Judd Matsunaga
Just because your aging parent dismisses your concerns, ignores safety issues or refuses to accept help, that doesn’t mean he or she has lost mental capacity. Diminished capacity is not lack of capacity. In fact, the only person that can legally declare someone “incapacitated” is a judge. If that hasn’t happened, someone who has cognitive impairment maintains all their legal rights and should be treated with respect.
However, communicating with someone who has dementia can be an extremely difficult and tricky process, especially because an elderly parent’s ability to understand others and express themselves can fluctuate from day to day (or even hour to hour). When communication between the two parties gets muddied, the consequences are typically felt on both sides. Frazzled nerves can lead to lost tempers, straining the bond between the caregiver child and the aging parent.
Millions of American families face daily interactions with someone whose memory and thinking skills are progressively declining. “When there’s a mismatch in communication, it can generate frustration,” said Katherine Lyman, a geriatric nurse practitioner at Harvard-affiliated Beth Israel Deaconess Medical Center. “The person with dementia may be overwhelmed; the caregiver can get upset. When you’re struggling, it takes so much patience.
“Relating to someone with dementia depends at least in part on which stage of the disease they’re in,” Lyman continued. “If their dementia is still mild, that’s different than when they’re in later stages, where someone may not be verbally communicating.”
Across the spectrum of cognitive impairment, certain communication strategies can smooth interactions between caregivers and dementia patients. Harvard experts suggest the following communication strategies:
- Be an active listener. Look directly at them while speaking, nod affirmatively and use other body language to let them know you’re tuning in. “Try to remain fully engaged, even if it’s only for five minutes,” said Dr. Suzanne Salamon, clinical chief of gerontology at Beth Israel Deaconess Medical Center. Active listening may also involve gently rephrasing the person’s wording if something seems garbled. “Can you detect a thread that you can reframe and ask, ‘Am I hearing this correctly?’” Lyman said. “That may help.”
- Don’t confront. If, for instance, you ask Mom if she took her pills and she says yes — but you notice the medication is still in her pillbox — avoid a standoff, Dr. Salamon advised. “Instead of saying, ‘I can’t believe you lied,’ or ‘Look, you forgot,’ you can wait a few minutes and say, ‘It looks like your pills are still in your pillbox — why don’t we take them now?’ and not even refer to her forgetting. If it’s not an emergency, just drop it for a few minutes and come back to it as if you haven’t talked about it before.”
- Agree with their reality. Trying to correct someone whose perceptions are altered by dementia never brings them back to your reality, Lyman said.
- Remove distractions. Even someone without dementia may struggle to listen and speak when the TV or radio is on or kids are running around. These stimuli are even harder to field for someone with cognitive problems. “If you’re trying to have a conversation, pick a place where there’s minimal distractions, a quiet place, one on one,” said Lyman.
- Use shorter sentences and smaller words. Dementia patients often can’t absorb much information at a time, so keep language simple. Break any tasks down into steps. “Start out with one or two sentences, since by the time you get to sentence three, they’re lost,” said Dr. Salamon.
- Ask yes-or-no questions. “‘Would you like a cup of tea?’ may work better than ‘What would you like to drink?’” said Lyman.
- Don’t interrupt or assume. It may be tempting to try to finish someone’s sentences or assume what they mean when they’re grasping for words. Fight the urge. “If they’re not able to find a word, ask, ‘Are you meaning to say this?’ or ‘Is this what you’re talking about?’ But give them time to try to work it out,” said Dr. Salamon.
- Write it down. Verbal communication isn’t always the best choice. Lean on lists and schedules to help guide someone with dementia toward activities, especially those they might resist.
- Use touch. Dementia can be a lonely experience, but loving attention and touch can connect you beyond words. “Holding hands can be extremely reassuring to them,” said Dr. Salamon.
Still, even if you’ve done your best to incorporate as many of the above suggestions and they’re not working, briefly disengage before tempers fly and things are said that cause division. “If your frustration is building, that’s when you tell the person, ‘I’ll be back in 15 minutes.’ Turn on the radio or TV for them and walk away for a bit,” said Lyman. “It’s important to take a moment to decompress.”
If you’re at your “wit’s end,” Lyman also suggests seeking support before you “blow a fuse.” Lyman often refers dementia caregivers to the Alzheimer’s Assn. to join a support group. “When you’re in it 24/7, it’s very lonely,” she said. “You think you’re the only one dealing with this, and you’re not. It’s so helpful to meet with others who are struggling with the same things.”
Finally, before it becomes too late, make sure your power of attorneys are up-to-date. One of the simplest, least expensive and smart estate planning documents for an older adult to have is a durable power of attorney document. A DPOA is a written document where an individual authorizes a trusted friend or family member (the “attorney-in-fact”) to act on the individual’s behalf regarding property and financial matters.
A power of attorney allows you to choose who will act for you and defines his or her authority and its limits, if any. Make sure to also name an “alternate” agent in case the primary agent cannot act.
If you do not have a POA and become too ill to manage your personal or business affairs, it may be necessary for a loved one to petition a court to appoint a legal guardian or conservator of your property. Do not assume that being married means you do not need a POA. If you become incapaciated without a POA, the court could appoint someone you don’t even know, i.e., a stranger, to control your loved one’s assets. That’s, as they say down South, “No bueno.”
Judd Matsunaga is the founding attorney of Elder Law Services of California, a law firm that specializes in Medi-Cal Planning, Estate Planning and Probate. He can be contacted at (310) 348-2995 or. The opinions expressed in this article are the author’s own and do not necessarily reflect the view of the Pacific Citizen or constitute legal or tax advice and should not be treated as such. Click here to read past columns.
