This story is a partCNET’s deep dive into the infinite complexity of the human brain.
I will never forget the last real conversation I had with my lovely late mother-in-law, Grace. She had Alzheimer’s disease for several years, and making calls on her smartphone was becoming difficult for her. So I was surprised to see her name pop up on my screen, calling out to me on a random Thursday night in the fall of 2021.
“Do you watch 60 Minutes?” she asked.
I stopped. I hadn’t seen the newsmagazine show in decades, but I knew it aired on Sunday nights, not Thursdays. I also knew how much Alzheimer’s confused my mother-in-law.
Before her illness, she was always up on the news and had strong opinions on politics—she even campaigned for John F. Kennedy when he was running for president in the 1960s. She kept her mind active well into her 80s by doing daily crossword puzzles in her favorite newspaper, the Los Angeles Times, and she loved to talk to me about new books.
But Alzheimer’s took away her focus, and often her words. I knew how difficult it was for her, how frustrated she became to the point of tears when she couldn’t understand each other. If she thought she was watching 60 Minutes on a night it wasn’t on, I wasn’t going to disagree with her.
“Yeah, I watch 60 Minutes!” I said immediately.
It was the right answer. In a happy and satisfied voice she said, “They are a nice couple, aren’t they?”
Couple? Who was the couple? Mike Wallace and Morley Safer? Aren’t they dead? It didn’t matter.
“Yes!” I said.
“Okay, I’ll let you go now,” she said, and the call ended. Grace died about a month later, aged 85. She had moved from her two-bedroom condominium in California to a beautiful assisted-living facility just eight months earlier, barely getting a chance to enjoy the hair salon, outings and other perks.
Her health deteriorated rapidly and she soon needed 24-hour care. We moved her from the hospital to a residential care home run by a compassionate Russian doctor, and she lived there for only a week before she passed away.
I am grateful every day that I agreed with her on that phone call. In her world, she was watching a “nice couple” on 60 Minutes on Thursday night, and I knew enough about her dementia to try to enter the world she inhabited.
‘I’ve got you covered’
Diana Vaugh knows how difficult it can be to talk to someone with cognitive loss, whether it’s Alzheimer’s disease, Lewy body dementia or another condition. Vaugh is a veteran nurse practitioner and board certified dementia practitioner. Her business, Vaugh Consulting, focuses on providing caregivers and family members with tools to communicate with loved ones suffering from dementia.
But Vaugh didn’t always know how to do it. Her birth mother, Jonah Kiser, suffered from dementia and died in 2008 at the age of 95.
“I did everything wrong,” Waugh says. “I was less than successful with her.”
Since then, Vaugh has published a short book, I Was Thinking: Unlocking the Door to Successful Conversations with Loved Ones with Cognitive Loss. She has spoken to countless caregivers and created numerous videos explaining her approach.
Waugh says he can sum up his philosophy on talking to them in one phrase: “I’ve got your back.” She also has strong feelings about the word “no” – she says caregivers shouldn’t use it. And she encourages caregivers to redirect potentially distressing conversations to focus on old memories that their loved one can easily discuss, as opposed to trying to quiz them on new information that their brains simply can’t access..
Her work won’t give her back that time with her mom, but she’s helped a lot of other people along the way.
Sheila Qualls’ 86-year-old mother has dementia, and Qualls worked with Vo on how to better communicate with her mom.
“I miss my mom, but Diana taught me how to ‘get to her,'” says Qualls. “Her techniques made a huge difference in how we responded to my mother and changed our lives.
The short-term memory drawer has no bottom
Waugh explains that your loved one’s memory has two “file drawers” – short-term and long-term memory. Items in long-term memory are generally still accessible. But the file drawer that is meant to collect short-term memories is bottomless. Memories just can’t stay put.
“Well if you ask [a person with memory loss] to go to lunch with you tomorrow, they put it in the short-term drawer [and it’s forgotten]” says Vaugh. “You show up, they’re still in their pajamas.” A wise man says: ‘Let’s go anyway.’
A person with dementia can’t tell you how they feel today, Waugh explains, because that involves short-term memory. But they can tell you “what it was like when they hurt their knee at 40”.
Tap into long-term memory
That’s why Vaugh encourages caregivers to tap into their loved one’s long-term memory whenever possible. Her slim book has numerous workbook pages where she encourages people to write down memories they can share with their loved one. What did they like to try? Listen? On touch?
Always have three stories ready, Vo tells clients, and then use them to keep an affected loved one talking. Bring up those old memories and encourage them to talk about those things.
Qualls says this tactic works.
“My mom may not remember who I am, but when I start talking about her childhood or childhood experiences, she can immediately tune in,” she says.
It can also be helpful to show photos to your loved one, but “make sure they’re old photos,” Waugh warns. A new great-great-granddaughter may be cute, but a person with cognitive loss is unlikely to have any idea who the baby is.
Redirect and redirect
Waugh tells the story of a woman who moved her elderly father from Nashville to Houston and worried that he would want to return to his familiar barn, now several states away.
In such a scenario, instead of telling him no, that his beloved barn is gone, Waugh says caregivers should calmly use the barn as a jumping-off point to get the man to talk.
“Say, ‘I was thinking about that racehorse you had,'” Vaugh says. “And when they start.” [talking]let them go.”
Qualls also found this method valuable.
“Diana also taught me how to answer questions when my mother asked where my father was,” Qualls said. “Divert and redirect.” Works like a charm. Diana taught me to enter my mom’s world instead of trying to bring her into my reality.”
Seizing the car keys
Many people first become involved in cognitive loss when they realize that their loved one can no longer drive safely. But how do you get them to hand over the keys? You might be tempted to lie and say their car broke down.
That doesn’t work, says Vaugh. If a loved one is early in their cognitive loss, “they’re going to call AAA to fix that ‘broken’ car.
Instead, she suggests telling them about a scary incident you recently experienced on the roads or claiming you recently got lost while driving. Stories like these can strike a chord with someone who is almost certainly starting to notice problems. You may also be able to convince them that a family member needs to use their car for a while, just so you have an excuse as to why it’s suddenly unavailable.
Here’s what you should never say
Vaugh encourages caregivers to avoid one word: no.
“‘No’ doesn’t do any good,” she says, explaining that the word only makes a loved one angry. If you can redirect the conversation instead, the person will probably forget the redirect in five minutes and happily move on. But if you piss them off by telling them “no,” they’ll be angry for the rest of the day, she says.
Vaugh understands why frustrated caregivers might be tempted to say no. Their loved one may be insisting that they have to come to work when they haven’t had a job in years.
By saying no, the caregiver hopes, she says, to bring the person back to reality by denying their “wrong thinking.” But the person they love lives in their own reality, and the caregiver will have to say “no” over and over again, adding stress to the relationship.
Avoiding “no” makes sense, but Vo also says caregivers shouldn’t say, “Do you remember?” What may seem like a gentle inquiry can be seen as a demanding quiz for someone with memory loss.
“It’s like waving a red flag in front of a bull,” Waugh says. “The person probably doesn’t remember whatever it is, and asking them to do that puts them under pressure they no longer know how to handle.”
What to say instead
Instead, Waugh encourages people to use the phrase from her book’s title, “I was thinking…” as a start to prompting memories. If a loved one tells you they need to start working, even though they haven’t had a job in years, calmly say, “I was thinking…” and then bring up the details of the job they once had.
If it suddenly occurs to them that they’ve lost a loved one – even if it happened years ago, you could start with “I was thinking…” and then relate a happy memory of that loved one’s pie baking skills.
Communicating successfully with loved ones who have dementia can be extremely difficult. Vaugh knows this very well.
“We have to stop looking.” [our loved ones] as always,” Waugh writes in his book. “When we change our expectations, we can find them as they are. We can have meaningful conversations. Our relationship, although different, will be much more fulfilling. It will give us happy memories for the second part of their lives.”