Communication and Relationships

Communication and Relationships with your care recipientIs communicating with your care recipient challenging? Could your relationship be better? In this education module, we review ways to help you communicate more effectively and also strengthen your relationships. 

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Also, be sure to check out our blog titled, “How to effectively communicate with people who have Alzheimer’s or Dementia“

Relating to Older Adults

We must be cautious about treating all people who are older as if they are all ill or cannot understand us well. Most older adults are independent and have their own ideas and opinions worthy of our respect. Treat older adults as you would treat anyone from a generation different from your own. Respond to their experience and language and do not expect them to adjust to your own.

Jeanie Crane, author of Let’s Visit, is a Fort Worth advocate and community volunteer. Drawing on her experiences as a family caregiver and a volunteer, she offers some insights into how to interact with older adults.

“Knowing grandparents seems to be a key to relating well to older adults. People who were around grandparents seem to be more comfortable and communicate more easily with older people. Older adults do not consider themselves older; they see themselves without age. Although their appearance may be that of someone who is older on the inside, they feel the way that they have felt throughout their lives.

Older adults may experience “time stress.” The world is moving too fast for them. Although many people experience this time stress, it can be challenging for older adults as they have to make constant adjustments to changes not only in the outside world but in their own health and lives.

Everyone needs to be needed and to live the best quality of life, whatever the circumstances.”

Practical Steps for Relating to Older Adults

Listening is probably not only the greatest gift that we can give to older adults, but is one of the most important skills in understanding their life and needs. An older adult once said “I stopped talking when people stopped listening.” Remember, there is a reason we have one mouth and two ears/

  • Recognize their view of their age
  • Relate to older adults as a 2-way communication bridge
  • Treat older adults as individuals not as part of a larger group labeled ‘seniors’ or ‘the elderly’
  • Health care providers: “Put down your clipboard and look at me.”

Reminiscence

Many older adults will reminisce about significant events and people in their lives. Reminiscence is a way of reliving and re-experiencing or savoring their history. The caregiver or listener can use reminiscence to build a better relationship and build a bridge between the past and the present. In addition, reminiscence can help the older adult:

  • Maintain self-esteem and reinforces a sense of identity
  • Feels a sense of achievement and pleasure
  • Cope with stresses related to aging
  • Gain status or acceptance by revealing life history
  • Place aspects of the past in perspective
  • Deal with emotions such as grief
  • Establish a common ground for communication

Reminiscence brings value to the listener in a number of ways:

  • Gaining knowledge and understanding of the period in which the person lived
  • By building a bridge between the past and present
  • Establishing a relationship through sharing information and experiences
  • It may also provide context about the person’s past (and present) behavior

Lastly, reminiscence can be used as a therapeutic tool in care planning or identifying assets, needs, and resources.

Caution: If someone begins to be upset or angry, redirect the conversation into another area. Steer the conversation in a different direction while not ignoring that he/she may be upset. Listen, reassure, and be supportive. Do not encourage reminiscence if it causes unpleasant memories to surface. In these cases, you may want to consult a professional to address these memories. 

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Essentials of Good Communication

“The difference between the right word and the almost right word is the difference between lightning and the lightning bug.”
 – Mark Twain

Watch your language – older adults want and need to be treated with dignity and respect.

Referring to people with a medical condition such as “handicapped,” “diabetic,” or “arthritic” is defining someone by a medical diagnosis, not as an individual. Avoid negative references and the use of words such as “suffers,” “afflicted,” “victim,” “unfortunate,” “confined to,” or “bound to” a wheelchair.

Here are some tips for communicating effectively with an older person:

  • Call the person by name
  • Assist the person’s orientation to time and place “Here it is Tuesday already”
  • Really listen
  • Pay attention
  • Speak distinctly
  • Talk directly at the person
  • Take your time, one thought at a time
  • Use body language/non-verbal cues
  • Use tone of voice appropriate to the conversation
  • Listen to silence
  • Acknowledge feelings even if you don’t agree
  • Look for hidden meanings
  • Encourage and reassure

Additional approaches may be helpful when communicating with a person with Alzheimer’s disease or dementia:

  • Identify yourself and call the person by name
  • Use active listening (check out what they hear)
  • Keep sentences short and simple
  • Use repetition
  • Speak clearly
  • Keep terminology simple, avoiding jargon and acronyms.
  • Use concrete statements.
  • Speak in a clear, even, normal tone
  • Wait for responses to questions
  • Don’t attempt to finish the person’s sentences for him or her
  • Use humor when appropriate

Dealing with Difficult Behavior

Sometimes older adults may behave in ways that are challenging to caregivers. They may be argumentative, angry, challenging, or resistant to any suggestion or help. These behaviors could include not wanting to take medications, refusing to see physicians, or denying any need for help.

Here are some tips when difficult behavior is an issue:

  • Find out what is causing the behavior. Is it a recent behavior? If so, see if there is a medical cause. Is there a treatment?
  • If the behavior is caused by dementia or mental illness, don’t confront. Validate the feeling, if not the content. You do not have to agree with the person but accept that the person feels that way.
  • Remember that it is difficult behavior – not difficult people.
  • Redirect someone who is getting agitated. Give him/her something else to do or to discuss.
  • Eliminate distractions, if possible.
  • Don’t take the behavior personally if it is related to a disease process. Often care receivers lash out most at those they trust the most; they know that certain caregivers will take abuse and still be there.
  • Use “I” messages. 

Impact on Relationships in the Family

Relationships with family members will change as the needs of the aging family member change. Our own feelings and reactions to the care receiver and others may change many times as we provide care for a family member. Family roles may change. Relationships, feelings, and reactions to family members often depend on past history with these family members. Complex relationships can create confusion, stress, and guilt. Other family members, including children and spouse, may feel neglected or ignored.

Although a controversial concept, some people believe that a common experience is a `role reversal` whereby the caregiver experiences a feeling that the roles and relationships of a lifetime are reversed. Adult children may feel that they not only take over the role of caregiver but also become the primary or sole decision maker. This change in responsibilities creates a completely new relationship. However, it is important to remember that the parent will always be the parent and the child will always be the child.

Role reversal can also happen between spouses. For example:

  • The husband, who always managed the family finances, is now unable to balance the checkbook, pay bills, or make investments due to dementia or Alzheimer’s disease. The wife assumes management of finances in addition to other household responsibilities and may have a full-time job outside of the home.
  • The wife becomes ill and can no longer manage household responsibilities such as cooking and cleaning. The husband must learn how to do laundry, shop, prepare meals and also work full time.

Sibling Relationships

Adult relationships with brothers and sisters are complex and range from love to detachment to hatred. Often, these relationships need to be re-evaluated. Your sibling is not the same person he or she was as a child, and you may still be using childhood images that are outdated. Why are sibling relationships important? Because all the siblings are the children of the care receiver. Your relationship with one another will affect the care that the parent will receive. Recognizing feelings and understanding how relationships with siblings developed in childhood and over time can help siblings to negotiate the roles and responsibilities of aging parents.

When relating with siblings and other family members:

  • Evaluate the needs of the family member.
  • Take the initiative to be part of decision making and to engage other siblings and other family members.
  • Communicate honestly. Stay away from statements that typically begin with “you” and sound like you are accusing someone of doing something wrong.
    • “You are not being responsible!”
    • “You obviously don’t care about me or our parents!”
  • Use “I” messages that are your own thoughts, opinions, and emotions and communicate them calmly.

Family Conference

A family conference is a very important part of effective caregiving and can help deal with sibling conflicts. The family conference should include spouses, children, grandchildren, friends, and any neighbors involved. (Be sure to include out-of-town relatives.)

  • Talk about the future, including fears, potential problems, wishes, individual roles and legal issues.
  • Determine best fit, matching the skills and resources of each sibling.
  • Share resources and partnerships. Engage other family members or people outside the family.

The family conference can be an effective way for the primary caregiver to ask for help. Use “I” statements when asking for help. Here are some examples of “I” statements:

  • “I cannot manage this alone.”
  • “I feel overwhelmed.”
  • “I am concerned that Mom’s care requires more than I can provide myself.”
  • “I feel that the responsibility for Mom’s care has been left to me and I don’t think that’s fair to either one of us.”
  • “I do not mean to complain or criticize, and I very much appreciate you listening to me.”
  • “I would like to let you know what I have found out about what they need and what we can do about it so far?.”
  • “I need you to call (Mom), (Dad), (other family member) at least once a month to help me out.”

Resources for Caregivers

  • Call 2-1-1 throughout Texas for information and access to health and human service information for all ages.
  • Call 800-252-9240 to find local Texas Area Agency on Aging.
  • Call 800-677-1116 – Elder Care Locator service to find help throughout the U.S.

Use resources such as Area Agency on Aging (AAA). Types of assistance provided by AAAs:

  • Information and referral
  • Caregiver education and training
  • Caregiver respite
  • Caregiver support coordination
  • Case management
  • Transportation assistance

Assistance available through AAAs for persons age 60 and older may include:

  • Benefits counseling
  • Ombudsman – advocacy for those who live in nursing homes and assisted living facilities
  • Home-delivered meals
  • Congregate meals
  • Light housekeeping

Be sure to check out our Resource Directory, FAQ, and Educational Events Calendar for more great information! Permission is granted to duplicate any and all parts of this page to use in education programs supporting family members caring for elders. 

Reviewed December 2022
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We hope this information is helpful to you in the important work you do as a family caregiver.
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