Telephone conversations with a person who has a speech and language difficulty can be challenging. After completing training 3, you may have some questions like:

• What if I can’t understand what the older person says?
• What if the person is having difficulty understanding what I am saying?
• What can I do if the older person freezes or their speech deteriorates during the call?

Don’t worry. There are ways to manage these situations. Also, together with the older person you can find techniques and ways to make the conversations effective and fun.

In this training we will share general tips and techniques to help you manage those challenging situations and help you to be a good call companion for an older person with Parkinson’s. The difference you can make to the older person is enormous so it’s worth making the most of each phone call.

Here are a few points to consider which can help make conversations easier:

• Background noise: If it is possible, make the calls from a quiet area. If the TV or radio is on in the older person’s room, suggest they turn it down or switch it off. It can be tiring both for the older person and you to make the calls effective when there’s background noise.
• Headsets: Use headsets if possible. They are more effective at cancelling out background noise as opposed to handsets.
• Concentration: Minimise distractions and focus on what the speaker is saying. It may be useful to jot down key words.

As mentioned in training 3, everyone with Parkinson’s is different and may or may not have the same speech and language problems. Start the calls with the assumption that the person has good understanding and no other cognitive difficulties. Initially speak at a normal volume and pace. As the conversation progresses it may become clear that the speaker has additional communication needs. This may mean you need to alter your approach.

Here are some general tips that will help you in your conversations:

• Allow more time for communication: slow down the pace, wait and listen while the older person is talking. Leave gaps between what has been said. Silence can feel uncomfortable, but the older person may need time to formulate what they want to say, initiate speech, or process information.
• Be an ‘active listener’: let the older person know you are listening, using ‘minimal responses,’ for example mmm, uh-huh.
• Keep it simple: in some cases, people with Parkinson’s can have difficulties understanding complex questions, sentences and conversations. You might need to use shorter sentences and questions, or rephrase what you have said using simpler words. For example “Have you seen a consultant?” to, “Did you see a doctor at the hospital?”
• Introduce one topic at a time: don’t make your conversations complex. Talk about one topic then shift to another. Make conversations a two-way process that engages the person.
• Avoid interrupting, answering questions, or finishing sentences: give time to the older person to structure their sentences or the answers to your questions. Try to use closed questions if possible so that they can answer ’yes’ or ‘no’. Interruptions, answering the questions on their behalf, or constantly completing their sentences may discourage them from communicating.
• Be honest: let the older person know you are having difficulties understanding them. Saying something like ‘I’m sorry, but I am not able to understand you,’ makes it more about you and less about their speech difficulties.
• Repeat: repeating the part of the sentence that you understood and letting the older person say again what you didn’t understand keeps the conversation flowing. For example, “You said you went upstairs to your room to get the what?” or, “You went somewhere yesterday, but I didn’t catch where you went.” You can also ask them to spell out the words you did not understand.
• Prompt: if appropriate, encourage the speaker to slow down and/or speak louder. This can sometimes make speech easier to understand.  Research has shown that people with Parkinson’s may not be aware of changes in their speech, so they may need prompting.
• Be patient during freezes: a call may go ‘silent’ sometimes if the older person is having difficulty initiating speech, has ‘frozen,’ or perhaps because they are distressed. In this situation avoid the temptation of filling the silence with chatter. You can acknowledge that they may be having difficulties by saying ‘It sounds like you might be having some difficulties at the moment. Don’t worry, I’ll wait.’ If you have waited for a while and there is no response, say something like ‘It sounds like you’re unable to speak at the moment. I am going to put the phone down now, but I will call you back in an hour.’ Ask the older person if they can let you know they are there and understood what you said by tapping the handset.
• Check with the older person: ask the older person if there is anything special they would like you do when you are communicating with them. For example, they may have specific techniques that works for them that they can share with you, or they may let you know which part of the day they feel more able to have conversations. Fatigue may affect their speech so for example in the morning they could have better conversations compared to evenings.
• Keep calm: be patient and talk normally, without shouting or sounding stressed or impatient. It may take time to know your older person’s needs and how to adjust yourself to meet those needs and make the conversations effective.