Joan was distressed. Speaking to me over the phone, her voice tight with tension: “TUESDAY.” She shouted. “THE APPOINTMENT IS ON TUESDAY. That is TOMORROW. Will you pick me up? IT SAYS TUESDAY. ON TUESDAY CAROLINE WILL TAKE you to your appointment.” She was reading from our communication notebook. Cognitive impairment and hearing loss made it difficult for her to read the words on the page, speak them aloud and then wait for an answer. Poor short term memory made it difficult for her to retain my answer.
Joan: “Caroline. CAROLINE are you there?”
Caroline: “Yes, Joan. I’m here. *pause* I will pick you up. *pause*”
J: “I don’t understand. Tomorrow. What time will you pick me up.”
C: “Joan.” *pause*
J: “Caroline. What time will you pick me up?”
C: “Joan.” *I’m waiting for her attention to shift.* *she gives an exasperated sigh*
C: “Joan. Turn your head to the right. *pause* Look at your clock.”
J: “I am looking at my clock.” (I know she isn’t. She’s looking at her phone.)
C: “Turn your head to the right and look at the date on your clock.”
J: “Hold on.”
(There is a pause over two minutes long)
J: “Caroline. Caroline it says it is November 23d. What does that mean?”
C: “Joan. Today is November 23rd. Monday.”
J: “Caroline your note says you will pick me up on Tuesday. Tuesday December 1st. I’ve already forgotten. What’s today?”
C: “Today is Monday, November 23rd.”
J: “Oh. But you are picking me up on Tuesday?”
Over the course of two phone calls and a total of 30 minutes, Joan calms and is able to put the pieces together “I don’t have to worry anymore.” She concludes. “I don’t need to call you again.” She reassures herself. “You’ll pick me up and I’ll wait for you.”
5 AgeWise strategies for Communicating with individuals with Cognitive Impairment
- It begins with a breath. Slow and deep to calm yourself. Things I tell myself: “She will repeat herself. This may take a minute. I can help her calm by being calm.”
- Speak slightly slower than usual. This allows time for them to process your words.
- Use short sentences and eliminate extra words. Instead of providing my response all at once: “You don’t have to worry, I’ll be there to pick you up for your appointment on Tuesday next week at noon.” I answer her specific question simply. She asks: “Is my appointment on Tuesday” I answer. “Yes.” She asks: “When is my appointment.” I answer, “Next week *pause* on Tuesday.”
- Maintain positive or neutral tone. Communicating requires a great deal of work for someone with cognitive impairment. Your tone will influence their experience of that work. Projecting frustration can easily promote distress.
- Eliminate barriers to hearing and focus. Whenever possible, position yourself to have good eye contact and allow for them to read your lips. Speak slower than you think you need to. Reduce other noises and/or visual stimulation.
For more communication tips visit: https://www.alzheimers.org.uk/site/scripts/documents_info.php?documentID=130