Alzheimer’s and Communication
Alzheimer’s disease is a chronic progressive degenerative condition which often causes deterioration in cognitive function beyond what is expected during normal ageing. The condition often starts slowly and progressively worsens with time (Burns & Iliffe, 2009). The most common early symptom of the condition is short-term memory loss, which eventually develops into dementia in 60 to 70% of the cases. In later stages of the disease, the affected present with problems with language, behavioural issues, disorientation and mood swings (World Health Organization, 2015; Burns & Iliffe, 2009). This progressive deterioration often leads to withdrawal. In the long run, bodily functions are lost and this leads to death within three to nine years following diagnosis (Todd, et al., 2013).
The cause of the condition is poorly understood. A greater risk is attributed to a genetic issue involving several genes (Ballard, et al., 2011). Whereas other risk factors are a history of either hypertension, depression or head injuries (Burns & Iliffe, 2009). According to Ballard et al., (2010), the disease process is characterised with plaques and tangles in the brain. This causes the destruction of brain tissue areas responsible for the sending, receiving and processing of messages. Persons suffering from the condition increasingly rely on caretakers for assistance through the progression of the disease.
Effect of Alzheimer’s on communication channels
Despite the differences in presentation in the three stages of the condition, all persons with the condition experience some focal language disorders which impact specific language functions while not affecting memory and intellect functions (Frank, 1994). Further on, Frank (1994) claims that communication in Alzheimer's goes through 3 phases. Communication deficits in the first phase are basically in the context area of lexical access and refined conversation skills. The second phase is characterised by increased difficulty in content areas (including a decline in memory function, and increased difficulty in concept formation). The third phase involves all of the presentations of the last two phases but the presentation may be more severe in terms of memory and intellectual deficits (Egan, et al., 2010).
In mild Alzheimer’s the patient can participate in meaningful conversations but may repeat the details, they may also be unable to find the right words, may substitute an incorrect word, or may not find any word completely. In moderate Alzheimer’s the patient has difficulty in communication evidenced by losing more words, thinking longer before expressing themselves, loses spontaneity, and the vocabulary gets limited. Whereas in severe Alzheimer’s the patient may rely on non-verbal communication (vocal sounds or facial expressions) as they often tend to lose the capacity for recognisable speech (Alzheimer's Asscociation, 2016; Alzheimer's Society of Canada, 2016).
The Role of a Speech Therapist in Alzheimer’s
Speech therapists play a central role in screening, assessing, diagnosing and treating persons with Alzheimer’s and other forms of dementia (American Speech-Language-Hearing Association, 2016). A speech therapist is involved in both the management of communication, cognitive and swallowing deficits. Speech therapists help the patient function at the best level through the remainder of the course of the disease. The goal of intervention by speech therapists in the case of Alzheimer's is not rehabilitative but rather facilitative or palliative (American Speech-Language-Hearing Association, 2016).
Specialists specifically attend to the cognitive aspects of communication, which include memory, attention, executive functioning and problem-solving.
Speech therapists help the patient to preserve communication and cognitive functioning for the longest time possible. To achieve this, a speech therapist may have to develop alternative communication strategies that will help the patient voice their wants and needs in an effective way. The goal is to allow the patient use the abilities that they are in possession within their interaction with caregivers, family, and friends.
Strategies Used by Nurse to Facilitate Communication with an Alzheimer’s Patient
Some of the strategies adopted include the use of written cues to facilitate memory recall, use of ‘memory blocks’ to help the patient remember details about his/herself and training caregivers and family members of strategies for better communication with the patient (American Speech-Language-Hearing Association, 2016). According to the recommendations of the Alzheimer’s Society, to facilitate communication between the nurse and the patient, approach them from the front, use names carefully, use body language and tone of voice carefully, avoid patronising them, minimise competing noise and also allow them to retain control through the conversation. To encourage verbal feedback, some of the suggested strategies include giving the patients simple choices, use of objects and pictures, reducing the amount of information being conveyed, giving them time to respond, rephrase questions when necessary, and also try to know as much as possible about the patient beforehand (Alzheimer's Society, 2016).
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Alzheimer's Society of Canada, 2016. Day to Day Series - Communications, Ontario: Alzheimer Society of Canada.
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Egan, M. et al., 2010. Methods to Enhance Verbal Communication between Individuals with Alzheimer's Disease and Their Formal and Informal Caregivers: A Systematic Review. International Journal of Alzheimer's Disease, p. 906818.
Frank, E. M., 1994. Effect of Alzheimer's disease on communication function.. Journal of The South Carolina Medical Association, 90(9), pp. 417-23.
Todd, S., Barr, S., Roberts, M. & Passmore, A. P., 2013. Survival in dementia and predictors of mortality: a review. International Journal of Geriatric Psychiatry, 28(11), p. 1109–1124.
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