How to communicate with a person with dementia

These tips can be used in whichever language the person usually communicates in, including British Sign Language. 

Everyone’s experience of dementia is unique, so not every tip may help the person you care for. Use the tips that you feel will improve communication between you.

Before the conversation with a person that has a dementia

Planning ahead of the conversation

You may sometimes be able to plan ahead for conversations. An example would be if you are visiting the person in a specific place such as a care home or hospital. Or you may want to speak with them about an important issue and want to take some time to prepare.

Plan enough time to spend with them. If you feel rushed or stressed, take some time to become calmer first.

Think about what you know about the person. How have they always communicated? What might help them if they are struggling to communicate?

There may be a time of day when they are less able to focus or communicate. Try to avoid these times for important conversations. Make the most of ‘good’ times and moments and find ways to adapt on more difficult ones.

Consider the environment

Communication works best in quiet and calm places, with good lighting. Busy environments can make it harder for a person with dementia to concentrate on the conversation. Ask them if you can turn off any distractions such as the radio or TV.

Stand or sit where they can see and hear you as clearly as possible – usually this will be in front of them, and with your face well-lit. Try to be at eye-level with them, rather than standing over them, and make eye contact as you would with anyone.

Think about language

Some people with dementia can begin to communicate using the first language they learned. If this happens and you do not speak this language, consider arranging for family members or friends who also speak the language to be there with you. 

You could use a translation or interpretation app on a smart phone or tablet. If you need an interpreter, speak to your local authority, the person’s care home, or an organisation such as the Institute of Translation and Interpreting.

If the person prefers reading, try using translated written materials.

During the conversation with a person that has dementia

How to engage the person with dementia

As their dementia progresses, they may seem more withdrawn, or less talkative. The way you phrase things can make a big difference in helping them join in conversations.

These tips can make it easier for them to understand and follow discussions, so they can participate and feel less isolated:

• Try to get their full attention before you start.
• Make sure they are ready for a conversation. For example, make sure they are comfortable and check they are not hungry or thirsty.
• Allow time between sentences for them to process the information and respond. These pauses might feel uncomfortable if they become quite long. However, feeling pressured to reply can stop people from responding in future conversations.
• Let them complete their own sentences without interrupting, even if you think you know what they are trying to say.
• Include them in conversations with others. It is important not to speak as though they are not there. Being included can help them to keep their sense of identity and know they are valued.
• If they don’t understand what you’re saying even after you repeat it, try saying it in a slightly different way.
• Too much information at once can be overwhelming. Try to stick to one idea or subject at a time. If they are finding it hard to understand, breaking down what you’re saying into smaller chunks may be more manageable.

Listening to the person with dementia

Listen carefully to what the person is saying. Offer encouragement both verbally and non-verbally. Non-verbal encouragement could be making eye contact and nodding. This ‘active listening’ can help improve communication. Learn more about non-verbal communication and dementia.

If they are having difficulty finding the right word or finishing a sentence, ask them to explain it in a different way. Listen and look out for clues. If they cannot find the word for a particular object, ask them to describe it instead. If you haven’t fully understood what the person has said, rephrase their answer to check your understanding of what they meant.

If you can’t understand what they have said, or if they say something that doesn’t make sense to you, think about what they may be trying to express. For example, they may just need reassurance or comfort in that moment.

If they are upset, let them express their feelings. Allow them the time that they need, and try not to dismiss their worries – sometimes the best thing to do is just listen, and show that you are there.

How to speak to a person with dementia

Putting some extra thought into the way you communicate can help ensure that the person gets the most out of your conversation. Remember that they may still understand a lot of what you’re saying, even if they’ve lost some ability to respond.  

• Speak clearly and calmly.
• Go at a slightly slower pace than usual if they are struggling to follow you.
• Use short, simple sentences.
• Plan short, regular conversations if they become tired easily.
• Try not to use ‘elderspeak’ such as speaking in a high-pitched voice and talking down to them as though they are a child. This can be upsetting and uncomfortable.
• Avoid trying to jog their memory. This can be frustrating and embarrassing for them. Instead, speak about the things you remember from the past so they have time to recall what they can with no pressure.
• Try not to ask too many open questions. For example, rather than asking what they would like to drink, ask if they would like tea or coffee. Giving choices is important, but too many options can be confusing.
• Try to be conversational with any questions. An example might be: ‘I’m going to have cake with my tea – I’ll get you one too, if you like?’
• What to talk about
• If you are planning to visit the person, it can be useful to take some time to consider topics or subjects they may enjoy talking about.

With any communication, it can help to think about previous conversations you have had with them and what helped you to communicate then.

Prompts can help, such as using a photo of someone or encouraging them to hold and interact with an object you are talking about. You can also use their environment – anything that they can see, hear or touch might be of interest.

Familiar objects or things that remind the person of their past can be a nice way for them to reminisce. This may also prompt conversations about events and memories from their life.

Sometimes they may have a mistaken belief or say something that you know to be untrue. For instance, they may ask about someone who has died, or may be confused about where they live. Think about whether it is necessary to correct these beliefs. If they are not causing harm or anxiety, then you may not need to. Learn more about how dementia an change someone's perceptions.

Asking questions is a good way to get the person talking. Keep in mind that asking too many questions, or asking complicated questions, can feel tiring. They may become frustrated or withdrawn if they can’t find the answer.

What do to when the conversation doesn’t go to plan

You won’t be able to plan every interaction, and not every conversation will go well. There will be times when you are in a rush, in a busy public place, or unable to get away from distractions. Remember that you can only do your best with what is in your control.

You and the person might not always understand each other. Try to laugh together about misunderstandings and mistakes. Humour can help to relieve tension and bring you closer together, although make sure they don’t feel you are laughing at them.

Managing stress and working on coping skills for when you’re frustrated or feeling overwhelmed can help you communicate positively with the person. If you do find yourself raising your voice or becoming angry or frustrated, step away from the situation if it’s safe to do so. If this happens, be kind to yourself and focus on reconnecting with them.