Communicating with someone with dementia

The principle

Dementia changes the brain's ability to process language at speed, retain new information for the length of a conversation, and adjust between speakers and topics. It does not, until very late, change the person's emotional perception or their need to be understood. The principle of good dementia communication is to lower the cognitive demand and raise the emotional clarity.

Before you speak

• Approach from the front, not from behind or the side;
• Get to eye level: kneel or sit down if the person is seated;
• Make calm eye contact and smile;
• Reduce competing demands: turn down the television, move to a quieter room, switch on a brighter light;
• Use the person's name, then pause.

How to phrase what you say

One message at a time

Compound sentences ("Could you put your shoes on, and we'll go to the shops, then pop into the post office, and then home for tea") overwhelm. Break into single steps with pauses:

1. "It's a sunny morning."
2. "Shall we put your shoes on?"
3. (After shoes are on) "Let's go for a short walk to the shops."

Closed questions, with realistic options

"What would you like for lunch?" is open and difficult. "Would you like soup or a sandwich?" is closed, with two clear options. "Would you like tomato soup?" can be even better.

Avoid testing

"Do you remember what we did yesterday?" is the most common phrase to remove from your vocabulary. Replace with statement-style comments: "That was a lovely day yesterday at the park. The ducks were so funny."

Use the right vocabulary

Pick familiar, concrete words. Avoid jargon and metaphor. "Your daughter Sarah is coming for lunch" is easier than "Sarah's popping over for a bite to eat."

Slow down

Slow your speech and increase pauses. Allow 10 seconds for a response before reframing. This feels longer than it is.

Body language

Most communication is non-verbal, and this is even more true in dementia.

• Open posture, no folded arms;
• Match the emotional tone of the situation: calm if calm is needed, warm if warmth is needed;
• Gentle touch on the hand or shoulder, where welcome;
• Mirror gestures rather than rushing ahead.

Listen well

Listening with full attention is itself a form of care. People with dementia often have insight into being rushed, even when their language is impaired. Acknowledge what you hear, even when the content is unclear, by reflecting back the emotion: "It sounds like that has been on your mind."

Validation rather than correction

Validation Therapy is an approach to communication that prioritises validating the underlying emotion over correcting the factual content. The classic example: a 75 year-old says "I need to go and pick up the children from school." The factual response ("Your children are 50 now; they do not need picking up") often distresses. A validating response ("It sounds like you are thinking about the children. They were lovely at that age, weren't they") reduces distress and opens connection.

Validation is not lying; it is meeting the person in the emotional reality they are in. Reserve gentle reality orientation for situations where it helps (the time of day, the day of the week) and where you can do it without distress.

Common situations

Repeated questions

Repeated questions reflect the inability to retain the answer, and often underlying anxiety. Answer calmly the first few times. If repetition persists, ask yourself what might be driving the anxiety (an upcoming appointment, a missing item) and address that. A written note on the kitchen table ("Sarah is coming at 3 pm") can absorb some of the repetition.

Wanting to go home (when at home)

"I want to go home" is almost never a literal request. It usually means "I do not feel safe / settled / comfortable here." Validate the feeling and reorient gently to a comforting activity: "Let's have a cup of tea first."

Asking after deceased relatives

One of the most common difficult moments. Repeatedly explaining a death is distressing and the news is lost again. A gentle validation approach, focused on memories rather than the fact of death, is usually kinder. ("She was so funny, wasn't she. Tell me about that holiday in Cornwall.")

Refusal of care

Refusal often reflects misunderstanding, embarrassment or pain. Try again later, change who is asking, change the wording, or change the approach. See personal care for the specifics.

Aggression

Step back, lower your voice, give space. Identify the trigger if you can. The fundamentals of de-escalation are on the agitation and aggression page.

The environment

Communication is shaped by the environment:

• Good lighting (especially in the afternoon and evening);
• Reduced background noise;
• Visual aids: a clock, a calendar, family photos, a daily plan board;
• Familiar objects in familiar places;
• Working hearing aids and glasses (the single most underused intervention).

Communication in advanced dementia

In severe dementia, language becomes more limited but communication does not stop. Touch, music, a calm voice, eye contact and shared presence remain powerful. Sit close, hold a hand, sing a familiar song. People often respond to music from their early adulthood when very little else lands. Sensory familiarity, comfort and dignity remain the focus.

For families using English as a second language

People with dementia often lose their later-learned languages first, reverting to the language of childhood. If English is not the family's first language, the person's most comfortable language may shift. Where possible, communicate in the language of childhood; arrange interpreting services for healthcare appointments.