This is Part 5 in a series. Please see the bottom of this article for a link to the first four parts of the Family Caregivers Communication Class.

We take talking with our parents for granted . . . until our aging parents can’t speak any longer.

My mom gradually stopped speaking and since October 2007 she only utters a few words or phrases occasionally. When she does speak, the words are often unintelligible, don’t make sense, nor relate to the conversation around her. I didn’t know it at first, but this medical condition is called aphasia. I thought it was just part of the progression of her Alzheimer’s disease.

What My Instincts Told Me To Do

As my mom became less talkative, I found myself looking for different ways to connect with her. These are some of the techniques I’ve used successfully:

Have eye contact with your aging parent before you speak. This helps my mom to focus on my words and facial expression.

Talk slowly, enunciate clearly and keep your sentences short. Put only one thought into a sentence. When I do this, Mom seems to follow some of what I’m saying.

Aphasics haven’t lost their intelligence, just their ability to speak. They are like a baby who understands and responds to language even before they can say words, phrases and/or sentences. I think my mom understands more than she can express.

Be inclusive when you speak. I tell my mom about all family news, events and contact from friends far and wide. I’m not even sure she knows who I’m talking about due to her memory loss, but I share happy things with her all the time. In my heart, I think she understands. I also avoid sharing bad news, either local or global, because why upset her? In my opinion, it’s just not necessary.

Add nonverbal communication into your conversations. Many times I “cuddle her up” which means lots of hugging, kissing, and massaging. Even if we don’t talk, she can feel my love for her through the sense of touch.

Watch your Golden Oldie closely when talking with them. While they may not verbalize, be alert for other ways they are “speaking” to you. My mom will nod ever so slightly or move her head side-to-side in response to a simple “yes” or “no” question, such as “Do you want to look at this book with me?” Sometimes she’ll look away, and I take that as a “Not interested” response. She also communicates in different ways with her eyes — raising her eyebrows at people at times, or closing her eyes tightly when she doesn’t like something.

Even if the words are gibberish, the inflection in her voice makes me think she’s saying something important to her. I reply in a similar tone to reassure and encourage her. Sometimes I say, “Mom, I didn’t quite understand you. Can you repeat it please?” But she isn’t able to.

Bring visual aids to enhance your “conversations.” I often bring cards I’ve gotten in the mail, some flowers, a stuffed animal, picture books, or photos (both old and new) to share with her and focus our attention on together. Seeing something she likes will spark a few words at times.

What I’ve Learned About Aphasia

Aphasia is an impairment in the ability to speak and understand others, and people with aphasia may have difficulty reading and writing, too. While it is most common among older people, it can occur in people of all ages, races, nationalities and gender. The most common cause of aphasia is stroke; about 25-40% of stroke survivors acquire aphasia. It can also be a result of head injury, brain tumor, or other neurological causes.

Aphasia affects about 1 million Americans, or about 1 in 250 people. More than 100,000 Americans acquire the disorder each year. As in my case, most people have never heard of it until they are facing it with a loved one.

There are many types of aphasia. Some people have trouble speaking, while others have a hard time following a conversation. In some people aphasia is fairly mild and you may not notice it right away. In other cases it can be severe and will affect all communication skills — speaking, writing, reading and listening.

Through my research I’ve found the additional tips below from the National Aphasia Association for communicating with our aging parents who have aphasia:

• During conversation, minimize or eliminate background noise (such as TV, radio, other people) as much as possible.

• Other modes of communication can include writing, drawing, and gestures.

• Give them time to talk and let them have a reasonable amount of time to respond. Avoid speaking for the person with aphasia except when necessary and ask permission before doing so.

• Keep communication simple but adult. Reduce your own rate of speech. You don’t need to speak louder then normal, but do emphasize key words.

• Don’t talk down to the person with aphasia. Their intelligence is still intact; don’t let others assume they are mentally retarded or mentally ill.

People who have aphasia as a result of a stroke or head injury may recover their ability to speak and communicate in time.

Aphasia and Alzheimer’s Disease

The impact of aphasia on relationships varies from family to family. My mom’s aphasia is part of her progressive brain deterioration due to Alzheimer’s disease. She will never recover her ability to speak, because the ideas and thoughts that she could express are disrupted along with her ability to communicate.

When my mom speaks I wonder if she’s thinking “What the heck happened to me?” because her words don’t come out right. Or does she think she’s communicating perfectly clearly? I’ll never know the answer to these questions. She doesn’t appear frustrated, so in my heart I hope she’s not.

What has been your experience caring for someone with aphasia?

What are your tips on how we can better communicate with them? Please write them in the comment section below.

Click here to read the first Four Parts of the Family Caregivers Communication Class.

This is Part 4 in a series.

You can read Part 1 “Think Before You Speak” here.

You can read Part 2 “Speaking Easily About Difficult Topics” here.

You can read Part 3 “Dealing with Pessimistic Aging Parents” here.

I recently spent eight days traveling with my cousins and one Golden Oldie aunt, age 90, who is hearing impaired and uses hearing aids. On our trip we visited another Golden Oldie aunt, age 95, who is completely deaf and whose hearing loss, unfortunately, cannot be helped by hearing aids. While this experience is fresh in my mind, It seems appropriate for me to share some valuable tips about communicating with seniors who have hearing loss.

Start With the Basics

This is probably obvious, but it could have a big impact on your Golden Oldie’s hearing ability: Be sure their hearing aid is turned on, fitted and adjusted properly and the batteries are charged. Many people who use hearing aids complain that background noises are amplified along with the sounds they are trying to hear, so no hearing aid is perfect. But insure that your aging parent has been to an audiologist, is following their recommendations and goes for re-checks if they are having any problems using the hearing devices successfully.

Considerations Before You Speak

Make sure your aging parent sees you approaching so you don’t startle them. If they don’t notice your approach, gently touch them on the arm or shoulder to make them aware of your presence before you begin speaking. Do not speak to them from behind or from their side.

Once you have their attention and focus, stand or sit directly in front of them. Have your face at the same level as their’s. Positioning yourself 3 to 6 feet away is optimal for listening and lipreading if they are able to do so.

Check the lighting to be sure you are not back lit and your parent isn’t just looking at a dark silhouette against a bright background. Try to have lighting directly on your face and check that the sun or a bright light isn’t shining right into their eyes.

Reduce or eliminate background noise as much as possible (such as music, TV’s, fans, or other conversations). While this isn’t always possible, there are helpful choices you can make. For example, eating in their home rather than going out to a dark and noisy restaurant where conversation may prove difficult or next to impossible.

If you go out to a restaurant or event with your hearing impaired Golden Oldie, strategically choosing a seat can improve their ability to hear. When possible, my aunt sits with her back to a wall because that means that she is only bombarded with sound from 180 degrees rather than 360 degrees. The wall deadens the sound somewhat, and if there is some textured covering, it even can muffle the bounce of sound.

Face-to-Face Conversations

Speak slowly and clearly in a normal tone of voice. Do not shout. Do not over exaggerate your lip movements. Using simple and short sentences may make it easier for your parent to comprehend.

If your Golden Oldie doesn’t understand what you are saying, try rephrasing it in different words to get your message across. Repeating the same words may lead to frustration for both parties.

Try not to jump from subject to subject. Let your Golden Oldie know that you’re changing the topic and check to make sure your aging parent is then focused on the new discussion.

Write your words down for them to read. We used a spiral notebook with my aunt who is deaf. We would write to her, and she would read our words and then speak her answer. An unexpected side benefit is that she now has a written record of our visit and can enjoy our visit over again by reading the notebook. When using this technique, be sure the lighting in the room is adequate. My aunt’s living room is dimly lit and I suggested to the caregivers that they add a halogen lamp in the rooms she uses most frequently, so she can more easily read the words people write to her.

You can make up a notebook with pictures or phrases often used in conversation with your parents that family or paid caregivers can then utilize.

Charades Anyone?

Utilize nonverbal means of communication to supplement your words. Provide visual cues through your facial expressions and natural gestures. I found myself using “Thumbs up” and “Thumbs down” gestures quite often with my aunts last week if we found ourselves in noisy places. Even someone untrained in lip reading can enhance understanding with nonverbal clues they see.

It helps if you do not chew gum or eat while talking. Keep your hands away from your face, too. If your Golden Oldie clearly sees your lips, they can connect what they’re trying to hear with the visible lip movements.

More Important Guidelines

My Golden Oldie aunt’s constant message to everyone is that louder is not better. When people raise their voices the sound becomes distorted, incomprehensible, and even painful because of hearing aid amplification.

If your Golden Oldie is tired or not feeling well, their ability to hear and comprehend may be less than usual.

Be inclusive. Sometimes my cousins and I would find ourselves chattering on around my two aunts who had no clue about what we were saying. One of us would then take the time to either speak slowly or write to them to keep them included in the conversation.

Be patient and kind. It may take a little longer and a little more effort to speak with your hearing impaired aging parents, but it will be well worth it to reach your goal of having many enjoyable and meaningful conversations with them.

Kindness is the language which the deaf can hear and the blind can see.

~ Mark Twain

If you have any other tips or suggestions, please write them in the Comments below. I love to learn from you, too!

This is Part 3 in a series.

You can read Part 1 “Think Before You Speak” here.

You can read Part 2 “Speaking Easily About Difficult Topics” here.

“For every minute you are angry, you
lose sixty seconds of happiness.”
~ Ralph Waldo Emerson

The two previous classes covered skills and strategies for talking about serious topics with our aging parents. However, what do you do to communicate with your aging parents when they are difficult people in and of themselves? By “difficult” I mean aging parents (or as I call them Not-So-Golden Oldies) who complain, whine, think negatively and/or have a pessimistic outlook on life.

Being able to communicate effectively with them in spite of their complaints matters. There are important issues you need to discuss (and often decisions to make) at this stage in their lives, so how do you get past their negativity and have fruitful conversations?

Here are several strategies that will help you connect with these extra-negative aging parents.

It’s Not Always What You Say That Matters

Nonverbal communication is one component that can make a big difference. Research has proven that in face-to-face conversations, body language accounts for 55% of what people notice and believe about the person speaking. So when you are speaking with your Not-So-Golden Oldies, try to sit or stand at eye level with them, which sends a message of respect and equality.

While speaking, reach out and touch them gently on the hands, arms or shoulders as a way to reassure them you are actively listening and focused on them. A kind touch will send messages of both comfort and caring. And before you part, give as many hugs as you can, even if the conversation didn’t go as well as you had hoped.

Words that Work

Use “glad, sorry, sure” statements to reassure your aging parent. For example, “I’m glad we talked about driving at night not being a good idea any longer. I’m sorry you got upset. I’m sure we can figure out a solution that will keep you and others safe.”

Use “separately, first” to focus on one issue at a time. Sometimes your Not-So-Golden Oldies will try to avoid a topic by bringing up other issues and sending the conversation off on a tangent. To get the discussion back on track say, “I’d like to talk about that also but separately. First, let’s figure out what we want to do about this issue.”

Combating Pessimism on Several Fronts

Take a solution-based approach. Ask your difficult parent to come up with three potential solutions to their problem. This will help them to focus on solutions, make them feel more in control of their lives, and also neutralize the negative energy around them.

Find a new project, hobby, volunteer job or “duty” for your Not-So-Golden Oldies to participate in. Give them something to do that will result in success, praise and positive reinforcement for a job well done. Success will increase their self-esteem and create a more positive attitude. The more positive experiences they have, the more pleasant their overall outlook will become.

Make them feel good about themselves. Show genuine appreciation when they do something that helps you. Be lavish in your praise. If possible, give words of encouragement or pay them compliments every time you are together. Everyone has redeeming qualities, even your whining Not-So-Golden Oldies, so find something good you can compliment them on. Remember they are often dealing with strong emotions on a day-to-day basis that could be pulling them down.

After they’ve vented about their list of complaints, immediately say to them, “Now tell me something positive.” Some aging parents don’t know how negative they’ve become. At first they will be astonished at your request, but by repeatedly giving them this gentle reminder, they may realize they don’t want to be such negative people and start to be more positive — at least around you!

Practice Compassion

It can be very hard to be kind and compassionate in the face of constantly disagreeable parents. You may be able to make a positive difference in their world, even if it is only for a short time. And you could be the catalyst that helps them become more of an optimist again, and able to enjoy their remaining years in a happier frame of mind.

Practicing kindness pays huge dividends. Trust in yourself, try the different techniques given above with your Not-So-Golden Oldies, and let me know how it goes in the comment section below. Something tells me you won’t be disappointed.

What other techniques have you used in dealing with pessimistic Golden Oldies or other people in your life? Feel free to add your experiences and tips in the comments below.

[Note: People who are overly negative may suffer from depression. If you suspect that a family member is possibly depressed (beyond having a pessimistic attitude), have them seek evaluation and treatment from their doctor as soon as possible.]

Outside Resources:

Communicating With Difficult People by Deborah Mackin

Dealing with Difficult People: 27 Secrets & Strategies You Can Apply Today by Colleen Kettenhofen

Dealing With The Negative People In Your Life by Alex Landis

This is Part 2 in a series.

You can read Part 1 “Think Before You Speak” here.

Last week I recommended that you think before you speak about difficult topics with your aging parents. This week I am adding one more important pre-communication strategy, along with communication guidelines for these discussions.

Think About Your Aging Parents’ Perspective

While I call senior citizens “Golden Oldies” out of respect for their life experiences and wisdom, you may have heard elderly people say that this stage of life is not so golden by any means. Think about how you might feel when you reach your 70’s, 80’s and beyond.

Changes happen to their bodies, minds and lives that they may have no control over.

For example, worsening eye sight and/or hearing, slowing down of reflexes and thinking, some forgetfulness, seeing friends become ill or die, having less energy to accomplish daily tasks, or recognizing the role reversal that’s occurring as they feel less in charge of their lives and their grown children are making more and more suggestions!

How would you feel in their place?

Afraid? Worried? Frustrated? Angry? Depressed?

Keep in mind that your aging parents are most likely feeling these strong emotions on a day-to-day basis. Then perhaps you can open your heart and speak from a place of compassion as well as with your practical goals in mind for the conversation. You may find great resistance to your ideas, or resistance to even broaching these tough issues. And this resistance is probably coming from your parents’ emotions, and not as a response to you personally. Try to hold onto this thought as you navigate through choppy waters!

“Kind words are the music of the world.”
~ F. W. Faber

Do’s and Don’ts for Caregiver Communication

[Note: These skills are for conversations with your Golden Oldies who do not have any cognitive impairments (i.e. dementia, Alzheimer's disease). Specific skills for that situation will be covered in an upcoming class in this series.]

• Even though your roles may have reversed, do not speak to your aging parents as if they are your children and you are their parents. Speak with them as you like to be spoken to — as equals, with respect and kindness. Don’t use a judgmental or condescending tone of voice.

• Stay calm and don’t lose emotional control. Try to avoid arguing, even though family members are often most highly skilled at “pushing each others’ buttons.” If your parents object to your ideas, try explaining them again. If you recognize the conversation is going downhill, see if you can turn it around by staying “on message” in a positive way.

• Use “I” statements rather than “You” statements. For example, instead of saying “You should . . .” or “You’ve got to . . .” use phrases such as “I think . . .” “I was hoping we could . . .” or “I’d like it if we . . . .” This is another reason to think carefully about what you want to say before you begin and to rehearse your words in advance.

• Use the 3-F formula (feel, felt, found). Avoid using the words, “I know how you feel” because your Golden Oldies will be thinking, “Oh no, you don’t!” Instead, use the 3-F’s: “I can see that you feel anxious about moving into assisted living. I think Aunt Regina and Uncle Frank felt that way too when they had to move. However, they found that after a few weeks, it really wasn’t as bad as they had anticipated.”

• Acknowledge your parents’ objections kindly. Don’t counter a potentially negative response immediately. Use a verbal cushion such as “I appreciate your fears about turning your checkbook over to me to pay your bills . . . Can you say more about why you think this may not work out?” Try to get to the crux of their objections.

• Paraphrase and ask questions for better understanding. Repeat what your parent said in your own words: “If I understand you correctly, you’re thinking that . . . .” This can also be done with emotions: “I sense that you’re feeling depressed about this.” Ask “how” and “what” questions to try to get your parents to share more of their concerns. Keep a dialogue going by not asking questions that can be answered with a simple “yes” or “no.”

• Practice active listening, which means listening attentively. Really focus on what your parents are saying, without thinking ahead to what ideas you want to respond with.

• When you reach a conclusion or solution, double-check to insure everyone is on the same page: “Am I clear that these steps, X, Y and Z, are what you want to do next?”

• You may have to agree to disagree and revisit the topic at another time. Finish the conversation on a positive note, with gratitude that you and your Golden Oldies have started a discussion about whatever the issue is. Be sure to leave them with kind words, affection and appreciation for the efforts they’ve just made in communicating with you.

“Never part without loving words to think of during your absence. It may be that you will not meet again in this life.”
~ Jean Paul Richter

What other techniques have you found work well when talking over tough issues with your Golden Oldies? Or with other family members?

Please add them in the comments below . . .

Outside Resources:

Communicating With Difficult People by Deborah Mackin

Dealing with Difficult People: 27 Secrets & Strategies You Can Apply Today by Colleen Kettenhofen

A girlfriend recently told me she had “The Talk” with her mother as spokesperson for all of her siblings. To which I replied, “Cindy, exactly which ‘Talk’ was it?”

As family caregivers you will most likely have more than one conversation with your aging parents on topics that are uncomfortable or difficult to discuss. These might include hiring in-home caregivers when more assistance is needed, moving out of their homes into assisted living, giving up driving, facing medical concerns and end-of-life issues, making decisions about funerals, wills and estates, plus a myriad of other issues.

This series will provide you with skills and strategies to ease these types of serious conversations. Future parts of this series will cover: talking with negative-thinking seniors, how to talk with seniors showing signs of dementia, and how to communicate with seniors who have physical impairments, such as vision loss, hearing loss or aphasia (not being able to speak). If you have a communication issue with your aging parents you’d like me to add, please feel free to contact me directly.

OK, let’s get started!

Communicating Is More Than Speaking & Listening

When we think about communicating, two aspects come to mind immediately — speaking and listening. However, when you are going to speak about important topics with your aging parents, it would be wise to think things through carefully on your own before you actually talk with them.

Think ahead about what your goal is for the conversation. Become familiar with what your concerns and motivations are, so you can express them clearly. Do you need to learn everything about your parents’ financial status, or do you have a more specific need, i.e. do they have long-term care insurance? Do they need to hire in-home caregivers or should they consider a move to assisted living? Focus on the specifics of what you want to cover.

Consider why a topic is difficult for you to broach with your Golden Oldies. For example, many of us are fearful of speaking about death and dying, especially with the people we love. Think through your own fears or insecurities on a subject first, so you can come to terms with the ideas yourself to some degree. Otherwise your emotional reactions may get in the way of communicating clearly with your parents.

For example, about twelve years ago, I had to tell my parents about a possible life-threatening illness and surgery I was facing. I was so incredibly nervous about telling them the bad news! Before I broached the subject, I figured out that I was worried they wouldn’t be able to handle the bad news I was going to tell them. Then I realized that I was being ridiculous! They were already in their 80’s at the time, and had been through many struggles during their lives. They had already taught me by example multiple times they were great at “rolling with the punches.” By thinking this through, I was able to lower my anxiety greatly and made our resulting conversation much easier from my perspective. (And they were wonderful in their calm reaction and supportive response to my health problem too.)

Be clear on this point: Are you doing this with your Golden Oldies or for them? Are they able to actively participate in the discussion and resulting decision? If it’s a safety issue, they may not have veto power over the decision you see necessary. This will definitely effect how you will present the problem and possible solutions. Or decide if it is something that really is their decision and you’re just sharing your opinion about it with them.

Image credit: gutter’s photostream

Bring notes. Do your research ahead of time to gather information you may want to present. While writing down your ideas, your brain “practices” what you want to say to your Golden Oldies. In this way you have the words to use in mind rather than reacting emotionally on the spot. And what words we choose to use definitely matter when the topics are emotional ones!

A letter can also be a way of easing into a hard subject. You can write a note ahead of time expressing your worries and your desire to have a discussion with your loved ones. This will allow your Golden Oldies time to think about the topic and gather their ideas as well. A friend of mine actually had her husband write a letter to her aging parents about her concerns, because she realized they had always communicated better with her husband over the years on important family matters.

Carefully select your time to start the conversation. If you know your aging parents are more energetic in the morning, you may want to see them then rather than later in the afternoon when they are more likely to need a nap. It may seem obvious, but catching seniors at their optimal time of day can help discussions go more smoothly. You as family caregiver should also feel well-rested and relaxed when you know you will be tackling a hard subject. Don’t start a deep discussion when any of you are feeling stressed or tired, mentally or physically. And select a place free of distractions or interruptions. Make sure there is ample time for the discussion and that none of you will have to head off to another activity or appointment.

Don’t rush the conversation to a conclusion because that could prove frustrating to you and your aging parents. As we age, it takes longer to do things, and that includes thinking things over as ideas unfold. This is especially true if it is the first time you’re broaching a hard subject. Many of the potentially emotional topics will need to be discussed several times before decisions are reached. Realize that fact going in and don’t try to rush your Golden Oldies into making decisions.

On the other hand, do not avoid conversations if they involve the safety of your aging parents or other people around them. It is easy to put off emotional conversations, but that won’t make the decisions any easier. Waiting will only increase the potential risk to your aging parents and others. And it is always better to make decisions beforehand, and not when you’re all in the midst of a family crisis.

Do you have any pre-communication strategies that you have used with your aging parents? Please share them in the comments below.

If you have any other family caregiver communication topics you’d like addressed in this series, please either leave them in the comments below or use the Contact form above to reach me.