How do you say hello to someone with Alzheimer’s Disease?
Early, slowly, and often.
“With people with Alzheimer’s and related dementias,” says Dr. Deborah Bier, “we have to be prepared to enter their reality. Their brains are changing, so they can’t come to us. We need to go to them.”
The occasion is a training session for employees of Caring Companion Home Care in Concord, MA. Dr. Bier, or rather Debbie, as I think of her, is my supervisor. There are seven of us, elder companions all, grouped on sofas and chairs in a lofty, whitewashed room in a renovated mill. We range in age from mid-twenties to early sixties, and in national origin from Uganda to the United States.
“Say we want to approach someone with dementia who’s sitting at the dining table,” Debbie continues. “What’s the first step we need to take?”
Approach from the Front
The first step, we learn, is to approach the person from the front, not from behind. Why? So they can see us coming. Changes in the brain due to dementia dramatically reduce the person’s field of vision.
“One of the big differences that happen when you have dementia is your vision changes,” says occupational therapist and dementia caregiving trainer Teepa Snow in her video, Aging Vision and Alzheimer’s, which we watch during our training session. “Not only color, awareness, and your ability to process that, but actually your field of vision. When we’re young, we can actually see all the way out to the side in our peripheral vision, top and bottom.” She stretches her arms out straight on either side and moves them in a big circle.
“As we age,” Snow continues, “our abilities go down, and we aren’t able to pay attention to quite as much. Our field closes in a little. By the time we’re 75, this is a normal visual field.” She bends her elbows a bit, narrowing the circle.
“But when you have dementia, close it down tight. By mid-disease, [the visual field] is about 12 inches around. What that means is it feels like you’re wearing binoculars. So move around in your environment with binoculars and see how everything changes.”
At this point in the training, I flash back on a memory. It was late on a snowy evening, several years ago. I was working in the memory care unit of a residential facility, trying to get one of the residents to sit down on his bed.
“It’s right behind you,” I said, patting the mattress vigorously and sweating with exertion. “See? It’s right here.”
“Aha!” I think, tuning back in to Snow’s presentation. “That’s the point! He couldn’t see the bed.”
“As a caregiver,” says Snow, “the more you know about the brain and how it works, and what changes when someone has dementia, the better your caregiving opportunities and skill set.”
I like that phrase, “caregiving opportunities.” As our training day moved on, I felt as though something within me had been awakened, some altered sense of empathic imagination. If my clients with dementia see the world as if through binoculars, surely I can present myself properly in their field of view. If the processing speed of their brains slows down, surely I can move slowly so that they’ll have time to process my approach. Otherwise, I risk triggering a fearful or angry reaction.
In summary, here are the steps that I learned from the training about how to say hello to someone with Alzheimer’s disease or a related dementia:
- Approach your loved one or client from the front. This enables them to see you coming, despite their narrowed field of vision.
- Move slowly as you approach. This makes it easier for them to process what’s happening, cognitively.
- Stand to the side. This brings you to a supportive, rather than confrontational, stance.
- Bend down or squat, if the person is seated. This brings you to eye level.
- Say their name and tell them your name. This helps them “place” you.
- Hold out your hand at their eye level and shake hands. This enables you to communicate with the kindness of human touch, safely and respectfully.
Finally, be ready to reintroduce yourself to your person with dementia as you come and go in the room. Particularly with someone in the later stages of the illness, the ability to track what is going on, to remember what just happened, is lost or highly compromised. Call them by name, tell them who you are and what you’re going to do, and create opportunities for connection between the two of you.
“Making a warm, positive connection with the dementia patient is the key to all care tasks,” Debbie says as our training session draws to a close. Saying a skillful hello to someone with Alzheimer’s disease requires that we come with an intention of acceptance, a willingness to meet their gaze and to imagine the world through their eyes.
Somehow I am reminded of the teachings of Buddhist monk Thich Nhat Hanh, who said, “When you love someone, the best thing you can offer is your presence. How can you love if you are not there?” As a care partner of someone with Alzheimer’s, I know that every moment we are together matters to both of us: every step, every gesture, every word, every smile.
Image credit: Caring Success — What You Need, by Roy Blumenthal via Wikimedia Commons.