How to speak to someone with dementia

Dementia causes people to have poor memory, get confused and say things that are completely out of character. This can make knowing how to speak to someone living with dementia more challenging.

There is no cure for dementia, so you’ll have to adapt to new ways of interacting with your loved one as the disease progresses.

It’s really important that people who live with dementia are encouraged and supported to have regular meaningful conversations. This is an essential human need and vital for supporting their self-esteem, mental wellbeing and even to ease symptoms because stress and isolation can aggravate symptoms of dementia.

Why can dementia make conversation difficult?

Dementia affects cognitive function and people living with the condition can struggle with conversation in a number of ways, including:

• Memory – The ability to remember the context of a conversation, previous conversations or events, or to find the right words to express themselves. They can also forget what they are trying to say before they’ve finished saying it.
• Comprehension and listening – Their brain doesn’t work as quickly or communicate with itself as effectively. This means they can struggle to piece together what you’re saying to create meaning.
• Mental fatigue – People with dementia can experience mental fatigue much more quickly and struggle with brain fog. Signs they may be mentally exhausted can include staring at you blankly more and more throughout the conversation, not replying or their words coming out in the wrong order.
• Hearing difficulties – Many people who have dementia are also of an age where their hearing is declining. There have also been links between dementia and hearing loss.
• Lack of confidence – All of the above can cause people to lose confidence in conversing. They can worry they are boring or annoying others, as well has have lower self-esteem due to losing some of their independence.

5 tips on speaking to someone who has dementia

1. Set the scene for a good chat

Being in a calm environment that also stimulates conversation can really help when speaking to a loved one with dementia.

This could include:

• Being somewhere comfortable and familiar to them.
• Being somewhere quiet and reasonably private. Busy public places can be distracting, as can rooms where a TV or radio are blaring. If you are in a pub or restaurant, try to find a quiet corner or sit outside if it’s warm enough.
• Sitting where they can clearly see your face. Choose a light area and sit so you can face them. This helps them to read your facial expressions.
• Having creature comforts such as tea and biscuits can help them to relax and not feel as if they are being rushed or in an interview.

2. Never presume, never patronise

Don’t presume the person remembers the context of what you are talking about or a conversation you had recently. If their dementia is severe, they may not even remember who you are. Remind them of your name and the context of what you’re talking about before you speak. 

It’s good to use a kindly tone but be wary not to speak to the person as if they were a child. This can come across as infantilising and patronising. Everybody likes to be treated with dignity and respect, so treat the person as an adult.

Try to include them in conversations you are having with others in front of them, even if they can’t fully engage.

3. Let them speak

Give the person with dementia plenty of time and space to speak. It can take them longer to find the right words or remember what they wanted to say, so be patient and let them go at their own pace.

It can also be challenging for them to actively listen to you and understand what you are saying for very long. Anyone zones out if someone is monologuing at them. Give the person plenty of opportunity to speak and when it is your turn, use short, clear sentences and questions to keep them engaged.

4. Use prompts to find things to talk about

Finding things to talk about can be challenging if the person can’t remember what they’ve been doing. Often they are living in a care home by the time their dementia has progressed that far, so staff can tell you what activities your loved one joined in with that week.

Use verbal and visual prompts to trigger memories and stories. Photos are particularly good. If you know which stories or topics they particularly like to tell and remember well, ask questions that trigger those, even if you’ve heard it a hundred times.

It’s vital to never tell a person with dementia that they’ve told you something or asked the same question multiple times. This can be extremely embarrassing and distressing for them and can do real damage to their self-esteem. Always listen or reply patiently as if this is the first time you’ve heard it. Writing answers to frequent questions down for them can also be better for you both.

5. Validate their feelings and don’t fret over inaccuracies

Dementia can cause people to make lots of mistakes and even have false memories (called confabulation) when recalling events. Don’t be pedantic about these or correct them all the time as this can harm their confidence and confuse them further. Only correct them if it’s essential or to comfort them.

Even if what the person is saying is factually untrue, their feelings about it are real. Validate those emotions by promoting them to express further how they feel.

Work into validation therapy found that long-buried and unresolved issues can resurface when a person develops dementia. They may start talking about trauma from their childhood or marital issues they had with their deceased spouse, despite never mentioning these things earlier in their life.

When this happens, the person is reflecting and trying to work through their feelings by talking to you, but they can’t easily do this due to their cognitive impairment. It’s very possible that these ghosts of the past are resurfacing in their mind because something is making them unhappy in the present and they don’t have the coping mechanisms to deal with this in the same way due to their dementia.