We all need to communicate with other people. Communicating our needs, wishes and feelings is vital – not only to maintain our quality of life, but also to preserve our sense of identity. This factsheet gives tips and advice for communicating with someone with dementia and on how to encourage the person to communicate in whichever way works best for them.
We tend to think of communication as talking, but in fact it consists of much more than that. A large proportion of our communication is non-verbal, which takes place through gestures, facial expressions and touch. Non-verbal communication is particularly important when a person with dementia is losing their language skills. This may also mean that a person with dementia behaves in ways that those caring for them find difficult and this may be because they are trying to communicate something.
Dementia and language
Difficulties with language occur in all forms of dementia but the particular problems experienced by a person will vary according to the type of dementia and level of disability they have. For example, in fronto-temporal dementia it may be the first symptom that a person develops. In many instances, language skills will vary from day to day and time to time. Make the most of 'good' days and learn to cope with the 'bad' ones.
An early sign that someone's language is being affected by dementia is that they can't find the right words – particularly the names of people. The person may substitute an incorrect word, or may not find any word at all. There may come a time when the person can hardly communicate accurately or successfully through language. This may be distressing for their loved ones, but it's a normal aspect of their memory loss.
Other factors may also affect the ability of a person with dementia to communicate – including pain, discomfort, illness or the side-effects of medication. If you suspect this might be happening, talk to the person's GP. If appropriate, make sure the person's glasses are the correct prescription, that their hearing aid is working properly, and that their dentures fit well and are comfortable.
Difficulties with communication can be upsetting and frustrating for the person with dementia and for those around them, but there are lots of ways to help make sure that you understand each other.
Tips: communicating with someone with dementia
Before you speak
- When possible, if you are rushing or feeling stressed, try to take a moment to calm yourself.
- Consider what you are going to talk about. It may be useful to have an idea for a particular topic ready, or to ask yourself what you want to achieve from the conversation.
- Make sure you have the person's full attention.
- Make sure that the person can see you clearly.
- Try to make eye contact. This will help the person focus on you.
- Minimise competing noises, such as the radio, TV, or other people's conversations.
How to speak
- Speak clearly and calmly.
- Speak at a slightly slower pace, allowing time between sentences for the person to process the information and to respond. This might seem like an uncomfortable pause to you but it is important for supporting the person to communicate.
- Avoid speaking sharply or raising your voice, as this may distress the person.
- Use short, simple sentences.
- Don't talk about people with dementia as if they are not there or talk to them as you would to a young child – show respect and patience.
- Humour can help to bring you closer together, and may relieve the pressure. Try to laugh together about misunderstandings and mistakes – it can help.
- Try to include the person in conversations with others. You may find this easier if you adapt the way you say things slightly. Being included in social groups can help a person with dementia to preserve their sense of identity. It can also help to reduce feelings of exclusion and isolation.
What to say
- Try to be positive.
- Avoid asking too many direct questions. People with dementia can become frustrated if they can't find the answer. If you have to, ask questions one at a time, and phrase them in a way that allows for a 'yes' or 'no' answer.
- Try not to ask the person to make complicated decisions. Giving someone a choice is important where they can cope with it, but too many options can be confusing and frustrating.
- If the person doesn't understand what you are saying, try to get the message across in a different way rather than simply repeating the same thing. You could try breaking down complex explanations into smaller parts and perhaps also use written words or objects.
- As dementia progresses, the person may become confused about what is true and not true. If the person says something you know to be incorrect, try to find ways of steering the conversation around the subject rather than contradicting them directly. Try to see behind the content to the meaning or feelings they are sharing.
- Listen carefully to what the person is saying, and give them plenty of encouragement.
- When you haven't understood fully, tell the person what you have understood and check with them to see if you are right.
- If the person has difficulty finding the right word or finishing a sentence, ask them to explain it in a different way. Listen out for clues. Also pay attention to their body language. The expression on their face and the way they hold themselves and move about can give you clear signals about how they are feeling.
- If the person is feeling sad, let them express their feelings without trying to 'jolly them along'. Sometimes the best thing to do is to just listen, and show that you care.
- Due to memory loss, some people won't remember things such as their medical history, family and friends. You will need to use your judgement and act appropriately around what they've said. For example, they might say that they have just eaten when you know they haven't.
Body language and physical contact
- A person with dementia will read your body language. Sudden movements or a tense facial expression may cause upset or distress, and can make communication more difficult.
- Make sure that your body language and facial expression match what you are saying.
- Never stand too close or stand over someone to communicate: it can feel intimidating. Instead, respect the person's personal space and drop below their eye level. This will help the person to feel more in control of the situation.
- Use physical contact to communicate your care and affection, and to provide reassurance – don't underestimate the reassurance you can give by holding or patting the person's hand or putting your arm around them, if it feels right.
Tips: communicating with someone with dementia and hearing loss
Most people over 70 will have some degree of hearing loss. Many will have significant hearing loss or may be deaf. People who are born deaf or become deaf at a very young age are said to have profound or 'cultural' deafness. Many people with profound deafness consider themselves to be part of the Deaf community. In the UK, Deaf people use British Sign Language (BSL) as their first language. People with 'acquired hearing loss' have become deaf over their lifetime, due to illness or injury.
If you are trying to communicate with a person with dementia but they are unresponsive, consider that hearing loss may be a factor. If you suspect that someone has a problem with their hearing the person should see their GP.
How you can help
- Speak slightly more slowly than usual but try to keep the natural rhythms of your speech.
- Do not shout or over-exaggerate words as this will distort your speech.
- Do not cover your mouth as this will interfere with lip-reading. The person should be able to see your face clearly – get onto the same level as them so that they are looking at your face straight on.
- Consider the physical environment – make sure the area is quiet and well-lit.
- Use visual clues – write your message down if the person is able to read and use objects or pictures to help the person understand. For example, show the person the meals they can choose from.
Last reviewed: July 2012
Next review due: July 2014
Reviewed by: Colin Barnes, Principal Speech and Language Therapist, Speech and Language Therapy Dept, St James Hospital, Portsmouth and Dr Claire Surr, Senior Lecturer and Head of Education Programmes, Division of Dementia Studies, University of Bradford, Bradford
This factsheet has also been reviewed by people affected by dementia.
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