To communicate, we have to do certain things in a certain order. We must decide what we want to say and what method of communication would be most effective. We then send the message to someone else. They have to interpret the message and decide on their response and reply or react.
Why communication breaks down
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.
Recognising change in communication
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.
Effective communication
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
Case study about communicating effectively with someone with dementia
Useful resources
Find out more about effective communication with people living with dementia.
Communication tips from Dementia UK
Research links
Improve your practice by accessing the latest research findings.
Language changes in bilingual individuals with Alzheimer's disease (2015)
A minimal interference technique to improve memory in people with Alzheimer’s
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