Dementia, sensory impairment and communicating

Hearing loss and dementia

Most people aged over 70 will have some hearing loss. They may consider themselves deaf, ‘hard of hearing’ or having ‘acquired hearing loss’. This may be due to age-related damage to the ears, or other causes such as noise damage, infection, diseases or injury.

People who are born deaf or become deaf at a young age may consider themselves as Deaf. They may use British Sign Language (BSL) as their first language and identify with the Deaf community.

How a person with hearing loss communicates will depend on:

• the type of hearing loss they have
• whether they use a hearing aid, speak British Sign Language, lip-read or a combination of these
• their personal preference and life history.

People with hearing loss are likely to experience more difficulties as a result of their dementia. They may already find it harder to communicate. Not being able to hear what is going on around them or hear other people speak can add to their confusion.

Dementia and hearing loss can also make people feel socially isolated, so having both conditions at once can be very difficult for someone. This makes good communication even more important.

Alzheimer’s Society has information in British Sign Language online. 

Tips for communicating with someone with dementia and hearing loss

These tips can help with communication with a person with dementia who has hearing loss.

• If the person uses a hearing aid, check that it is fitted and working properly. If you think the hearing aid isn’t working or if you need help checking it, speak to the GP or make an appointment with the audiology department at your local hospital.
• It may be helpful to check if the person has too much ear wax, as this may make any hearing loss and communication difficulties worse.
• Ask the person if they would like to lip-read. 
• Turn your face towards the person and ensure your face is well-lit so your lip movements can be easily seen.
• Don’t shout or over-exaggerate words or lip movements. This can actually make it harder for the person to understand you.
• Speak clearly and slightly slower, but keep the natural rhythms of your speech.
• Don’t cover your mouth.
• Consider using visual prompts such as objects or pictures to help.

Sight loss and dementia

Many people have some sight loss as they get older. This may be age-related, or due to a condition such as cataracts or age-related macular degeneration (AMD). Many people with sight loss will need glasses to help them see.

People with sight loss are likely to experience more difficulties as a result of their dementia. Not being able to see what is around them can lead to a greater sense of disorientation, as well as worse mobility and a higher risk of falls.

Having both dementia and sight loss can also make people feel isolated from those around them, which makes good communication even more important.

Communicating with a person with dementia and sight loss may be difficult, as the person may not be able to pick up on non-verbal cues or follow a conversation as easily. There are a number of things you can do to help them. See the tips below. 

Alzheimer’s Society has information in audio format and on CD. You can listen online to factsheets, The dementia guide: Living well after diagnosis, or stories from other people affected by dementia.

Tips for communicating with a person with dementia and sight loss

• Check the person is wearing their glasses, if needed, and that these are clean and the prescription is up-to-date. If someone has more than one pair of glasses, make sure they are clearly labelled for the activity they are used for – for example, reading glasses.
• Introduce yourself or try to get the person’s attention before starting or ending a conversation. If you don’t, they may become confused about who is talking, or if they are being spoken to.
• If you are helping the person with a task, let them know what you are going to do before and during it.
• Use reference points when describing where something is – for example, ‘Your water is on the table to your right’. It may be helpful to use imaginary hands on a clock face to describe where something is, especially for people who have lived with sight loss for many years (for example, ‘The cup is in front of you at 12 o’clock’).
• Make sure the physical environment is not making communication difficult – – for example, make sure that the lighting is consistent and can be adjusted. Try to reduce shadows as the person may mistake them for obstacles.
• If you are communicating with someone in writing, such as sending them a letter or writing an email, think about the colour of the background and font size (for example, black text on a yellow background often makes text easier to read, as does larger or capitalised text). If they have a mobile phone, you could also change the settings with their permission to make text messages easier to read.

Learning disabilities and dementia

People with learning disabilities are also at greater risk of developing dementia at a younger age, particularly people with Down’s syndrome.

Around 1 in 10 people with learning disabilities have serious sight problems.

You should make sure a person with learning disabilities and dementia has a communication passport – a practical tool that gives information about a person’s complex communication difficulties, including the best ways to communicate with them.