Communication and understanding


Expert reviewer Professor Graham Stokes, Bupa Global Director of Dementia Care
Next review due September 2020

"The person you knew is still there. They might just not be able to communicate in the same way, but they're not gone, they are still there, and they still need your love and affection." - Susan

Your loved one may find it more difficult to communicate because of the dementia. Unless they are given chances to have conversations, see family and friends and express their feelings, they may feel frustrated and isolated.

In this section, we look at tips that can help you converse with your loved one and help them to feel understood. We've also included some information in this section about coping with behaviour changes and, in particular, aggressive behaviour. Such behaviour can be upsetting, but managing the situation in a positive way can make a big difference.

Having conversations

People with dementia can find it difficult to express themselves. This can lead to problems communicating with those around them. If you’re having problems communicating, the following tips may help you and your loved one understand each other better.

  • Listen carefully and get their full attention before you speak.
  • Speak slowly, use shorter sentences and give them time to reply.
  • Try to speak conversationally rather than asking lots of questions in a row. Too many questions may make them feel pressured.
  • When you do ask questions, ask one at a time. Don’t forget to give plenty of encouragement and time to answer.
  • Ask closed questions that can be answered with a yes or no. For example, ‘Would you like a cup of tea?’ rather than ‘Would you like tea or coffee?’
  • Physical contact can be helpful; for example, holding their hand if it feels right.
  • Pay attention to their facial expressions and body language. These can give you clues about how they’re feeling.
  • Try to laugh together about any misunderstandings that might happen.

Behaviour changes

Your loved one’s behaviour will probably change as the dementia progresses. This may be difficult to cope with and can make you feel upset and stressed.

Trying to understand the meaning behind their behaviour may help to explain it. Sometimes it may be their way of telling you what they want or don’t like. Although each person with dementia is different, some common types of unusual behaviour include:

  • doing things over and over again
  • restlessness
  • behaving in a way that other people may find embarrassing (lack of inhibition)
  • night-time waking
  • hiding and losing things

Responding to aggressive behaviour

Sometimes your loved one may be unable to communicate their needs, or know what to do about them. Because of this, they may feel frustrated, which can cause them to behave in a way that could be seen as aggressive.

Aggressive behaviour can be very distressing for both you and your loved one. This kind of behaviour could involve shouting, making hurtful comments, pinching, scratching or biting.

Working out the cause of the behaviour can help you find a solution. The following tips may help you to respond to aggressive behaviour.

  • Don’t take it personally – they may be trying to tell you something.
  • Try and stay calm, even though you may feel frustrated and upset.
  • Try not to shout at your loved one – they may then feel threatened which can make things worse.
  • Give them plenty of space and time.
  • Try to act normally and be supportive; don’t punish unusual or difficult behaviour.
  • Walk away and return later if it’s becoming too upsetting.

If you’re worried about a loved one’s behaviour, contact your mental health specialist for advice.

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Sharing memories

People with dementia tend to remember the past better than recent events. Because of this, you may find your loved one enjoys activities that focus on reminiscence. You could look at photos together, watch footage of memorable events, or put together a ‘memory box’ of significant items and mementos.

Playing a favourite piece of music may make your loved one smile and put them at ease. If they had a job that they were passionate about, a favourite football team, or another treasured hobby, it could be a great talking point.

Your first instinct when talking about memories may be to ask ‘Do you remember when...?’ But a direct, factual question like this may not always be best for a person with dementia. They may be worried about getting the answer wrong or feel pressured. It might be better to share a memory yourself, to encourage your loved one to do the same.

Seeing friends and family

When caring for someone with dementia, try to help them have opportunities to see friends and family members whenever possible. Just like for anyone else, keeping close relationships going is an important part of their wellbeing.

Face-to-face contact is always best. But if family members live far away, a regular phone call can be something for your loved one will look forward to. It may help to avoid them feeling bored or isolated.

If your loved one has hobbies that provide social contact – like playing a sport, or gardening on an allotment – try to help them continue. Over time, they may want to build new friendships, perhaps with other people affected by dementia. Local support groups can be great for this. Our section about support for dementia carers has more details about how to look for local groups.


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Related information

    • Communicating well with a person with dementia. Social Care Institute for Excellence. www.scie.org.uk, last updated May 2015
    • Communicating and language. Alzheimer's Society. www.alzheimers.org.uk, last reviewed July 2012
    • Having a conversation with someone with dementia. Social Care Institute for Excellence. www.scie.org.uk, last updated May 2015
    • Behaviour in dementia as a form of communication. Social Care Institute for Excellence. www.scie.org.uk, last updated May 2015
    • Dementia. NICE Clinical Knowledge Summaries. cks.nice.org.uk, last revised August 2016
    • Behavioral and psychologic symptoms of dementia. The MSD Manuals. www.msdmanuals.com, last full review/revision February 2016
    • Walking about. Alzheimer's Society. www.alzheimers.org.uk, last reviewed December 2015
    • Aggression. Alzheimer's Society. www.alzheimers.org.uk, last reviewed May 2013
    • Reminiscence for people with dementia. Social Care Institute for Excellence. www.scie.org.uk, last updated May 2015
    • The person behind the dementia. Social Care Institute for Excellence. www.scie.org.uk, last updated May 2015
    • Dementia: independence and wellbeing. National Institute for Health and Care Excellence (NICE), QS30 2013. www.nice.org.uk
    • Dementia 2013: The hidden voice of loneliness. Alzheimer's Society, 2013. www.alzheimers.org.uk
    • Dementia resource for carers and care providers. National Institute for Health and Care Excellence (NICE). www.nice.org.uk, accessed July 2017
  • Reviewed by Graham Pembrey, Lead Health Editor, Bupa Health Content Team, September 2017
    Expert reviewer Professor Graham Stokes, Bupa Global Director of Dementia Care
    Next review due September 2020



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