1. Communicating With Patients Who Have Alzheimer's Disease By: Danielle Ham, SPTA

2. Objectives  What is Alzheimer’s Disease?  Alzheimer’s Disease Facts  Changes in Communication  Helping Alzheimer’s Patients Communicate  Caregivers

3. What Is Alzheimer's Disease?  Alzheimer's disease is a progressive degenerative disorder that attacks the brain's nerve cells, or neurons: resulting in loss of memory, behavioral changes, thinking and language skills.  Alzheimer's disease and other dementia's gradually diminish a person's ability to communicate.

4. Alzheimer’s Disease Facts  An estimated 5 million people aged 65 and over have Alzheimer’s disease. Another 200,000 people under age 65 have younger-onset Alzheimer’s disease.  Every 68 seconds, an American develops Alzheimer’s. In 2050, an American will develop the disease every 33 seconds.  Alzheimer’s is the sixth-leading cause of death in the United States overall and the fifth-leading cause of death for those aged 65 and older.  Alzheimer’s is the only cause of death among the top 10 without a way to prevent it, cure it or even slow its progression.  In 2013, Medicare and Medicaid will spend an estimated $142 billion caring for those with Alzheimer’s and other dementias.

5. Changes In Communication  Repeated stories  Trouble with word finding  Using familiar words repeatedly  Speak less often  Easily lose train of thought  Have difficulty organizing words logically  Difficulty expressing emotions and thoughts  Have trouble understanding others

6. Helping Alzheimer's Patients Communicate  Understand behaviors  Be patient and supportive  Offer a guess and be attentive  Encourage unspoken communication  Limit distractions  Short and simple words  Maintain eye contact  Validate patient

7. Understanding Behaviors  Aggression and Anger– Verbal or physical. Suddenly, with no apparent reason or result from a frustrating situation.  Anxiety and Agitation- They may become restless, causing a need to move around or pace  Depression- very common, especially during the early and middle stages.  Hallucinations- They may see, hear, smell, taste or feel something that isn’t there.  Memory Loss and Confusion- May not remember familiar people, places or things.  Repetition- May do or say something over and over, they may undo something that has just been finished.  Sleep Issues and Sundowning- May have problems sleeping or increases in behavioral problems that begin at dusk.  Suspicion and Delusions- Suspicious of those around them, even accusing others of theft.  Wandering- May not remember their name or address and can become disoriented, even in familiar places.  Abuse- can occur anywhere, including at home and in care settings. Also from people who take advantage of their cognitive impairment.

8. Be Patient and Supportive  Try not to interrupt  Encourage patient to express thoughts and feelings  Show that you care about what the patient is saying  Avoid correcting, criticizing, and arguing

9. Offer a Guess and Be Attentive  If a patient can't find the right word try guessing the right word  Be careful not to cause unnecessary frustration  Show that you are listening  Use gentle relaxed voice and friendly facial expressions

10. Encourage Unspoken Communication  If you don't understand, ask the person to point or gesture  Adapt to their way of communicating  Acknowledge facial expressions

11. Limit Distractions  Reduce background noise  Keep hands away from face when talking  Avoid mumbling  Speak naturally; Don't shout  Find a quiet place that supports the persons ability to focus

12. Short and Simple Words  Ask one question at a time  One step commands  Avoid pronouns; Identify persons and things by name  Rephrase rather then repeat

13. Maintain Eye Contact  Gain patient's attention  Visual communication is very important  Approach the person from the front  If patient is sitting go to their level slowly to talk to them  Call the patient by his or her name

14. Validate Patient  Validate what the patient has to say  Forget the fact you need to tell them the truth  The truth is not their world

15. Caregivers  In 2012, 15.4 million family and friends provided 17.5 billion hours of unpaid care to those with Alzheimer’s and other dementias – care valued at $216.4 billion.  Nearly 15 percent of caregivers are long-distance caregivers, living an hour or more away from their loved ones. Out-of-pocket caregiving costs are nearly twice as high for long-distance caregivers compared with local caregivers.  More than 60 percent of Alzheimer’s and dementia caregivers rate the emotional stress of caregiving as high or very high; more than one-third report symptoms of depression.  Due to the physical and emotional toll of caregiving, Alzheimer’s and dementia caregivers had $9.1 billion in additional health care costs of their own in 2012.

16. Just Remember  Their changes in communication  Their behaviors are altered  Validate their world  Remember the caregivers and any support you can give.

17. References  http://www.webmd.com/alzheimers/guide/improving-communication http://www.webmd.com/alzheimers/guide/improving-communication  http://www.alz.org/care/dementia-communication-tips.asp http://www.alz.org/care/dementia-communication-tips.asp  http://www.alzfdn.org/AboutAlzheimers/definition.html http://www.alzfdn.org/AboutAlzheimers/definition.html  http://www.alz.org/alzheimers_disease_what_is_alzheimers.asp http://www.alz.org/alzheimers_disease_what_is_alzheimers.asp  http://ptjournal.apta.org/search?submit=yes&submit=Submit&pubdate_year= 2009&volume=89&firstpage=569&doi=&author1=&author2=&title=&andorexac ttitle=and&titleabstract=&andorexacttitleabs=and&fulltext=&andorexactfullt ext=and&fmonth=&fyear=&tmonth=&tyear=&format=standard&hits=10&sortsp ec=relevance&submit=yes http://ptjournal.apta.org/search?submit=yes&submit=Submit&pubdate_year= 2009&volume=89&firstpage=569&doi=&author1=&author2=&title=&andorexac ttitle=and&titleabstract=&andorexacttitleabs=and&fulltext=&andorexactfullt ext=and&fmonth=&fyear=&tmonth=&tyear=&format=standard&hits=10&sortsp ec=relevance&submit=yes