Communication and understanding

Expert reviewer, Versha Sood, Dementia Lead in Bupa Care Services
Next review due March 2023

"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

Dementia can affect the way your loved one communicates with you and with the people around them. It can also affect their understanding of situations, conversations and events. The way they communicate and express themselves also changes as dementia progresses. All of these things can be frustrating and upsetting for them and for you. But, by giving them the chance to have conversations, see family and friends and express their feelings, you can help them feel better understood and less isolated. It will also help you to continue to support them.

In this article, we look at tips that can help you communicate with your loved one and help them to feel understood. We've also included some information about coping with behaviour changes.

Two people reading instructions on a medicine container

Dementia affects communication

Dementia can affect communication and understanding in lots of different ways. Each person is different though and not everyone is affected in the same way. These are some of the main difficulties you might see:

  • problems finding and using the right words
  • memory problems, which might mean they withdraw from conversations or ask you to answer on their behalf
  • repeating the same words and phrases
  • being easily upset or argumentative
  • difficulty thinking, which means they may not be able to say what they want
  • problems understanding what is being asked of them or following instructions

Having conversations

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

  • Remove as many distractions as you can (for example, the TV) and choose a quiet place to talk that encourages a two-way conversation.
  • Listen carefully and get their full attention before you speak. Sitting close to them on the same level will help.
  • Speak slowly and clearly, use short sentences and give them time to reply. It can take longer for someone with dementia to think and process what you’ve said, so talk at their pace.
  • Try to speak conversationally rather than asking lots of questions in a row. Too many questions can make them feel pressured and they may forget what you’ve asked very quickly.
  • Try using an object or picture as well as words. Seeing and touching something relevant can help your loved one to stay focused on the topic. For example, if you’re talking about a person, use their photograph.
  • Gentle touch can be helpful – for example, hold their hand if it feels right or lightly touch their face to get their attention.
  • Be respectful in the way you communicate and 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.
  • When someone has dementia, their emotions can often be close to the surface. Expect a few tears or some angry words and try not to take them personally.
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Sharing memories

In the earlier stages of dementia, people tend to remember the past better than recent events. Because of this, you may find your loved one enjoys activities that focus on past events or reminiscences. It can help them to feel more confident and capable when their memories are clearer. You could look at photos together, watch footage of memorable events, play music or put together a life story book or photo album. Life story books are records of someone’s life and experiences and making one with your loved one is a great way to help them open up and talk.

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

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

Seeing family and friends

Besides making communication more difficult, the symptoms of dementia can make it harder to be sociable and interact with other people. So, when caring for or supporting someone with dementia, try to help them see friends and family members whenever possible. Keeping close relationships going is an important part of everyone’s wellbeing.

Face-to-face contact is usually best but that’s not always possible. Family members and friends who live far away can help by making a regular phone call. This is something your loved one can look forward to and it may help to reduce feelings of boredom or isolation.

If your loved one has hobbies which involve socialising – for example, 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.

Communicating through behaviour

Our behaviour is a way of communicating and we all express ourselves in lots of non-verbal ways, such as facial expressions, gestures and actions. Your loved one’s behaviour will probably change as their dementia progresses and communication becomes more difficult. You’ll probably find that they use speech less and less and you’ll need to try to understand what they’re telling you by looking at their behaviour.

Trying to understand the meaning behind new behaviour may help to explain changes in behaviour. Sometimes it may be your loved one’s way of telling you what they want or need or what they do or don’t like. Or it may be a way of expressing a feeling, discomfort or pain. It may be an expression of frustration or distress.

Some behaviours can be challenging to manage and live with. This can be difficult to cope with for both of you and may make you feel upset and stressed. Although each person with dementia is different, some common behaviours include:

  • doing the same thing over and over again
  • restlessness and walking about
  • behaving in a way that other people may find embarrassing (lack of inhibition)
  • night-time waking
  • hiding and losing things
  • aggression, such as making hurtful comments or shouting, hitting and pinching

Working out what is causing challenging behaviour can help you prevent or reduce it. So, think about physical issues such as hunger, emotional needs such as boredom or loneliness, and things in the environment that might cause distress. A change in your loved one’s behaviour, may be related to their care. It can be a good time to think about the kind of care they’re getting and whether that might need to change.

If you’re worried about a loved one’s behaviour, you can also contact their GP or mental health specialist for advice.

Communicating in the later stages of dementia

As dementia progresses, speech becomes more difficult and your loved one is more likely to communicate in non-verbal ways. This can mean using sounds, gestures, behaviour and actions instead of words. You might also find that even if they can speak to you, what they’re saying doesn’t make sense.

But your loved one is still communicating, so it’s important to try to find ways to understand their needs. This will help you continue to support them to communicate. Here are some tips.

  • Make eye contact with them and smile. Use non-verbal communication yourself, such as gestures, hand movements, touch and your body language.
  • Take your time and try not to rush.
  • Communicating in a similar way to them (mirroring) can sometimes work.
  • Talk about something they would usually enjoy, such as a past hobby or interest.
  • Do activities together or use their senses to stimulate and comfort them, such as playing music, touching things with different textures, stroking a pet or looking at photos.
  • You could try a communication tool such as Talking Mats. This consists of picture or digital cards that your loved one can point to when they’re answering a question.

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Related information

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  • Reviewed by Sarah Smith, Freelance Health Editor, and Marcella McEvoy, Bupa Health Content Team, March 2020
    Expert reviewer Versha Sood, Dementia Lead in Bupa Care Services
    Next review due March 2023