The Yellow Sheet
Compassionate Communication with the Alzheimer’s Disease Patient
By Liz Ayers, An employee and volunteer of the Alzheimer’s Association and a former caregiver
Don’t remind them they forget.
Don’t question recent memory.
Don’t take it personally!
Give short, one sentence explanations.
Repeat instructions or sentences exactly the same way.
Allow plenty of time for comprehension.
Eliminate “but” from your vocabulary; substitute “nevertheless.”
Agree with them or distract them to a different subject or activity.
Accept the blame when something’s wrong (even if it’s fantasy.)
Leave the room, if necessary, to avoid confrontations.
Respond to the feelings rather than the words.
Be patient and cheerful and reassuring. Do go with the flow.
My appeal to you: Please elevate your level of generosity and graciousness.
They are not crazy or lazy. They are saying normal things, and doing normal things for Alzheimer’s Disease (AD) patients. If they were doing things, or saying things to deliberately aggravate you, they would have a different diagnosis.
Some days they’ll seem normal, but they’re not. Their reality is now different than yours and you cannot change them. You can’t control the disease. You can only control your reaction to it.
Their disability is memory loss. They cannot remember and can’t remember that they cannot remember. They’ll ask the same question over and over, believing it’s the first time they’ve asked.
They do not hide things; they protect things by putting them in a safe place. Do not take “stealing” accusations personally.
They are scared all the time. Patients react differently to fear. Some may become passive, uncooperative, hostile, angry, agitated, verbally abusive, or physically combative. The may even do them all at different times, or alternate between them. Anxiety may compel them to shadow you (follow you everywhere.)
EXAMPLES FOR COMMUNICATING
Patient: “What doctor’s appointment? There’s nothing wrong with me.”
Don’t Reason: “You’ve been seeing the doctor every three months for the last two years. It’s written on the calendar and I told you about it yesterday and this morning.”
(short explanation) “It’s just a regular checkup.”
(accept blame) “I’m sorry if I forgot to tell you.”
Patient: “Nobody’s going to make decisions for me. You can go now…and don’t come back!”
Don’t Confront: “I’m not going anywhere and you can’t remember enough to make your own decisions.”
(accept blame or respond to feelings) “I’m sorry this is a tough time.”
(reassure) “I love you and we’re going to get through this together.”
(distract) “You know what? Don has a new job. He’s really excited about it.”
DO REPEAT EXACTLY
Patient: “I’m going to the store for a paper.”
Don’t Repeat Differently: “Please put your shoes on…You’ll need to put your shoes on.”
(repeat exactly) “Please put your shoes on…Please put your shoes on.”
DON’T REMIND THEM THEY’RE FORGETTING
Patient: “Joe hasn’t called for long time. I hope he’s okay.”
Don’t Remind: “Joe called yesterday and you talked to him for 15 minutes.”
(reassure) “You really like talking to Joe don’t you?”
(distract) “Let’s call him when we get back from our walk.”
Patient: “I didn’t write this check for $500. Someone at the bank is forging my signature.”
Don’t Reason: “What? Don’t be silly! The bank wouldn’t be forging your signature.”
(respond to feelings) “That’s a scary thought.”
(reassure) “I’ll make sure they don’t do that.”
(distract) “Would you help be fold the towels?”
DON’T TAKE IT PERSONALLY
Patient: “Who are you? Where’s my husband?”
Don’t Take It Personally: “What do you mean—who’s your husband? I am!”
(go with the flow, reassure) “He’ll be here for dinner.”
(distract) “How about some milk and cookies?…Would you like chocolate chip or oatmeal?”
DO ELIMINATE “BUT” – SUBSTITUTE “NEVERTHELESS”
Patient: “I’m not eating this. I hate chicken.”
Don’t Say But: “I know chicken’s not your favorite food, but it’s what we’re having for dinner.”
(say nevertheless) “I know chicken’s not your favorite food, (smile) nevertheless I’d appreciate it if you’d eat a little bit.”
DON’T ASK QUESTIONS OF RECENT MEMORY
Patient: “Hello Susie, I see you’ve brought a friend with you.”
Don’t Question Memory: “Hi, Mom. You remember Eric, don’t you?…What did you do today?”
(short explanation) “Hi, Mom. You look wonderful! This is Eric. We work together.”
“Once dementia is diagnosed, the patient is excused 100% of the time.”
Adapted from Alzheimer’s: A Handbook for the Caretaker by Eileen H. Driscoll, R.N., Branden Publishing Company.
You can also download a printable version of this here: Compassionate Communication (printable version)