Article Archive
November/December 2016

The 5 Love Languages and the Alzheimer's Journey
By Edward G. Shaw, MD, MA, and Deborah Barr, MA, MCHES
Today's Geriatric Medicine
Vol. 9 No. 6 P. 30

In their new book Keeping Love Alive as Memories Fade: The 5 Love Languages and the Alzheimer's Journey,1 coauthors Deborah Barr, MA, MCHES; Edward G. Shaw, MD, MA; and Gary Chapman, PhD, describe how care partners of an individual with Alzheimer's disease (AD), despite the individual's progressive cognitive loss, can maintain emotional intimacy and genuine love with the simple yet powerful framework of Chapman's five love languages (5LL).

The 5LL can help individuals, couples, and families cope with the devastating diagnosis and journey of AD. The authors contend that the 5LL are tools that can make it possible to sustain an emotional connection with a memory-impaired individual, novel in that the love languages have been used almost exclusively in relationships with people who are on equal footing in terms of their cognitive ability to give and receive love. With progressive cognitive decline, the person with AD gradually loses the ability to manage his or her side of the relationship, although the individual's deep human need for love does not disappear with the diagnosis. Providers can suggest the 5LL communication strategies to caregivers as ways to remain connected with loved ones.              

Unique Communication Approaches
Keeping Love Alive as Memory Fades uses the metaphor of literal languages to help readers understand that the ways individuals perceive emotional love are so distinct from one another that they essentially comprise five different "languages" or channels of communication. Each of us has at least one language that communicates emotional love to us more than the others. The five love languages are defined as the following2:

• Words of Affirmation: Unsolicited compliments, whether verbal or written, or words of appreciation. Examples: "I love you." "You did an amazing job!" "You look great in that dress." "I really appreciate your attention to details." Dialects include words of encouragement, humble words, and words of kindness. Saying nice things about a person to others counts as well because the message often travels back to him or her as others repeat the compliment. A "Words of Affirmation person" can be emotionally devastated by insults and harsh words.

• Quality Time: Giving someone your full undivided attention. Dialects are quality conversation (sharing thoughts, feelings, desires, and experiences, with the emphasis on really listening to another person) and quality activities (sharing memory-making experiences). A "Quality Time person" can be hurt by half-hearted or distracted listening, or by repeatedly postponing promised time together.

• Gifts (or "receiving gifts"): Any purchased, handmade, or found tangible gift to let someone know you care. A gift is a visible symbol of love. Price is irrelevant. It is the thoughtfulness and effort behind a gift that sends the "I love you" message. Being physically present, the gift of your time is an intangible gift that is very precious to some people, especially in times of crisis, illness, or celebration. A "Gifts person" can be hurt by a forgotten anniversary or birthday, or left feeling empty in a relationship void of tangible tokens of love.

• Acts of Service: Doing helpful things for another person, such as setting the table, walking the dog, washing dishes, vacuuming, or grocery shopping. The purpose of acts of service is to lighten the load of the other person. Acts of service require thought, planning, time, and effort. The idea is not simply to stay busy or to do the tasks you enjoy most but to do the things that are most meaningful and helpful to the other person. An "Acts of Service person" can be hurt by laziness, someone leaving a mess for them to clean up, or forgotten promises to help.

• Physical Touch: Deliberate touch that requires your full attention to deliver, such as a back rub, a foot massage, a hug, a high five, or a kiss; incidental touch that requires little or no extra investment of time, such as sitting close to a person on the sofa or touching his or her shoulder as you walk by. For a "Physical Touch person," touch sends the clearest "I love you" message. For these people, a slap or any kind of abuse or neglect can cause extreme emotional pain.

While these languages sound like great ways to say "I love you," husbands and wives, parents and children, and even two close friends rarely speak the same love language. We naturally reach out to others using our own languages, the one that makes us feel the most loved, rather than speaking the other person's language, ie, the one that makes him or her feel most loved. So even when both people go to extraordinary lengths to express love to each other, if they are both speaking their own love languages rather than the other person's, neither of them will feel emotionally loved.

Once people gain an understanding of the 5LL and discover which one means the most to the significant people in their lives, they must make an effort to speak to each person in that person's own love language. When two people mutually embrace this idea and intentionally, consistently, and fluently communicate love to each other in the way that is the most meaningful to the other person, both people feel emotionally loved, and their relationship deepens, even under challenging circumstances.

Connecting With AD Patients
The love languages make it possible to maintain a meaningful relationship with a spouse or parent with AD; however, the care partner must realize it will not happen automatically. Rather, he or she must repeatedly make intentional if not sacrificial "love by choice" decisions that exceed what is required in relationships unaffected by dementia. The depth and breadth of the connection lies almost entirely in the hands of the care partner.

The following are examples of how the 5LL can be used to create or maintain an emotional connection with an Alzheimer's patient.

• Perhaps the most common frustration among care partners of a loved one with AD is questions repeated over and over again, sometimes within minutes of a previous inquiry. Care partners should answer each repeated question as though it were being asked for the first time. Answering calmly each time demonstrates the love language Words of Affirmation when the tone of the response is kind, loving, and affirming. By contrast, if a person with AD asks, "What time are we going to dinner tonight?" and a spouse responds angrily, "As I've told you over and over and over, at 6 o'clock. Don't ask me again!" a wedge will be driven between them. The AD individual will feel stupid and unloved, and the spouse will feel regretful and unloving.

• Looking through a favorite photo album from the past with a parent who has AD is an example of the love language Quality Time. Long-term memory is preserved in the early stage and through most of the middle stage of AD. A parent with AD is much more likely to remember his or her parents, siblings, and other close family members and friends from the old days more so than grandchildren and great grandchildren. Quality Time, or as the authors renamed it in the setting of dementia care, "Quality Moments," reinforces loving relationships from the past, and brings closer together the family members sharing in this special time with a parent or grandparent.

• Music, particularly favorite songs from adolescence and young adulthood, is often embedded deeply into long-term memory and can be recognized, stirring positive emotions even in a person with middle- to late-stage dementia. Because of music's unique impact, an excellent gift to a person with AD is an iPod loaded with favorite music from teen and young adult years. Typically, the iPod is connected to ear buds or headphones, allowing the person with dementia to be absorbed into a comforting musical world. This is an example of touching a person with AD through the love language of Gifts.

• AD is characterized by a progressive loss of short-term memory and executive function. Many of the tasks previously performed routinely by an individual with AD such as shopping, cooking, cleaning, and doing laundry can no longer be performed because he or she has forgotten how or is unable to perform sequential tasks. Allowing this individual to help around the house, for example, vacuuming, (even though he or she may push the vacuum cleaner back and forth in the same place) provides a sense of autonomy and competence and ultimately, the feelings that he or she is loved, appreciated, and valued. Whether the task is accomplished is irrelevant. Allowing the help is an act of kindness on the part of a patient's care partners. Thus, in the setting of dementia care, we refer to this love language as "Acts of Kindness" rather than Acts of Service.

• Sitting on a couch next to a loved one with AD, holding his or her hand and watching a favorite TV show or movie together is an example of the love language Physical Touch (as well as Quality Time). Touch can be affirming and loving to an individual with AD. Other love languages can be incorporated, such as saying "I love you" (Words of Affirmation) and sharing a bowl of ice cream or popcorn (Gifts).

Physicians, nurses, certified nursing assistants, social workers, and other medical and mental health practitioners will also find that the strategies described will help them empathize with, express care and compassion for, and encourage the AD patients and families with whom they work.

— Edward G. Shaw, MD, MA, dually trained as a physician and a mental health counselor, is coauthor of Keeping Love Alive as Memories Fade: The 5 Love Languages and the Alzheimer's Journey. He was the primary care partner for his wife, Rebecca, who was diagnosed with early-onset Alzheimer's disease at the age of 53 and died recently at the age of 62 following a nine-year battle with the disease. Inspired by his wife's journey, Shaw, a practicing radiation oncologist for 23 years and world-renowned brain tumor expert, shifted his medical interest to dementia diagnosis and treatment. He founded the Memory Counseling Program that is part of Wake Forest Baptist Health in Winston-Salem, North Carolina, where he is a professor, physician, and counselor.

— Deborah Barr, MA, MCHES, is a master certified health education specialist and journalist in Winston-Salem. An experienced wellness writer, she brought a health educator's perspective to aspects of the book, including the detrimental health effects of long term caregiving and the looming Alzheimer's disease epidemic.

1. Barr D, Shaw EG, Chapman G. Keeping Love Alive as Memories Fade: The 5 Love Languages and the Alzheimer's Journey. Chicago, IL: Northfield Publishing; 2016.

2. Chapman G. The 5 Love Languages: The Secret to Love That Lasts. Chicago, IL: Northfield Publishing; 2015.