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Dementia care: Communication, communication, communication

Posted Jan 03 2013 6:04pm

As anyone who cares for a person with dementia will know only too well, when the person loses their ability to communicate, frustration is an obvious outcome. Yet this problem is probably the biggest for people with dementia, their families and carers. And as the illness progresses, the person with dementia gradually loses their ability to communicate – they find it increasingly difficult to express themselves clearly and also, to understand what others say.

The difficulties experienced in communicating thoughts and feelings are different for every person and there are many causes of dementia, each affecting the brain in different ways.

Changes in the person with dementia might include:

  • Difficulty in finding a word – a related word might be given instead of one they cannot remember.
  • They may speak fluently, but make little or no sense.
  • They may be unable to understand what you are saying or may only be able to grasp part of it.
  • Writing and reading skills may deteriorate.
  • They may lose the normal social conventions of conversation and interrupt, ignore the person speaking, or fail to respond when spoken to. 
  • They may have difficulty in expressing emotions appropriately.

NB communication problems may be due to impaired vision or hearing, so this needs to be checked. Glasses or a hearing aids may help some people. Check that hearing aids are functioning correctly and glasses are cleaned regularly.


Carers need to pay attention to how they present themselves to the person with dementia. Communication is made up of three parts:

  • 55 % is body language, (the messages we convey subconsciously through our facial expressions, posture and gestures
  • 38 % is the vocal tone and pitch
  • 7% only, is the words we use

These percentages highlight the importance of how we present ourselves to a person with dementia. Negative body language, like turning away, audible sighs and raised eyebrows, can be easily picked up. Addressing someone with dementia in a patronising or belittling way will be as obvious to them as it is to others. The best way to communicate positively with a person with dementia, is to be natural, and to try to view the world as they might see it, go slowly enough to make yourself understood and gentle enough to show you care for them.

Even though the person with dementia may not understand what is being said, they still retain their feelings and emotions. It is vital to help them to maintain their dignity and self-esteem, to be flexible and to allow plenty of time for a response to a question. Where appropriate, using gentle touch will keep the person’s attention and communicate feelings of warmth and affection.

When speaking with a person with dementia:

  • Be calm and be genuine; speaking in a gentle, matter-of-fact way
  • Keep sentences short and simple, focusing on one idea at a time
  • Always allow the person enough time to understand what you have said 
  • It can be helpful to use orienting names or labels, like ‘your son Jack’
  • Remember that humour is vital to communication and can be an effective tool to cut through blocks (but should never be used to laugh at rather than laugh with the person).
Hand gestures and facial expressions, pointing or demonstrating can help communication. Touching and holding the person’s hand may help keep their attention and also show them that you care.

When communicating with a person with dementia, try to:
  • Avoid competing noises, such as TV or radio
  • Stay still while you are talking. This makes it easier for the person with dementia to follow what you are saying
  • Maintain regular routines – this helps to minimise confusion and can assist communication
  • Keep a consistent approach. It is much less confusing for the person with dementia if everyone uses the same style of communication. Repeating the message in exactly the same way is important for all the family and carers.
  • Approach a conversation with the attitude that you are going to enjoy each other's company.
  • People with dementia still have rich memories from their earlier lives. Encourage them to share personal recollections
  • Never argue with the person. Instead, try to 'be' in their reality or time frame and 'go with it'. 
  • Avoid ordering the person around. Always try to go with them and use simple persuasion.
  • Avoid being negative about the person's abilities. Instead, help to re-inforce their self-esteem by celebrating what they can do.
  • Don’t be condescending. A condescending tone of voice may be picked up, even if the words are not understood.
  • Avoid direct questions that rely on a good short-term or 'working' memory. (e.g "what did you have for breakfast today?")
  • Never talk about the person in front of them as if they are not there.
Christine Bryden has had dementia, since she was 49. She has shared a number of her insights about ways family and carers can help a person with dementia. Christine is also the author of Who will I be when I die? I wrote about the meeting we had here .

Here are some of her suggestions for communicating with a person with dementia:
  • Give us time to speak. Wait for us to search around that untidy heap on the floor of the brain for the word we want to use. Try not to finish our sentences. Just listen, and don’t let us feel embarrassed if we lose the thread of what we say.
  • Don’t rush us into something because we can’t think or speak fast enough to let you know whether we agree. Try to give us time to respond and to let you know whether we really want to do it.
  • When you want to talk to us, think of some way to do this without questions, which can alarm us or make us feel uncomfortable. If we have forgotten something special that happened recently, don’t assume it wasn’t special for us too. Just give us a gentle prompt – we may just be momentarily blank.
  • Don’t try too hard to help us remember something that just happened. If it never registered, we are never going to be able to recall it.
  • Avoid background noise if you can. If the TV is on, mute it first.
  • If children are underfoot, remember we will get tired very easily and find it very hard to concentrate on talking and listening as well. Maybe one child at a time and without background noise would be best.
  • Earplugs may be useful if visiting shopping centres or other noisy places.
Please remember
  • Positive communication with a person with dementia helps them to maintain their dignity and self-esteem.
  • A cheerful, caring and empathetic attitude, appropriate body language and the right environment are all important aspects of good communication.
  • Be flexible and allow plenty of time for a response.

Adopt these techniques and your enjoyment of the person's company will grow exponentially.


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