Having a conversation with someone with dementia

Communication is critical for everyone. There are two main forms of communication – verbal (the things we say) and non-verbal (gestures, touch and body language). This feature focuses on the verbal form of communication and will provide you with some practical tips on how to help a person with dementia.

For information on non-verbal communication, see the feature in this section on Behaviour as a form of communication.

What we say should match how we say it – the tone we use... and the faces that we pull while we are saying it.

Laura talks about good communication in the video How to communicate with someone with dementia

For more on the importance of good communication, and from the point of view of people with dementia themselves, read the feature What other people can do to help me live well in the section Getting to know the person with dementia.

Getting ready to communicate or have a conversation

Minimise background noise

People with dementia can find it difficult to concentrate in any environment, including their own home. If there is a lot of background noise (for example, from a TV, radio, vacuum cleaner, or traffic outside) then your chances of good communication are lessened. Removing or reducing distractions inside or outside the home will substantially improve your ability to communicate. Try shutting windows to reduce sounds from outside or turning the TV or radio down or off, remembering of course to ask the person’s permission to do so and explaining why it makes sense.

Relax

You are likely to be moving and talking at a much faster pace than the person with dementia. So when getting ready to have a good conversation you need to be relaxed and slow down your pace. Take a deep breath and exhale slowly. Relax any bodily tension you may be showing, drop your shoulders, unclench your jaw and stretch out. Now think about what you are going to talk about.

Think about how the person may be feeling

Try to put yourself in their shoes or seat. What is their emotional state likely to be? Are they relaxed and happy or anxious and distressed? Are they calm or frightened? Are they likely to respond to humour or are they angry and frustrated? You may be aware of what’s been happening to them prior to your conversation. If not, try to find out so you can think about your approach.

It may feel like the first time for the person with dementia

Short-term memory loss in a person with dementia can prove challenging for family and friends and when providing care and support. While you may see the person several times during a day, each visit may feel like the first for them. This can have a great impact on a conversation, so consider how you would respond. The best approach for a care worker in these circumstances may be to introduce yourself on each visit and explain why you are there.

How to get the communication started

Greetings or ‘verbal handshake’

Think beforehand about how you are going to greet the person. Do they know who you are? They may not know you even though you know them well. Think about whether you need to say your name or whether a warm hello will suffice. A warm, friendly approach is important in creating a relaxed atmosphere for a conversation to start and develop.

Physical approach

Think about where the person is. What can they see from where they are standing or sitting? What are they doing? Are there any sight or hearing problems that will have a bearing on how you should approach them? Generally, make sure that the light is on your face rather than behind you to ensure you can be seen clearly. Aim for good eye contact. Coming in low at eye-level if the person is seated will be less intimidating. If the person is withdrawn, sitting alongside them making some minimal movement and sound may be a gentler way of getting their attention rather than trying to strike up a conversation straight away.

Emotions and touch awareness

How does the person look? What emotions are they showing? Being sensitive to the person’s mood can offer an opportunity to begin a conversation (for example, if they appear to be happy, you could say, ‘You look happy today’). Does the person respond to touch in a positive way? A light touch on the back of the hand can often feel reassuring and non-threatening. If the person moves their hand away from you, take your cue from them and be careful how you use touch. If the person takes the opportunity to clasp your hand this may be an indication that they need more physical reassurance and support. With people who are quite withdrawn, a gentle touch on the cheek can be a way of getting them to look at you. Again be sensitive to their reaction to the touch and take your lead from them.

Checking understanding in the conversation

Identify the emotional state of the response

How is this person feeling? If they have been able to speak, what do the words convey? What does their tone of voice convey? What does their facial expression tell you? What does their body position tell you? What does their respiration rate tell you? Is there any indication that the person is in physical discomfort or pain?

Observing the above will help family members, friends and care staff to achieve better understanding in a conversation. In dementia care you need to listen with your eyes and your ears.

Don’t shy away from tears or laughter

People with dementia often lead very emotional lives. Anxiety and grief may be quite near to the surface. Don’t shy away from tears. Stay with the person and offer them natural support.

You may not be able to fix the cause of the anxiety or grief, but seeing this through with them and not being afraid will help them enormously. Never underestimate this. Likewise, having a belly laugh together over something silly is a great way of getting to know each other.

Say what you think the other feels

You have listened with your eyes and your ears to how the person is feeling. A simple statement of what you have observed will let the person know that you care how they feel. For example, ‘You sound sad right now’ or ‘You look really relaxed sitting there’.

Keep it simple

Be open to a range of possibilities

We often go into situations with set ideas of what we want to speak about or what we expect to hear and we try to switch the conversation quickly to the topic we have in mind. At the beginning of a communication, take your lead from the person with dementia. Don’t try to switch topics too soon. In allowing the conversation to develop, give the person time to say what is on their mind. When the person says x they mean y (or z or t).

Be aware that as word finding becomes more difficult for the person with dementia the content of speech becomes more limited. So, for example, a female name such as Julie may come to represent every female helper rather than referring to Julie in person. A reference to ‘needing my mum’ may mean that the person is feeling scared and unattached rather than a literal question needing a literal answer about the whereabouts of the person’s mother.

Put present and past together to understand the other person’s reality

The more that you know about the key stories, people and themes of a person’s life the better you become at interpreting meaning. If you are puzzled by a response, think about what the person has just been experiencing before your conversation, and think about what you know about the person’s past and see if you can make a connection.

Keeping the conversation going

Dr Jennifer Bute, who has dementia, talks about the importance of ‘patterns’ in speech and conversations. She says: ‘If one can catch a flavour or hint of what the person is talking about, and can latch on to that, often the person can pick up on the pattern (of the conversation).’

Dr Bute – who was a GP before she was diagnosed with early onset Alzheimer’s disease and whose father had dementia – talks about speech and questions in an educational video on her website.

What can we do to help keep the conversation going?

Keep it simple

Keep sentences short to make it easier for a person with dementia to follow what you are saying. Be a good listener and give the person time to think and respond.
As Dr Graham Stokes, Bupa’s dementia specialist, says:

If you can only remember for 30 seconds and are facing someone talking endlessly at you, very quickly you forget what the beginning of the conversation was about. All you are facing is a stream of words that might be relatively meaningless.

You can see Dr Stokes talking about good conversation in the Bupa video ‘Communication with people living with dementia’.

Use the person’s name often

This is a reminder to the person with dementia that you are still talking to them and helps to maintain their concentration and keep the conversation going.

Use visual aids and other prompts

Having some key words or pictures on cards in front of you can really help people with dementia stay focused. They will often struggle to keep the topic of the conversation in mind as the conversation progresses. Having pictures or objects in front of you will help. For example, if the conversation is about medication, have the medication on the table or use a picture of someone receiving medication there.

Music offers another way to communicate. It can lift a person’s mood and allow them to express their emotions. For more information on the benefits of music, see the Creative arts feature in Keeping active and occupied.

Confirm understanding of what has been said

Words used by a person with dementia don’t always make sense. If you have a good relationship with and knowledge of the person you can probably guess the meaning. But it is important not to assume what has been said. Try to check you are on the right track by repeating a word or phrase used, or suggest other words to confirm understanding of what has been said.

Correcting ‘mistakes’

It is often tricky to know whether to correct mistakes, for example when someone has got the wrong time of day or got muddled up. Be wary of your tone and approach if you feel you need to correct the person. Consider offering a tentative alternative such as ‘I wonder if you think it's morning already? I think it’s about 11 at night now – look everyone else is in their beds?’

Remember that confrontation is usually pointless

Sometimes people will accept your point of view or explanation, other times they won’t. If they won’t, then graciously agree to disagree and move the topic of conversation on to something less troubling.

Little and often is usually better

Be vigilant for signs of fatigue. Finding words for things and communicating at length can be particularly tiring for some people with dementia. Take a break, but take every opportunity to keep communication going.

How to finish the conversation

Just as you prepared to start a conversation, so you must think about how you will bring it to a close. If you are leaving the person’s home, make sure you say goodbye. You should not leave the person thinking you are still in their home, perhaps in another room. This may cause confusion or anxiety.

Ensure you have their attention, smile, and let them know you enjoyed your time together and the conversation. Shaking their hand or touching them is a common gesture which gives them a strong clue you are leaving. Leave them reassured and let them know you look forward to talking again. If you are likely to be speaking to them very soon, for example later that day, say when you will return and leave a note close by indicating when the next visit will be.

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