Copyright 2013 by Health Professions Press, Inc. All rights reserved.

CONTENTS

About the Author . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ix

Preface. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xi
Acknowledgments. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xiii
Introduction. Memory Aids for a Variety of Purposes:
Beyond Conversation. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
1. The Continuing Evolution of Memory Books . . . . . . . . . . . . . . . . . 3
2. Using Memory Aids to Enhance Conversation. . . . . . . . . . . . . . . 15
3. Using Memory Aids to Enhance Orientation. . . . . . . . . . . . . . . . .41
4. Using Memory Aids to Enhance Communication
of Wants, Needs, and Safety. . . . . . . . . . . . . . . . . . . . . . . . . . . . .55
5. Using Memory Aids to Increase Engagement and Activity . . . . . .77
6. Using Memory Aids to Modify Challenging Behaviors. . . . . . . . . 97
7. Using Memory Aids in Adult Day, Assisted Living,
and Long-Term Care Settings . . . . . . . . . . . . . . . . . . . . . . . . . . .113
8. Using Memory Aids in the Home Environment:
Helping Family Members Make and Use Memory Aids . . . . . . .125
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .139
Photo Credits. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 145
Index. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 147

iv

Copyright 2013 by Health Professions Press, Inc. All rights reserved.

PREFACE

am very pleased to have updated this book, which was first published
in 2007 under the title Memory Books and Other Graphic Cuing Systems: Practical Communication Aids for Adults with Dementia. Because of the widespread adoption of visual cueing strategies by speechlanguage pathologists and others nationwide and throughout the world,
there have been many novel and creative applications of these commonsense strategies to a wide range of challenges caused by memory
impairment. I continue to learn from each individual with memory loss,
as well as from family members and professional and lay caregivers
who have tried these techniques, sent me feedback, and participated in
research studies over the years. Thanks to all of you! Your generosity
and willingness to assist with these projects has made it possible to better understand how visual cues can be used to maximize the quality of
life of persons with memory loss and their families.
Memory aids are continually evolving. We continue to discover
new ways to support memory and to creatively overcome challenges
that create fear and frustration in the lives of our clients and family
members. For example, as technologies advance we are finding ways to
use software applications via devices such as the iPad and other tablets
as well as smartphones as visual cueing systems.
This revised edition includes the following additions, among many
others:
Information and insights gleaned from formal evaluations of nursing
aides who received training on the use of memory aids
Technologically based memory aid adaptations and modifications,
including for people with vision or hearing impairment, non-English
speakers, and those who have difficulty turning pages
Updated and expanded guidelines for designing a memory aid implementation plan to address challenging behaviors across different
care settings
Information on reading comprehension as it relates to advanced dementia and instructions for checking the reading grade level of text
to be used in a memory aid
More than 30 downloadable memory aid resources for professional
and family caregivers (see p. v)

viivii

Copyright 2013 by Health Professions Press, Inc. All rights reserved.

viii

Memory and Communication Aids for People with Dementia

This revised edition is the culmination of many years of dedicated work

by many individuals whose involvement in projects to implement memory aids was driven by personal hopes for their own family member
with memory loss. None of this would have been possible without the
support of the agencies that funded the research (the Alzheimers Association and the National Institute on Aging) and recognized this work
with awards (the Hearthstone Im Still Here Foundation), as well as
the many colleagues who helped to conceptualize the research designs
and methods, implement the procedures and collect the data, analyze
and present the results at national and international conferences, and
share the findings through journal publications and contributed book
chapters. This community of scholars is unsurpassed in their dedication to the discovery of effective interventions for improving the quality
of life of individuals with dementia and their families and caregivers. It
continues to be an honor to work with each and every one of you.

Copyright 2013 by Health Professions Press, Inc. All rights reserved.

INTRODUCTION

Memory Aids for a

Variety of Purposes
BEYOND CONVERSATION

urs is a busy, fast-paced world full of names, faces, places, facts,

and figures to remember and use. We have appointments to keep,
phone numbers to call, important facts to remember, and so
much more that we often experience memory overload. How many of us
can function without our memory aidscalendars, appointment books,
shopping lists, post-it notes, small scraps of paper in a coat pocket or at
the bottom of a purse? Many manufacturers are taking advantage of our
inadequate memories by offering us technological substitutes (computers, calculators, cell phones). In this technological age, we depend on
many different technologies to augment our memory capacity.
If the average person is overworking his or her memory just to
get through the day, imagine the challenges that face individuals for
whom memory loss is a symptom of a larger problem. The purpose
of this book is to describe the evolving use of memory strategies
(i.e., written and visual cues) that has been researched with a variety
of individuals and in various formats, from memory wallets, memory
books, and memo boards to reminder cards. The original motivation
for the development of memory wallets and memory books was to
enhance conversation. Persons with dementia reported having difficulty
remembering words, the names of familiar persons and places, and the
topic of a conversation. Their family added observations of withdrawal
and depression, frustration and anger, and avoidance of conversational
interactions within group situations. The apparent solution was to
provide a collection of pictures and sentences that the person could
read to remind him- or herself of specific people, places, and events to
discuss. As reported in Bourgeois (1990, 1992b), individuals with mild
to moderate dementia demonstrated immediate changes in the content
of their conversations when reading aloud from a memory wallet or
1 1

Copyright 2013 by Health Professions Press, Inc. All rights reserved.

Memory and Communication Aids for People with Dementia

memory book, including elaborating on a topic. These improved

conversations continued over time and in some cases for up to 24
to 30 months, despite continued cognitive decline. Serendipitously,
caregivers reported the usefulness of a memory book page to resolve
other challenging behaviors, such as repetitive questioning. This led to
providing written answers to questions in a variety of places, from a
memo board on the refrigerator to an index card carried in a purse to a
post-it note on the car dashboard.
As the idea of using written text to cue memory has spread, professionals have adopted this strategy for the functional goals addressed
in therapy with their clients who are experiencing memory loss. Goals
related to orientation, communication of wants, needs, and safety, increasing activity and engagement in activities, and reducing problem behaviors have been addressed successfully with a variety of written cues.
Speech-language pathologists (SLPs) are spreading the word among
their colleagues in physical therapy, occupational therapy, and nursing.
Nursing aides, in particular, have been the focus of specific training programs designed to provide them with the tools to make their interactions
with residents who have dementia more satisfying and successful. As
this strategy continues to be used and adapted to solve a variety of problems, the technology is evolving. This book provides current information
on how to make and use written cues for a range of memory-related
problems and to spark creative and new ways to solve them.

Copyright 2013 by Health Professions Press, Inc. All rights reserved.

ALZHEIMERS & DEMENTIA / COMMUNICATION

BOURGEOIS

These interventions are highly effective and can be used across a wide range
of settings and challenging behaviors associated with dementia.
There is only one question regarding this exceptional bookWhy arent you using it?
Cameron J. Camp, Ph.D., Director, Center for Applied Research in Dementia

This is a must have book for professionals who provide services for people
with memory loss and for faculty who prepare these professionals.
David Beukelman, Ph.D., Department of Special Education & Communication Disorders, University of NebraskaLincoln

Nina Simmons-Mackie, Ph.D., BC-ANCDS, Department of Health & Human Services, Southeastern Louisiana University

se the ingenious communication and memory aids

featured in this practical guide to significantly improve
the ability of people with dementia and related memory
impairments to stay connected, engaged, and functioning at
their optimal level of independence. Presenting a wide array
of evidence-based examples, Memory and Communication
Aids for People with Dementia contains all of the
information needed to develop personalized supports for any
individual and every circumstance.
From low-tech options such as memory wallets, memo
boards, planners, and reminder cards to commercial products
available through new electronic technologies, these simple
but powerful tools help to provide conversation prompts,
answers to common questions, and reminders for daily living.
Confusion, anxiety, frustration, and challenging behaviors are
reduced when individuals are able to
communicate their needs and preferences to caregivers
remember important names, places, and events
complete tasks unassisted
engage in meaningful conversations and social interactions
preserve their dignity and identity
Abundant examples of useful content and formats are
supplemented by more than 30 downloadable guides,
forms, and templates to use or customize. Speech-language
pathologists, occupational and physical therapists, activity
directors, direct care staff, and family members interacting
with adults with memory impairments will welcome this
practical and life-enhancing resource.
ABOUT THE AUTHOR: Michelle S. Bourgeois, Ph.D., CCC-SLP, is Professor in
the Department of Communication Sciences & Disorders at the University of South
Florida. A clinical researcher specializing in dementia, she has published numerous
research articles, books, training manuals, and CD-ROMs.

www.healthpropress.com

Formerly published as Memory

Books and Other Graphic Cuing
Systems, this completely revised
edition features many updates
and improvements:
Troubleshooting tips to increase
the use and acceptance of
communication aids
New methods for evaluating and
supporting reading skills
Improved, full-color graphics
Use of computer-based
technologies and systems (e.g.,
tablets, smartphones, e-readers)
New resources to involve families
Adaptations for people who are
hearing or visually impaired or
non-English speakers
Enhanced focus on therapeutic
goal setting and rehabilitating
communication

ISBN-13 978-1-938870-06-4
ISBN-10 1-938870-06-0

9 781938 870064

90000

>

Memory and Communication Aids for People with Dementia

An extremely readable and practical guide to managing memory. . . . I highly recommend!