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Section 1
Alzheimer's Caregiver: Interaction

Question 1 | Test | Table of Contents | Introduction | Geriatric & Aging CEU Courses
Social Worker CEU, Psychologist CE, Counselor CEU, MFT CEU

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On this track, we will discuss Positive Interaction Techniques which can be used by the caregiver of an elderly person with Alzheimer’s. Included on this track are four basic rules for positive interactions. The four basic rules for positive interactions discussed on this track are stay pleasant, calm, and reassuring, help maintain self-esteem, use simple sentences, and use nonverbal clues.

I have found that positive interaction techniques are productive in helping an elderly person with Alzheimer’s understand what is being communicated. Would you agree that as a patient loses the ability to communicate with words, he or she may still understand nonverbal cues?

4 Positive Interaction Techniques

Technique #1 - Stay Pleasant, Calm, and Reassuring
An elderly person with Alzheimer’s may mirror the caregiver’s feelings. To gain productive results, the caregiver may need to stay pleasant, calm, and reassuring. Jeff’s father, Howard, age 83, had slowly lost most of his language skills with the progression of Alzheimer’s, however Howard’s expressive aphasia was not yet complete. For example, Howard would try to tell Jeff something and be unable to say the word he wanted. He then would then get frustrated, which resulted in having more trouble speaking.

Howard had the most trouble with nouns and adjectives.  Specific names and descriptive words eluded him. When Jeff was helping him dress, Howard would try to tell Jeff that he wanted to put on his brown shirt, but he would lose the words. Or, Howard would use the word ‘bath’ to fill in the blank for a word he could not say.  For example, Howard might state, "I want to put on my brown bath." Howard knew that he wasn’t communicating clearly, but he did not know why.  After gesturing at his torso, Howard had to wait for Jeff to understand. 

Instead of showing his frustration or despair, Jeff would stay pleasant, calm, and reassuring. Jeff stated, "It’s really hard to deal with my father sometimes.  But I just try to relax and treat him like I would want to be treated.  You know, that golden rule thing." Could the caregiver of the client you are treating benefit from receiving these reminders to stay pleasant, calm, and reassuring? Perhaps you could play this track for him or her.

Technique #2 - Use Simple Sentences
Next, Jeff used simple sentences because they are easily understood. However, you have probably experienced that oversimplification can lead to anger. I find it best to speak to mildly impaired patients as normally as possible. For example,  Jeff would guide Howard to the closet, pick a shirt, show it to Howard and state, "What about this one?"  At the other extreme, even the best communication techniques and use of simple sentences may not work with extremely impaired patients. Do you agree?

Technique #3 - Help Maintain Self-Esteem
In addition to staying pleasant, calm, and reassuring and using simple sentences, the third basic rule for positive interaction is to help maintain self-esteem. Jeff knew he had to allow extra time for dressing and other tasks. But when time was short, Jeff found that he could ease the process by helping maintain Howard’s self-esteem rather than getting impatient.

Jeff would simply get the appropriate clothes for Howard and state, "You always look great in this, Dad." Jeff would make sure Howard was looking right at him. Howard saw the warm facial expression and smile.  Howard also heard Jeff’s calm voice. By helping Howard maintain self-esteem, Jeff was engaging in a positive interaction instead of the more negative reaction which may feel more natural to the caregiver of a person with Alzheimer’s. 

Technique #4 - Use Nonverbal Clues
Jeff would also use other nonverbal clues. Jeff would accompany his instructions to Howard with a hug or a gentle shoulder rub. This usually worked because Howard interpreted Jeff’s actions as meaning he was not angry or impatient. Howard felt that Jeff was simply making a suggestion.Think of your Howard. Could these techniques for positive interaction benefit your client? Would it be helpful to play this track for the caregiver of your client?

On this track we discussed positive interaction techniques which can be used by the caregiver of an elderly person with Alzheimer’s.  Included on this track are four basic rules for positive interactions. The four basic rules for positive interactions discussed on this track are stay pleasant, calm, and reassuring, help maintain self-esteem, use simple sentences, and use nonverbal clues.

On the next two tracks we will discuss managing difficult behaviors. The next track will focus on analyzing behavior. In order for the caregiver to continue with an ongoing assessment of the patient’s Alzheimer’s and associated behavior, I have found five steps which may be useful when analyzing behavior. These five steps regarding analyzing behavior are deciding if the behavior is a problem, what the problem really is, with whom the problem occurs, where the problem occurs, and when the problem occurs.

Peer-Reviewed Journal Article References:
Carling, M. A. (2003). Review of Counseling the Alzheimer's caregiver: A resource for healthcare professionals [Review of the book Counseling the alzheimer's caregiver: A resource for healthcare professionals, by M. S. Mittelman, C. Epstein & A. Pierzchala]. Families, Systems, & Health, 21(4), 435–437.

Moreau, N., Rauzy, S., Viallet, F., & Champagne-Lavau, M. (2016). Theory of mind in Alzheimer disease: Evidence of authentic impairment during social interaction. Neuropsychology, 30(3), 312–321.

Schulz, R., Belle, S. H., Czaja, S. J., Gitlin, L. N., Wisniewski, S. R., & Ory, M. G. (2003). Introduction to the special section on Resources for Enhancing Alzheimer's Caregiver Health (REACH). Psychology and Aging, 18(3), 357–360. 

What are four basic rules for positive interactions? To select and enter your answer go to Test.

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