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Alzheimer’s etiquette: Stay calm, accept the patient’s reality

When talking to people with Alzheimer's, approach from

When talking to people with Alzheimer's, approach from the front so the person can see, hear and understand you best, and reintroduce yourself every time you enter the room. Photo Credit: Fotolia

During a routine trip to my local grocery, I ran into an acquaintance I had not seen in more than a year. She looked great and was her typically upbeat, energetic self. We exchanged hellos. I was not prepared for what came next.

“I was recently diagnosed with early-stage Alzheimer’s,” she said.

This warm, accomplished, Berkeley-educated woman, a mother and grandmother who was my go-to person for local political goings-on, great books and recipes, then said, without skipping a beat, “I am doing OK right now, and I have signed up for a clinical trial.”

I hugged her and told her how sorry I was. Told her there are no words. In a daze, I finished my shopping. Driving home, I burst into tears.

It was many months later that our paths crossed again. I saw her across the room at our local synagogue. She was not close enough to say hello. In a way, I was relieved. Would she recognize me? And if not, what do I say?

According to the Alzheimer’s Association, as many as 5.4 million Americans have the disease. For friends and relatives, there is the inevitable question of how to act.

“We know when we are friends with someone with Alzheimer’s and interacting in a variety of settings, we may do our best to do the right thing and say the right thing,” said Ruth Drew, director of family and information services at the Alzheimer’s Association. “But it may not always be the right thing.”

If you find yourself in a similar situation, here are a few tips from experts for interacting with Alzheimer’s patients:

  • There is no point debating a faulty fact or memory. The person with dementia truly believes the statement, so arguing will probably cause only conflict and stress. And even if the patient acquiesces, he or she almost certainly will not recall doing so.
  • Embrace their reality. The disease is going to give the patient a view of the past — and even the present — that is different from yours. These people have forgotten who has died, they aren’t sure what year it is, etc. So if someone with dementia says, “When can we go see my mom?” and you know that the mother is dead, you would not say, “Your mother is dead.” You could instead say, “Let’s go tomorrow” and move on to another subject. The goal here is not truth but finding a way to avoid upsetting the person.
  • Don’t give a lot of instructions, but do ask the patient to help. Everyone wants to be helpful. The word “help” is key. Can you help me set the table? Or fold the laundry?
  • Reintroduce yourself every time you enter the room. You do not want to assume that the patient knows you, especially if you’re not a family member or close friend. But even relatives should expect this to be necessary as the disease progresses. You don’t want to scare someone with dementia by suddenly appearing at the person’s side. You’ll want to approach from the front so that the patient can see, hear and understand you best.
  • Do not quiz. Asking such things as “Do you remember what you had for breakfast?”; “When’s your birthday?”; and “Don’t you remember my name?” can very upsetting for someone who cannot remember. Instead, offer gentle reminders: “The eggs you had for breakfast seemed good.” “Look who’s here: It’s your grandson James.”
  • Choose simple words, and use a calm voice.
  • Don’t act upset in front of the person if he or she doesn’t recognize you or says something that doesn’t make sense, and don’t talk as if the patient isn’t there.
  • Minimize distractions (turn off the television or radio if that won’t upset them) to help them focus on interacting.
  • Make eye contact when speaking, and call the person by name, making sure you have his or her attention before you start to talk. Allow time for a response — sometimes it can take a while — and try not to interrupt when the patient is speaking.

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