Suggestions that may help you and your loved one communicate more effectively.

As people age, it’s natural for them to have sight and hearing losses. As the eyeball continues to grow longer and as the lens thickens and yellows, people don’t see as well as they used to. Diseases like diabetes can also impair vision.

And when age reduces people’s ability to hear high-frequency sounds, including sibilants like the letters “s” and “f,” they don’t hear conversations as well as they used to.

Stroke, voice-box removal or brain damage can limit or eliminate someone’s ability to speak, while confusion—either from short-term causes like infection or medications, or long-term causes like Alzheimer’s disease—can make communication difficult at best.

The first step in improving communication under these conditions is making occasions for it to take place. Given the frustrations, it’s easy to make excuses not to talk or listen, but if you make the time, you can:

• Give someone homebound, who’s not in touch with many people, important human contact with the outside world.
• Mutually express feelings and avoid resentments.
• Grow closer to the person you’re caring for.

This is especially important because keeping lines of communication open helps you both address any problems as early as possible. So:

• Make time to talk, even though it might be just over a cup of coffee or during television station breaks. It will mean a lot to both of you.
• Find common interests. If you can’t, then don’t be afraid to talk about yours. If friends drop by, try to include your relative in the conversation.
• Be patient, especially if your relative is confused or has impaired speech. Let them have time to finish sentences, and resist the natural temptation to finish sentences, interrupt or speak for them.
• Despite physical impairments, your relative is still likely to be mentally alert. So treat them with respect; never patronize them or talk down to them like children.
• Being left alone in a corner seeing and hearing others talking can make your relative feel isolated and worthless. So always include him or her in group conversations.

When Your Relative Has A Hearing Loss

• Think about how you pitch your voice and how fast you talk. Lower and slower will make you easier to hear and understand.
• It also helps to sit facing someone with impaired hearing; seeing your lips will make your words more understandable.
• Use body language and gestures to help get the point across.
• Learn sign language if your relative is deaf, or develop special signs between you.
• Properly fitted hearing aids can help your relative communicate better and live more independently, as can specialized telephones and personal and portable amplifiers, and the National Association for the Deaf can give you information or a whole range of additional aids.

When Your Loved One Has A Visual Impairment

Sight loss can slowly develop from gradual aging, or it can strike as suddenly as a disease or injury. It can involve anything from wearing thick glasses to seeing only straight ahead, to seeing blank spaces or blurs or only light and darkness.

• Make an effort to avoid nonverbal responses, such as nods or headshakes. Remember that body language, like outstretched arms or facial expressions, may be un-seeable.
• Smiling when you talk is one exception to this rule; your relative may not see it, but it will come through when you speak.
• When you first approach a blind person, always say, “Hello,” followed by a reassuring pat on the arm or shoulder or a handshake. If it’s someone you don’t know, introduce yourself.
• Don’t be afraid to use common expressions like, “Nice to see you”; even blind people say it.
• If other people join you, address your relative by name or lightly pat his or her arm to signal you’re speaking to them.
• When you’re leaving, say so, so he won’t be left talking to himself. To give relatives with impaired sight more independence at home, make sure frequently used personal items are always kept in the same place, where they can be more easily found.

Special writing aids help visually impaired people write in straight lines, while Braille and large-print and audio-cassette books help them read and write. Being registered as blind by an ophthalmologist can qualify your relative for a whole range of services and equipment that make living and communicating easier; the American Association for the Blind can give you more information.
 
Confusion And Memory Loss

Confusion can cause memory loss, or memory loss can cause confusion. So can infection, dehydration or medication. Someone who clearly remembers an event that took place ten years ago may completely forget something you said ten seconds ago. He or she may keep asking you the same question over and over again—not just because they forgot your answer, but because they forgot they even asked the question.

In addition to being very patient, there are practical communication steps you can take to help confused relatives remember things and become less dependent on you:

• Whenever possible, communicate at the time something has to be done, and always use active phrases. “It’s time to take your medicine” works better than saying, “You need to take your medicine at three o’clock” hours before.
• Make written reminders specific—“Your appointment with Dr. Goldman is 11 AM on Thursday, May 16,” not “Doctor appointment Thursday.”
• Make your questions direct ones. “Would you like tea or coffee?” rather than “What would you like to drink?”
• Leave written reminders to encourage independence, but first discuss them to minimize resentment over your relative’s home being cluttered up with bossy messages.
• Make sure all clocks and calendars are correct. Set alarm clocks for times your relative needs to take medication.
• List the things that are happening that day—visitors, outings, appointments and the like—on a notice board.
• Place reminder notes—“Have you turned off the oven?” for example—in strategic places.

Impaired Speech

When stroke, voice-box removal or brain damage limits or eliminates a relative’s ability to speak, that places an extra burden on you as the caregiver. Because in addition to talking clearly, respectfully and reassuringly, you now have to decipher what your relative wants to say. Exactly what and how heavy this burden is can often depend on what caused the speech loss:

• Someone who had his or her voice box removed is probably more prepared for speech loss. A special device may be fitted to permit speaking with air belched from his stomach. With time and patience for learning how to use it, the two of you can have normal conversations.
• Someone brain-damaged may be able to speak but unable to find the right word. While this can be mutually frustrating, with patience you can learn to understand your relative’s needs.
• Just as the name implies, the speech loss that strokes cause can be sudden. Your relative will literally have to be taught how to speak again. Meanwhile, knowing but being unable to communicate needs can be very frustrating and distressing. A speech-language pathologist, trained in recognizing and overcoming speech problems, can help with exercises that help your relative shape his or her mouth to form different sounds.

You can also make communication easier by going beyond the spoken word.

• Always keep pencil and paper on hand so your relative can write instead of talking.
• Look into typing aids like typewriters, computers or specialized machines.
• Cut out pictures of things your relative frequently uses or needs from magazines. Paste each picture onto an index card which your relative can hold up or point to.

Remember that whether it’s a hearing, vision, memory, or speech impairment, your relative is still likely to be mentally alert. So treat them with respect; never patronize them or talk down to them like children.

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