10 Tips for Positive Communication with Someone Living with Dementia

Have you ever found it difficult to communicate with a loved one as their mental ability changes?

Caregiving presents numerous challenges, and one of the most profound is communication when a loved one’s mental abilities begin to decline. Watching someone you care about struggle to find the right words or recognize familiar faces can evoke a whirlwind of emotions—from frustration and sadness to an overwhelming sense of helplessness. You may find yourself grieving for the parts of them that seem to fade away, feeling frustrated when simple conversations turn into complex puzzles. It’s essential to acknowledge that these feelings are natural and part of the caregiving journey. However, amid these challenges, every small moment of connection can hold incredible meaning, reminding us of the love and bonds that endure.

 Here are my top 10 tips for communicating with someone who is cognitively impaired.

1. Address the patient directly.  When speaking with someone with cognitive impairments, it’s essential to make them feel included and valued in the conversation, rather than talking over them or as if they’re not present. Excluding them—either by ignoring them directly or speaking about them to others—can make them feel isolated, overlooked, and disrespected. Instead, aim to engage them directly in the conversation, regardless of their cognitive challenges. This shows that you recognize their feelings and perspectives as important.

   To further reinforce this, sit down to be at eye level with them. Meeting their gaze not only signals respect but also helps establish a comforting, one-on-one connection, which can make them feel safer and more involved. When you’re eye-to-eye, it also allows them to read your facial expressions and body language more easily, which can aid in comprehension. Give them your full attention—put away distractions like phones or other conversations—so they feel like the focus of your time and care. Small gestures like these contribute to a warmer, more supportive interaction and encourage them to engage more openly

   
   
   
2. Gain the person’s attention before you begin speaking. Imagine you’re deep in thought or daydreaming, and suddenly someone starts talking to you. You only catch part of what they’re saying, and you’re left trying to piece together the rest. It can feel disorienting, right? Now, imagine how much more challenging this might be for someone with cognitive impairments, who already struggles with processing information and following conversations. When they miss the beginning of a sentence or topic, it’s often much harder for them to ‘catch up,’ which can lead to confusion and frustration.

   To support clear and comfortable communication, make sure you have their full attention before you start speaking. Approach them calmly, make gentle eye contact, and consider starting with their name or a light touch on the hand to ensure they’re fully present with you. You might say something like, 'Mom, can I talk with you for a moment?' This way, they’re prepared to listen, making it easier for them to follow along without the added stress of trying to figure out what they missed. Taking this small step helps create a smoother, more focused interaction and makes them feel respected and included in the conversation from the very beginning

   
   
   
3. Speak distinctly and at a natural rate of speed. When communicating with someone who has cognitive impairments, it’s natural to feel that speaking more loudly will help them understand better, especially if they seem slow to respond or appear confused. However, raising your voice generally doesn’t improve their comprehension and may even add to their discomfort or anxiety. Speaking louder doesn’t change the clarity of the words, and it can come across as forceful or overwhelming, making it harder for them to focus on what you’re saying.

   Instead, aim to speak at a natural volume but with clear enunciation, focusing on using simple words and short sentences to convey your message. Try to eliminate any background noise, if possible, as distractions can further reduce their ability to process what you’re saying. If they seem to have trouble hearing you, it might help to move closer (while staying in their line of sight) and make sure your face is visible so they can pick up visual cues, like facial expressions and lip movement. This approach respects their need for clarity without inadvertently adding stress or making them feel pressured

   
   
   
4. Speak simply and present one question or idea at a time.

   Using simple, straightforward questions can help avoid confusion and ease communication with someone who has cognitive impairments. Processing complex questions or open-ended options can be overwhelming, as they require more mental effort to understand, organize, and respond to. People with cognitive challenges may struggle to follow multi-step questions or may feel stressed when trying to think through multiple possibilities. By offering a yes-or-no choice or limiting options to two or three, you create a manageable decision-making process that reduces any feelings of frustration or anxiety.

   For example, rather than asking, 'What would you like for lunch?' try 'Would you like a sandwich or soup for lunch?' or even 'Would you prefer a sandwich today?' With fewer choices, they can focus on recognizing familiar words and make a comfortable decision. Keeping things simple in this way respects their cognitive limits and provides them with a sense of control without feeling pressured. I usually stick with two choices, which seems to be an ideal balance—enough for them to express a preference without adding extra mental strain.

   
   
   
5. Help orient the patient. As dementia progresses, it can become increasingly difficult for your loved one to recognize familiar people, even close family members. Simply assuming they’ll remember who you are may lead to moments of confusion or anxiety for them. Often, they may have a vague feeling of familiarity— ‘I know this person’—but struggle to place exactly who you are or how you fit into their life. It’s a bit like when you run into someone in a public place who clearly knows you, but you can’t quite recall where you’ve met or what your relationship is. This disorientation can be unsettling, so gently helping them recognize you can be reassuring.

   To help them feel oriented, try introducing yourself by name and relationship at the start of your interaction. For instance, you might say, 'Hi, Mom, it’s your daughter, Jane.' This friendly, clear introduction offers both comfort and clarity, allowing them to feel grounded in who you are and why you’re there. You can also add small details if they seem confused, like 'I came by yesterday to bring you lunch,' which may further connect the dots. Remember, the goal is to reduce any stress or uncertainty they may feel by providing gentle, loving context. Even if it feels a little repetitive, these introductions show respect for where they are cognitively and help make each interaction feel familiar and safe

   
   
   
6. Take time to listen to the person. Encourage your loved one to share their thoughts, feelings, and needs openly. Let them know that what they have to say is important and that you genuinely want to understand their perspective. As they begin to speak, make a conscious effort to give them all the time they need to respond fully, even if it means sitting in silence for a moment. Processing thoughts and forming responses can take longer as cognitive abilities change, and a bit of extra patience can go a long way in helping them feel heard. Try to avoid interrupting, finishing their sentences, or guiding the conversation too quickly. This level of patience shows respect for their autonomy and can give them the confidence to share their honest feelings or concerns. Sometimes, a gentle nod or a simple 'Take your time; I’m listening' can reassure them that you’re fully present and there’s no rush. This kind of attentive listening not only strengthens your bond but also helps them feel secure, validated, and valued in the conversation.
   
   
7. Support and reassure the patient. When your loved one responds accurately, even if it's something small, take a moment to acknowledge it warmly. Simple affirmations like 'Yes, that’s right!' or 'Exactly!' can boost their confidence and let them know they’re on the right track. For someone experiencing cognitive challenges, these reassurances can help them feel valued and understood rather than pressured or judged. It’s also important to remind them that this is not a 'test' or something they have to get 'right' every time—this is just an open, relaxed exchange of thoughts and information. This approach can relieve any anxiety they might feel about making mistakes and encourages them to participate without fear. By framing your conversation as a two-way dialogue rather than a quiz, you help create a safe, positive environment that nurtures self-assurance and mutual understanding.
   
   
8. Gently provide assistance If your loved one is searching for a word or concept but seems stuck, try to give them the space to find it on their own without immediately jumping in to fill the gap. It can be tempting to help right away, but allowing them a few extra moments to find the word not only respects their autonomy but also supports their confidence. However, if they continue to struggle, you can gently guide them by offering one or two possible words related to the topic, or by asking a simple, clarifying question like, 'Are you talking about ___?' or 'Is it something about [subject]?' This kind of gentle nudge can help point them in the right direction, and often just the sound of the right syllable or a related idea is enough for them to recall the word they’re looking for. This approach respects their efforts and keeps the conversation collaborative, helping both of you stay on the same page without feeling rushed or pressured
   
   
9. Try rephrasing the statement. If your loved one doesn’t seem to understand you, it can be tempting to repeat the same words or phrases, but this may only add to their frustration and confusion. Instead, try changing your approach by rephrasing the question or statement in simpler terms or with different wording. Sometimes, specific words or phrasing may be harder for them to process, even if the meaning is clear to you. Rephrasing the sentence can sometimes lead to an immediate breakthrough. For example, instead of asking, 'Are you ready to go outside now?' you might try saying, 'Would you like to go out for a bit?' Shifting the structure or vocabulary can help them grasp the meaning more easily and respond with confidence. Flexibility in language shows patience and respect for their changing abilities and can lead to those wonderful moments of connection when understanding is reached.
   
   
10. Older people have hearing and/or vision problems. This can further compound their confusion and make communication even more challenging. When a person struggles to hear clearly, they may miss parts of a conversation, leading to misunderstandings or feelings of isolation. Vision impairments can make it difficult for them to read facial expressions, recognize gestures, or even see who is speaking, causing additional anxiety or disorientation. Together, these sensory limitations can add to their frustration, and as caregivers, it’s helpful to be patient, speak clearly, and ensure good lighting and proximity when communicating. Small adjustments, like facing them directly and minimizing background noise, can help reduce this added layer of confusion and create a calmer, more supportive interaction."

Conclusion:

Navigating the challenges of communication in caregiving can be daunting, especially as cognitive abilities decline. It’s crucial to approach these interactions with empathy, patience, and a willingness to adapt. By fostering an environment of understanding and connection, caregivers can create meaningful moments that not only enhance communication but also strengthen the bond with their loved ones. Remember, every word spoken and every gesture made carries the potential to uplift and reassure, transforming moments of difficulty into opportunities for love and connection.

Questions

• What small changes can you implement in your daily interactions to enhance communication with your loved one?

• In what ways can you celebrate the small victories in communication, even when the larger challenges feel overwhelming?
• How can you encourage your loved one to express their thoughts and feelings more openly, even as their cognitive abilities change?

Comment below!