them as you would to a young child─and be very patient. Offer them ongoing comfort and reassurance, too. If he or she is having trouble communicating, let the person know that it’s okay. Encourage the person to continue to explain his or her thoughts, no matter what.

  • “Communication and Alzheimer’s.” Alzheimer’s and Dementia Caregiver Center. Alzheimer’s Association. Web. 2015.
  • “Alzheimer’s: Tips for Effective Communication.” Healthy Lifestyles, Caregivers. Mayo Clinic. Web. 2013.
  • “Advice for Nurses and Other Healthcare Professionals: Communication”. Alzheimer’s Society. Web. 2015.

6 tips for dealing with a compulsive talker | San Luis Obispo Tribune

Dealing with a compulsive talker? There are ways to help curb that behavior, according to retired San Luis Obispo therapist Linda Lewis Griffith. Dean Hollingsworth Dallas Morning News/MCT

I recently attended a dinner party where one of the participants talked the entire evening.

He told long, boring stories about his latest exploits. He interrupted others when they tried to speak. If anyone interjected their own experiences, he reverted the conversation back to himself.

This otherwise pleasant, affable man seemed oblivious to the reactions of his fellow diners. He failed to notice their obvious disinterest or recognize that they might have something to say.

When someone finally managed to divert the dialogue, Mr. Talkalot’s eyes glazed over and he got up to get more food. As soon as he returned to the table — you guessed it — he picked up the monologue where he’d left off.

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This person is a compulsive talker, a behavior most often associated with attention-deficit/hyperactive disorder (ADHD).

According to the American Psychiatric Association, symptoms of hyperactivity and impulsivity include excessive talking, blurting out answers, having difficulty waiting one’s turn in a conversation and interrupting or intruding on others.

Compulsive talkers can also be argumentative and short-sighted. They have trouble seeing others’ viewpoints or listening to what they have to say.

They may come across as rude and disrespectful, taking a “My way or the highway” stance and being unwilling to back down.

Some compulsive talkers are so annoying that folks avoid them at social gatherings.

Disgruntled listeners feel compelled to resort to normally unacceptable strategies, such as telling the offender to stop talking or butting in with stories of their own. Perhaps they resent being overlooked in conversations, as if they were less important. At the very least, they’re exhausted by the overtalker’s non-stop gabbing and having to wait for a split second of silence when they can finally speak.

Of course, overly loquacious people aren’t bad. In fact, they’re often uber friendly and tons of fun to be around. The goal is to harness their verbal energy so everyone gets a chance to talk.

Here are a few tips for dealing with compulsive talkers.

How to deal with a compulsive talker

Attempt to redirect the conversation. Without being confrontational, introduce another topic and ask others to share their thoughts.

Intervene. Kindly say, “Mary, you’ve gotten to talk for a while. I want to hear about Doug’s new job.”

Point out the pattern of interrupting. Kindly but firmly stop the overtalker in his tracks and say, “Matt, I asked Hillary a question and you cut her off. Please let her continue.”

Talk to the overtalker privately. If the behavior is interfering with meetings or family gatherings, take the offender aside, apprise him of your concerns and express the impact his actions are having on others. If you’re in a position of authority, develop a strategy for helping him change.

Leave the room. Sometimes the best answer is to let the compulsive talker hold court out of earshot. After all, some folks may be enjoying the conversation.

Orchestrate gatherings. Expand your guest list to include other talkers. Overtalkers are less offensive in large crowds and easier to tolerate with outgoing people in the room.

Linda Lewis Griffith is a retired marriage, family and child therapist who lives in San Luis Obispo. Reach her at [email protected]

What causes non-stop talking in an elderly person (80s) ?

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