Do’s and Don’ts When Talking to Someone With Dementia

Communicating to understand one another, and feel understood, is one of the most important aspects of being human. For people living with dementia, this becomes much harder. 

If you are caring for someone with dementia, it is important to know how the condition changes the way people interact with those around them. That way, you can make adjustments so that there is better understanding and a more meaningful connection between you and your loved one — at every stage of dementia. 

How dementia affects communication  

Different types of dementia affect the brain differently. But every type of dementia affects the way a person processes information and interacts with the world around them. 

In the early stages of dementia, there may not be a noticeable impact on communication. But as the condition progresses, the way a person communicates is affected by:

• Forgetfulness:A person with dementia may quickly forget a recent event or something you said. This can make it harder to carry on a conversation. And sometimes these errors create embarrassment, which can also affect the way the person communicates.

• Changes in attention and focus:These changes can make it difficult for someone with dementia to follow the flow of a conversation. As a result, the person may change the conversation abruptly or lose interest.  

• Language difficulties:People with dementia may have trouble finding the right words. They may substitute one word for another, or they may need to describe something instead of using the word for it. This can sometimes make conversations more halting and lengthy. 

• Social isolation:Communicating can become a frustrating activity for someone with dementia. As a result, the person may become less likely to start a conversation or avoid social settings altogether. 

• Personality and mood changes:Dementia often causes changes in personality and mood. Some people may become more irritable or emotional, while others may become more emotionally blunted or flat. 

• Lower tolerance for stress:Experts believe that people with dementia become less able to handle stress than usual. Accumulation of stress then results in agitation and other stress-related behaviors. 

When you are trying to connect with a loved one who has dementia, it can be comforting to remember that the changes in their behavior and the way they interact are a symptom of the disease. They are not from a lack of care or consideration. 

Tips to improve communication when someone has dementia

Some communication strategies can be used in any stage of dementia. Other techniques may need to be adjusted or changed as a person’s dementia progresses. Here are some “do’s” to keep in mind when talking with someone at various stages of dementia.

General communication strategies

When talking to someone at any stage of dementia, try to:

• Keep the conversation person-centered by taking into account their culture, background, personal preferences, and interests.

• Stay positive, be encouraging and supportive about what they have to say, and keep the topics light-hearted and easy.

• Talk slowly and clearly so they have time to process what you are saying.

• Give them extra time to voice their thoughts. 

• Keep background noise to a minimum. 

• If possible, make sure the environment is comfortable for you and them.

Early-stage communication

In the early stages of dementia, people may continue to communicate normally. But it still helps to keep in mind the following tips when talking to someone with early-stage dementia: 

• Try not to assume what the person does or does not know; caregivers and friends should avoid answering questions or taking over tasks that the person can still do on their own.  

• Allow plenty of time for the person to participate in the conversation. 

• Present one option instead of two or more choices to minimize stress around decision-making. For example, it may be better to say “Would you like some water?” instead of “What would you like to drink?”

• If you are verbalizing instructions, break them down into single steps. As an example, getting ready could instead be a list of things that starts with putting on shoes. 

Later-stage communication 

As dementia advances into later stages, nonverbal communication becomes increasingly important. Caregivers can connect with people in these stages with:

• Reassuring facial expressions

• Gentle touch 

• Familiar items and photographs

• Favorite music

• Favorite movies or shows

All these things can be soothing and therapeutic for someone with dementia. It is also worth noting that companion animals can also provide tactile comfort and nonverbal emotional connection. 

What not to do when talking to someone with dementia 

It is natural to want to help someone who is having trouble communicating. But it is important to remember that these good intentions don’t always produce the intended results. With that in mind, here are some “don’ts” to keep in mind when talking to someone with dementia.

Don’t remind

Many dementia caregivers have to train themselves to avoid the phrase “don’t you remember?” While this is a natural response to someone being forgetful, it can provoke anxiety for someone with dementia. 

On the other hand, it is appropriate to help someone with dementia reminisce about a topic they want to explore. Let your approach be gentle and allow them to guide you.   

Don’t quiz

Well-intended caregivers will often quiz their loved one who has dementia as a way to help them “exercise” their brain. This can produce stress and frustration on both sides. Physical exercise and social interaction are better ways to stimulate the brain and possibly slow the progression of dementia.

Don’t contradict

People with dementia often experience altered perception. They may think they are in a different situation or time. They may even believe deceased loved ones are still living. In these cases, contradicting their beliefs can produce stress, sadness, and other negative emotions. 

In these situations, a gentle approach is again needed. If it won’t hurt to go along with their beliefs, this can actually be comforting for them. When this isn’t possible, subtle distraction techniques, such as changing the subject or pointing out something new, can be helpful. 

Don’t rush

People with dementia are more likely to become agitated or confused when under pressure.  Remember to keep the pace of conversation slow and the tone calm. Caregivers learn that interacting with someone with dementia is an exercise in patience. 

Don’t push

Sometimes, communication may not be going well. If someone with dementia does not seem to be in the frame of mind to talk, then the best approach might be to try again later. This is especially true if the person is stressed, tired, or dealing with other physical symptoms. 

Don’t exclude

Sometimes, people shy away from interacting with a loved one with dementia. They may feel awkward about having a conversation in the “right” way. But this can lead to increased isolation, loneliness, and depression — both for the person with dementia and their caregiver. 

Ongoing social interactions are important both for people living with dementia and their caregivers. 

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Written by:

Jennifer Arnouville, DO, FAAFP

Jennifer Arnouville, DO, FAAFP has been a practicing physician since 2010. For the first 12 years of her career, Dr. Arnouville had a primary care geriatrics practice.

Edited by:

Katie E. Golden, MD

Katie E. Golden, MD, is a board-certified emergency medicine physician and a medical editor at GoodRx.

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