Dementia and Communication: 5 Easy Ways to Start a Conversation

What To Do When Your Mom Sleeps 

All Day Long

So often, I hear the same complaint  from family members and caregivers:

My mom sleeps all day long.
My dad just sits here watching TV.
She never has anything to say.
He's stopped talking to us.

My typical response:

Give her a reason to stay awake.
Offer him something else to do.
Ask the right questions, talk about the right things.
Provide opportunities for conversation.


Yesterday, I was talking with a daughter of a patient about the importance of creating opportunities to communicate, socialize, interact and connect. The patient has dementia but is still able to function on a conversational level when the subject is simple and concrete...here and now.  I gave a few examples of ways to initiate conversation and promote exchange. I emphasized the importance of providing chances for engagement and socialization. 

This daughter appeared to be listening attentively. She nodded to agree and then said the one thing that makes me cringe every time:

I'll  buy some flashcards at the dollar store. We can talk about those.

 UGH....I HATE FLASHCARDS FROM THE DOLLAR STORE!

These cartoon cards are perfect if you want to teach a toddler the ABCs but they are juvenile and irrelevant to the daily lives older adults. No matter how hard you might try, there's just no way you can have a meaningful conversation with flashcards like these. Instead...

Here is a list of things a speech pathologist recommends for striking up great conversation with a spouse, parent, friend, neighbor or patient.

Dementia and Communication:

5 Super Easy Ways to Start a Conversation

1.  Use the newspaper:

• read and discuss the headlines
• go shopping using the sales circulars 
• read the life stories of the people in the obituaries
• work together to complete the crossword puzzle
• skim over the police blotter- usually good for a laugh
• read and discuss the Dear Abby letters 
• find great coupons then make a shopping list
• browse the want ads

2.  Use what's on hand:

• look a photo album together
• thumb through the pages of a catalog
• talk about recipes in cookbooks
• look at magazines
• sort through the mail together
• spend some time enjoying beautiful photography in a picture book
• talk about the family photos, decor and art around the house
• plan out your television viewing using the TV Guide
• sing along with the radio
• read aloud from a book or magazine then discuss 
• read or retell stories from the Bible
• reminisce- it's always fun to walk down memory lane

3.  Use an electronic device: 

• browse Pinterest- personally, I could do that for hours
• Google search a topic or place of interest 
• play a simple game- I have apps for tic tac toe, Farkle and Connect Four
• scroll through posts on Facebook and Instagram
• create a new post for Facebook or Instagram
• watch You Tube videos- gotta love those amazing cat videos!
• see what's available on Craig's List- it can be more fun than you might think
• use Face Time or Skype to visit with friends and family

4.  Use the television: 

• talk about current events after watching the news
• watch a game show and play along -Family Feud, The Price is Right, Wheel of Fortune
• talk about the characters or the plot of  a TV show during a commercial break
• watch a cooking show
• watch a DIY or home improvement show
• Watch and learn together, then discuss- fabulous programs on:
• History Channel
• PBS
• AMC 
• Western Channel
• QVC or HSN
• Weather Channel- but only as a last resort

5.  Use others:

• chat with friends and family member over  the phone
• invite a neighbor for a brief visit
• invite a pastor or friend from church to stop by
• get out and about- talk with neighbors, other shoppers, wait staff, cashiers, etc.
• visit with home healthcare workers- they've always got a good story to tell

These fun and easy conversation starters are sure to get people talking. Browse through the list and see which ones you might be able to include the next time you want to engage a person with dementia. Pick and choose the ones you like best. As always, modify as needed.

Good luck and have fun!


Oh yeah, if you just have to have flashcards, skip the trip to the dollar store and invest in a set of good quality picture cards. I recommend Pictures for Progress.  As an SLP, I use them every single day to elicit meaningful conversation about real life topics. Try them...I know you will like them!


Think in the morning. Act in the noon. Eat in the evening. Sleep in the night. 
William Blake

22 Ways to Clear Pocking Without Using A Toothette Brush

The Trouble With Toothettes

Toothette Oral Swabs, or as I call them, Toothette brushes, are an important part of daily patient care in facilities from coast to coast. Easy to come by, Toothettes can be found all over the place: in central supply departments, nurses' stations, bedside tables, bathrooms, therapy gyms, rehab offices and on top of nightstands. 

I keep a bunch of them stashed in my desk drawer, I almost always have one in my pocket, and it wouldn't be unusual to find a Toothette in my purse. Abundantly available, I grab these brushes by the handful and pass them out to my patients up and down the halls.  

I think I'm being clear... there's no shortage of Toothette brushes in healthcare facilities.

In case you've never used a Toothette, they're just a little pink sponge on a stick. The thing that makes them extra special is a light coating of a pleasant, minty dentifrice.  (Now there's a word you don't use very often!)

These swabs are perfect for moistening a chronically dry mouth, they're good for scrubbing teeth and most importantly, they can gently remove tiny little food particles from hard to reach places in the back corners of the mouth. With such great versatility, you just have to love the Toothette swab.

With that in mind, fast forward to....


Today, I overheard a phone conversation between my patient's wife and her insurance company. They were discussing Toothettes.  I only heard half of the conversation, of course (because she was on the phone), but I'm pretty sure I know what the insurance company representative was saying. 

Here's what I actually heard and what I imagined was being said:

     You won't pay for them?
     No, we won't pay for them.

     It's medical equipment my husband needs.
     Uh huh, but we won't pay for them.

     What if I call the doctor and get a prescription?
     It won't matter, because we won't pay for them.

     He had a stroke and he pockets food in his mouth.
     Yes, but we don't pay for them.

     It's so important to keep his mouth clean. 
     Right, but we don't pay for them.

     What am I supposed to do?
      You'll have to pay for them yourself.

     Those things are really expensive.
     Uh huh, that's why we don't pay for them.

     I guess I'll have to ask the speech therapist what to do.
     Yeah, because... we won't pay for them.

She hung up the phone and immediately called my name. Looking like she was ready to pull out her hair, she asked:

     Can you believe my insurance company won't pay for those pink sponges?
     Yes, I can believe it. Insurance usually doesn't pay for Toothette brushes. 
     Once you're home, a Toothette is a luxury item.

     Those little things are hard to find and when you do, they are expensive.
     What am I supposed to do? 


Oh boy, I love it when people ask me that question! 

I did some super sonic brainstorming as I sat at her kitchen table and came up with a list of suggestions on how to handle oral pocketing when your supply of Toothettes is scarce. 

How To Clear Pocketing:

22 Toothette Alternatives

 Before Eating

1. eat softer foods
2. add extra gravy or sauces to meats and veggies
3. chop meats, fruits and veggies into small/ smaller pieces
4. make sure veggies are tender cooked
5. adjust seating
6. position head and body to midline

While Eating

1. take smaller bites
2. chew thoroughly
3. use a liquid wash
4. perform a lingual sweep
5. alternate solids and liquids
6. aim utensil to the strong side of mouth/ away from the weak side of mouth
7. chew on the stronger side
8. reduce the rate of intake
9. adjust seating as needed
10. maintain head and body at midline position

After Eating

1. use a gloved finger (yours or theirs) to sweep out particles
2. use an infant finger brush to gently remove foods
3. use a soft, small head toothbrush (infant, toddler or adult) to pull out particles 
4. swish and spit using water or mouthwash

Improve Oral Motor Function

1. perform therapeutic cheek exercises to increase strength and range of motion 
2. perform therapeutic lingual exercises to increase strength and range of motion

I'm a speech pathologist first but I'm also a darn good creative problem solver.  As a result, this family has 22 effective ways to resolve oral pocketing without spending a penny. Give that SLP some bonus points!

This isn't an all inclusive list, but I hope it reminds you that we have lots of options when it comes to alleviating oral pocketing. Please comment below if you know of any other methods not mentioned above. 

By the way, a few of these terms are considered professional jargon, so if you're not sure what, when, why or how, be sure to consult a speech pathologist for additional information. 

Be true to your teeth or they will be false to you.
Soupy Sales

Language Based Activities for Valentine's Day

Love is in the Air

Valentine's Day is approaching and love is in the air! Sweeten your speech therapy session by incorporating any or all of these heart related activities.

Have your patients explain these heartfelt expressions. They are a great way to get people talking and can be a nice compliment to your normal therapy activities. 

Write the sayings on construction paper hearts and glue them together to make a wreath (your occupational therapy friends may like this idea, too). Encourage family, friends and caregivers to use the wreath to elicit conversation...it makes a wonderful carryover activity. 

• have a big heart
• eat your heart out
• have your heart set on it
• a heart of gold
• cold-hearted
• pour out your heart
• wear your heart on your sleeve
• cross your heart
• with all your heart
• from the bottom of your heart
• heart and soul
• heart skipped a beat
• change of heart
• heavy heart
• whole-hearted
• half-hearted
• in my heart of hearts

Another way to stimulate speech is with thought provoking questions.  

• What would be a great gift to give a woman/ man on Valentine's Day?
• What is the best/ worst Valentine's Day gift you ever received?
• What happens to people when they fall in love?
• What are some Valentine's Day traditions you enjoy?
• How have dating traditions changed over the years?
• What's your opinion about on line dating?
• What's your idea of a perfect date?

Print copies of this heart shaped word search to address scanning, reading, attention and/or concentration. For extra fun, use a pink highlighter to complete the task.

For patients that need to improve oral motor strength or range of motion, assign homework: ask that they give or blow 10 kisses before your next session. No one has ever refused this assignment! 

Have a conversation using conversation hearts.  Take turns reading  and discussing the sayings printed on the tiny candies.  Feel free to eat as you go! Brainstorm your own list of two or three word expressions that would be appropriate for printing on a heart. To target writing, cut out construction paper hearts and have your patient write a few of these new sayings on the heart shaped candy. Use them for door or window decorations when you're through.

Finally, share these fascinating facts about the heart, providing education and discussing the importance of making heart health decisions now.  To address memory, challenge your patient to recall a few of the facts or recommendations provided in this infographic.

In a conflict between the heart and the brain, follow your heart.

Swami Vivekananda

5 Foods to Avoid: Reduce Your Risk of Developing Alzheimer's Disease

Eat This, Not That

Over 5 million individuals in the United States are living with Alzheimer’s disease, and as the population ages, the number is expected to grow. While the disease can strike as early as the 30s, most who are diagnosed are over the age of 65, and the risk increases with age. Nearly two thirds of those with Alzheimer’s are women. 

While there is no known cure for the disease, researchers have identified several lifestyle factors, including diet and exercise, which appear to affect not only the risk of developing Alzheimer’s, but also the progression of the disease.

Last week, I told you about a recently published study involving the MIND (Mediterranean- DASH Intervention for Neurodegenerative Delay) diet. Researchers have determined that following an eating pattern that has components of the DASH and Mediterranean diets will not only decrease the risk of hypertension, heart attack and stroke, but could reduce the risk of developing Alzheimer's disease by 53%. 

Also encouraging is their finding that even for those with just moderate adherence to the diet, the reduction in risk is still 35%.

While both the DASH and Mediterranean diets are rich in plant foods such as fruits, vegetables, and whole grains, as well as healthy fats, the MIND study identified ten food groups that appear to be beneficial to brain health, and five others that are harmful to the brain. In other words, the food groups in the MIND diet are deemed either "brain-healthy" or "brain-unhealthy." 

To recap, the brain-healthy MIND diet recommends:

• Every day, you eat at least three servings of whole grains, a salad and another vegetable and you drink a glass of red wine
• On most days you snack on nuts
• Every other day you eat half a cup of beans
• At least twice a week you have poultry and a half-cup serving of berries (blueberries are best)
• Dine on fish at least once a week
• Olive oil is what you primarily use at home

Here are the five brain-unhealthy food groups 

researchers tell us to limit to reduce the risk of developing dementia:

Red Meat 

Red meat isn't banned in the MIND diet, but the researchers say you should limit consumption to no more than four servings a week to help protect brain health. That's more generous than the Mediterranean diet, which restricts red meat to just one serving a week.

Butter and stick margarine

Butter and stick margarine should be limited to less than a tablespoon per day on the MIND diet. Brain-healthy olive oil can often be used instead.

Cheese  

Cheese may be delicious but it doesn't do your brain any favors, according to the MIND diet study. Eat cheese no more than once a week if you want to reduce your risk of Alzheimer's.

Pastries and Sweets

You already know they're not so good for your waistline, and it turns out pastries and other sweets could have a negative effect on brain health as well. The MIND diet recommends limiting yourself to no more than five of these treats per week.

Fried and Fast Foods

 Fried foods and fast food round out the MIND diet's list of unhealthy food groups. Limit your indulgence in fried food to no more than once a week for optimal brain health.

Even if you don’t have a family history of Alzheimer’s disease or other risk factors, you may still want to try this eating plan. Because the MIND diet focuses on nutritious whole foods, “It’s not just good for your brain. It’s good your heart and overall health, too,” says Majid Fotuhi, MD, PhD- chairman and CEO of the Memosyn Neurology Institute.

One of the best things about the MIND diet is that you don’t have to stick to it perfectly to see benefits.  “That makes it more likely you’ll follow it for a long time,” says Dr. Fotuhi. What's more, "The longer people eat the MIND way, the lower their risk of getting Alzheimer’s disease."

Considering this, it's no wonder that the MIND diet was featured by U.S. New & World Report as one of the Best Diets of 2016.  Their panel of health experts included nutritionists and physicians specializing in diabetes, heart health and weight loss.  In all, the experts scored 38 diets on short term weight loss, long term weight loss, ease of compliance, safety and nutrition. Their assessment of the MIND diet is impressive...

#1 Easiest Diet to Follow 

#2  Best Diet Overall 

#3  Best Diet for Healthy Eating 

#4  Best Diabetes Diet 

#4  Best Heart Healthy Diet 

Even though diet plays a big role, it's only one aspect of preventing Alzheimer's Disease. If you do decide to make your diet more MIND-like, experts recommend you take a few extra steps to lower your risk even more:  

• keep your portions in check
• be careful about how food is prepared (avoiding extra sugar, salt, fats and calories)
• make a point to drink several glasses of water each day
• get regular exercise
• manage your stress 

Make good choices today so you don't have regrets tomorrow.

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