Effective communication with people with dementia

The process of communication can break down at any point.

Perhaps there’s a lot of background noise and it’s difficult to hear, maybe we’re tired or we’re using the wrong method of communication.

A breakdown in communication can result in feelings of frustration in a person living with dementia, which may in turn impact on the way they behave.

Consider how you feel when you cannot make yourself understood or cannot understand what is being asked of you, perhaps on a foreign holiday.

Communication skills will change over time. Changes may be subtle to begin with:

• taking a little longer to find the right word or describing items instead
• losing their train of thought mid-sentence
• difficulties understanding what is being said or following complex sentences.

As dementia progresses, people will rely more and more on the other person’s nonverbal communication, how things are said and the tone of voice.

It’s important that we recognise these changes and adapt what we do to make communication as effective as possible.

Minimise distraction

• turn the television off or move to a quieter area
• get the person’s attention
• does the person prefer to be called Mrs Jones? Elizabeth? Liz? Betty?
• Use their name at the beginning of the sentence to cue a person in

Think about your body position

• Can they see you?
• Get down to the person’s level, make eye contact. The visual field will shrink as the dementia progresses, so always approach from the person’s dominant side. You may need to get quite close before connection is made!

Speak clearly and calmly

• Simplify your sentences without speaking in childlike terms
• Use words the person uses. So if they call the toilet the ‘powder room’, so should you
• Avoid joining two sentences together by using ‘and’, ‘or’, ‘but’. Start a new sentence.

Think about your tone of voice

• Don’t speak to the person as you would to a child
• Your tone of voice will be affected if you are in a rush, cross, or fed up
• Remember it’s not always what you say, it’s how you say it!

Avoid too many questions

• Consider yes / no questions
• While it’s important to give people choices, sometimes too many choices will cause confusion.
• If you read out a list of choices at mealtimes, people often ‘choose’ the last on the list, as it’s the one they remember!
• It may be better to simply ask “would you like fish?” which requires a yes or no response or even better, show them the options.

Communicate without words

• Use exaggerate gestures. For example, show a person how to brush their teeth by doing the actions instead of explaining how to do it
• Use pictures to help with decision making
• Consider writing it down. Some people will be able to read, whereas others may not
• Use touch to reinforce spoken word

Communication isn’t just speech. We communicate with each other through our body language, our facial expressions, the noises and movements we make.  It’s important to learn ways of communicating that work for the person with dementia, not ones that work for us.   

These are the ways in which we communicate.

Here is some advice on communicating well with people with dementia. 

Working with PPE

We know that there will be additional barriers to communication when using PPE (personal protective equipment). Staff will need equipment to protect them, but this can be confusing and upsetting for some people. Here are some resources to help you overcome some of those barriers. 

Guidance and PPE considerations when supporting people living with dementia.

Here is a helpful video with tips on how to explain wearing gloves.

Culture and language

It is important to recognise a person’s language and culture when you are learning about who they are.

Welsh language

Welsh speakers living with dementia need be supported to speak their first language. Some may struggle to remember English words. If you’re not a Welsh speaker, you could try the following ideas:

• find out if there are Welsh speakers who could speak to the person with you
• learn some basics, such as pronouncing a persons name
• use more facial expressions and body language.

Here are some useful resources to help you to communicate in Welsh. This resource has the ability to produce and respond to human speech (text to speech and speech recognition) and you can go here and hear how to pronounce phrases such as ‘how can I help’ and ‘where is the pain’.

The Caring in Welsh App is particularly useful to support workers with little or no Welsh language skills.

Working with people from black, Asian and minority ethnic communities

There are some useful leaflets on dementia in a number of languages. It is important to share information leaflets with carers or family members too.

There are some really helpful resources on the Dementia Alliance for Culture and Ethnicity website.

There are also resources on providing spiritual care to different faiths at the end of life.

Find out more about effective communication with people living with dementia.

Communication tips from Dementia UK

7 things not to say to somebody with dementia

The Daily Sparkle (a daily reminiscence newspaper full of articles, quizzes, old news stories, gossip, puzzles, singalongs and entertainment geared towards stimulating the mind and improving memory

Relish (a suite of activity products to assist people with dementia in leading active, engaging and fulfilling lives – enjoying activities that are meaningful to them)

Apps for Communication - A series of downloadable tools that can help people who have difficulty communicating verbally to express their wishes

Improve your practice by accessing the latest research findings.

Language changes in bilingual individuals with Alzheimer's disease (2015)

Mapping differences in memory and thinking abilities in people with and without dementia. Alzheimer’s Society)

A minimal interference technique to improve memory in people with Alzheimer’s

Help us to improve the Dementia resource for care professionals by telling us what you think about it in our short four question survey.