How to Communicate with Someone with Alzheimer’s Disease: Surprising Things You Should Know

In 2021, Lady Gaga was performing at Radio City Music Hall with the late, great Tony Bennett, who was suffering from Alzheimer’s Disease, yet he managed to remember the lyrics and songs they were both singing. Suddenly, he called her by her name, something he hadn’t been able to do during rehearsals. As she recalled, it was an emotional moment – a watershed moment. Was it also, perhaps, an example of how music can spark memory?

“Absolutely!” says Justine Vaccaro, LMSW, Director of Social Work at the Nathaniel Witherell, “which is why we have a Music & Memory Program here at the Witherell.” She says that even for those in the advanced stages of Alzheimer’s – as Bennett was – who are essentially uncommunicative, when they attend a musical event at the Witherell, something changes. “Without any prompting, they begin clapping, tapping their feet, smiling, and sometimes they sing along because whatever music memories they have are usually associated with happiness.”

And even when these residents are not at a musical program, she said the Witherell uses donated iPods, uploaded with an individual’s favorite music to enjoy, because music plays such an important role in their lives. “I know CDs are antiquated but we seek donations for them, too, because many in the older generation don’t understand technology like Alexa. With these devices, we can play the music they like in their rooms all day. It helps keep our residents’ minds busy, and that’s important.”

Being Educated About Alzheimer’s Is Paramount

Alzheimer’s Disease is a form of dementia that affects 6.7 million American adults over 65 years of age. It not only destroys a person’s memory over time but also diminishes communication skills, eroding one’s ability to understand the meanings of words let alone finding the right ones to use.

“Alzheimer’s Disease is devastating, and is really tough on families and caregivers,” says Vaccaro, “which is why we at the Witherell regard memory care as an important specialty. Our program is extensive, with the goal being to provide a safe, caring, and enriching environment for our residents. We have been trained to care for people who have Alzheimer’s and related dementias, and we constantly continue in-service training. We also educate families about the disease and how it is manifested because families need our support. Education is paramount.”

From the very first time they visit, families are part of the process.

“We ask them how they’ve been communicating with their loved ones, what are their loved ones’ likes and dislikes, and to give us the names of individuals who have been important to them in the past. This is key in case the resident calls out for them,” she explains. “Equally significant, we include the loved one in these conversations as we never want to speak over anyone.”

The Witherell staff are always available to help advise families about what to expect, say, and do. “It’s hardest on them as they have been deeply and emotionally invested in their loved ones well-being for most of their lives,” Vaccaro explains.

Typically, Alzheimer’s Disease progresses over time, which can be helpful for families to know in terms of their planning.

“In the early stages, individuals are able to carry on conversations and participate in activities, even if they repeat themselves and forget what they might have been talking about or doing –  even 30 minutes prior,” she says. “The key is not to assume that those in the mild stages of Alzheimer’s can’t communicate, so they should be included in conversation.” She recommends, however, that you give the person time to respond to a question or something being discussed, and not to interrupt unless they ask you to help them with a word or description.

What You Can Do

The more dramatic changes occur during the moderate or second stage, which can last for a few years, when people have much greater difficulty communicating.  Even so, you can be helpful. Here’s how:

• Maintain eye contact when speaking to the person.
• Ask just one question at a time – something closed-ended like yes or no types of questions.
• You also can ask simple open-ended questions, such as “What do you see?”;
• Speak in short sentences but no baby talk, which can come across as condescending.
• Be patient, calm and friendly. Give the person time to respond.
• Avoid showing exasperation and anger, and don’t criticize or argue. Better to listen and figure out what your loved one is trying to say. You can repeat what they’ve said to clarify, then ask them if you got it right.
• Offer visual clues. In other words, body language counts. Use facial expressions, gestures. Even if they cannot communicate, people with Alzheimer’s can still read body language really well.
• Approach the person from the front. Says Vaccaro: “If you approach from the rear, it may startle them as sometimes they’re not aware of their surroundings. They tend to spend a lot of time in their heads.”
• Bring a photo album to help initiate a conversation or spark a memory.
• If your loved one spontaneously reaches out to hug you, allow that. It’s a positive.
• Be flexible. You may be surprised by something that your loved one says. “For example, if they say they have to get to work, and you know that’s not possible, maybe respond by saying ‘Gee, there’s a lot of traffic today,” instead of telling them they aren’t going anywhere – because they believe what’s in their minds,” Vaccaro advises. “Diversion is a good strategy; try to bring joy and humor to the situation.”

In the late stages of Alzheimer’s, when residents need round-the-clock care, and when any conversation is difficult, you can still do some of same things you did during more recent stages of the disease, like play music, view a photo album together, tell a story. You can even ask them to point if they seem to be having difficulty speaking. Says Vaccaro: “Some don’t, but many times, if they can’t speak, they’ll suddenly grab your hand. They want to feel connected and comforted.”

As for Lady Gaga and Tony Bennett, the warm memory of their making great music together lives on.

For more information about the Witherell’s Memory Care Program, please contact Justine Vaccaro at Justine.vaccaro@witherell.org or call her at 203-618-4257.  You also can contact Elaine Conklin at elaine.conklin@witherell.org or 203-618-4313.