Communication & Non-Verbal Communication in Dementia Care
Introduction: Why Communication Matters
Communication is the heart of caregiving. For people living with dementia, it becomes both more challenging and more important over time. Words may fade, memory may slip, and conversations may feel different, but the person still needs to feel connected, safe, and valued. Communication is not just about exchanging facts — it is about creating comfort, trust, and dignity.
When we think of communication, we usually think of words (spoken). But communication also includes everything we do without speaking: our tone of voice, facial expression, posture, gestures, touch, and even the pace at which we move or talk. This is called non-verbal communication, and for people with dementia, it often speaks louder than words.
For caregivers, this means that every interaction is an opportunity. The way you look at someone, the speed of your voice, or whether you smile can make the difference between agitation and calm.
Scenarios That Show the Power of Communication
“I want to go home.” Instead of saying, “You are home — stop asking,” the caregiver sits beside the person and says softly, “You miss your home. Tell me about it.” This validation brings calm and helps redirect gently.
Word-finding trouble. A man asks for his “hand clock” instead of “watch.” His daughter could correct him, but instead she smiles and says, “Yes, your watch. Let me get it.” He feels understood rather than embarrassed.
Bath refusal. A woman refuses to bathe. Instead of insisting, the caregiver smiles warmly, shows a warm washcloth, and says, “Let’s just wash your hands and face for now.” This smaller step feels safe and respectful.
Suggestions & Reminders
Always remember: you can’t change the disease, but you can change the moment.
Focus on making the person feel safe and respected rather than proving facts right or wrong.
Think of yourself as a translator: your job is to translate your care into signals the brain can process calmly.
How Dementia Changes Communication
Dementia affects the brain areas that control language and understanding. This means both verbal and non-verbal communication are altered. What looks like “nonsense” or “confusion” often makes sense when you look beneath the surface.
Verbal Changes
Word-finding trouble: The person may know what they want but cannot find the word.
Example: A man says, “hand clock,” meaning watch. His caregiver validates the attempt and hands him his watch without correction.
Repetition: The same question or phrase is asked again and again.
Example: A woman asks, “When are we going to the doctor?” every few minutes. Instead of showing frustration, her caregiver calmly repeats, “We go at 2:00. Let’s look at the clock together.”
Speaking less or going silent: Some people gradually stop talking as much.
Example: A father sits quietly at dinner, saying nothing. His son talks about a baseball game they used to watch. The father doesn’t reply, but he smiles faintly. That smile is communication.
Mixing up words or names:
Example: A woman calls her daughter “Mom.” The daughter responds gently with warmth, knowing the feeling matters more than the accuracy.
Non-Verbal Changes
Tone of voice may carry the real message: A person may say “I’m fine” but in a sharp, shaky voice that signals distress.
Facial expressions may mismatch words: Someone says “yes” while frowning and gripping a chair tightly. The body reveals fear.
Gestures or behavior replace words: A person tapping their lips might be trying to ask for a drink of water.
Why This Matters
Focusing only on words can lead to misunderstanding.
Responding to tone, expression, and behavior allows caregivers to meet the person’s needs.
Treating “odd” or repeated speech as a communication attempt (not nonsense) preserves dignity.
Suggestions & Reminders
Look beyond words. Every sound, gesture, or silence is a form of communication.
Tone tells the truth. Listen for how something is said, not just what is said.
Behavior is a clue. If someone is restless, pulling at clothes, or pacing, ask yourself: What are they trying to tell me?
Don’t dismiss silence. Quiet moments may still carry connection through smiles, eye contact, or touch.
Verbal Communication Strategies
Words still matter, especially in the earlier and middle stages of dementia. But caregivers must learn to simplify, slow down, and support success. The goal is not perfect conversation but making the person feel heard, respected, and calm.
Speaking Simply & Clearly
Long explanations are overwhelming. Break it down to one step.
Example: Instead of saying, “Why don’t you come sit over here so we can get ready for lunch and then after that we’ll go outside,” say: “It’s lunch. Sit here, please.”
Why it works: Fewer words are easier to process.
Offering Simple Choices
Open-ended questions feel like a test. Yes/No or A/B is best.
Example: “What do you want for lunch?” → silence.
Better: “Do you want soup or a sandwich?” → resident nods “soup.”
Why it works: Provides dignity without pressure.
Avoiding Arguing or Correcting
Correcting memory mistakes can shame and frustrate.
Example: Resident: “I need to catch the bus for work.”
Wrong: “You don’t work anymore.”
Better: “You worked hard at your job. Tell me about it.”
Why it works: Validation honors feelings, not facts.
Allowing Extra Time
Silence doesn’t mean they didn’t hear you. It often means they are still thinking.
Example: Caregiver asks, “Would you like tea?” Waits calmly. Thirty seconds later, the resident says, “Yes.”
Why it works: Patience prevents frustration.
Suggestions & Reminders
Slow down. Your pace is part of the message.
Celebrate small wins. If they answer “soup” after 30 seconds, that’s success.
Let go of correcting. The goal is peace, not accuracy.
Be respectful. Avoid baby talk — speak simply but like the adult they are.
Ten Tips for Communicating with a Person with Dementia
www.cdss.ca.gov
Non-Verbal Communication Strategies
As dementia progresses, non-verbal communication often becomes the main language. Smiles, eye contact, posture, and tone can make or break an interaction.
Eye Contact & Facial Expression
A gentle gaze and warm smile show safety and kindness.
Example: A caregiver frowns and says sharply, “Come on, let’s go.” The resident resists.
Better: Caregiver smiles softly, meets eyes, and says warmly, “Let’s do this together.”
Posture & Positioning
Standing over someone can feel intimidating. Sitting at eye level communicates respect.
Example: A man grows upset when his son hovers over him. The son kneels, softens voice, and says, “I’m right here.”
Gestures & Demonstrations
Showing works better than telling.
Example: Instead of saying, “Brush your teeth,” the caregiver demonstrates brushing, then offers the toothbrush. The resident copies the action.
Touch (If Welcomed)
Safe, gentle touch can bring reassurance.
Example: A woman paces at night. The caregiver gently takes her hand and hums as they walk. She slows her pace and relaxes.
Why This Matters
Non-verbal signals set the emotional tone of every interaction.
People with dementia often trust body language more than words.
Suggestions & Reminders
Lead with your face. Smile before you speak.
Match your movements. Move slowly and calmly — rushing creates stress.
Get down, don’t loom. Sit or kneel to eye level whenever possible.
Use gentle touch sparingly. Only if the person welcomes it — never force touch.
Remember: your body speaks louder than your words.
Combining Verbal & Non-Verbal Communication
Definition:
The most effective communication happens when words, tone, and body language all match. If they don’t, the person with dementia will almost always believe the non-verbal signals over the words.
Why This Matters:
Imagine being told “It’s okay” with a sharp voice and crossed arms. Even if the words say “okay,” the body says “angry.” For people with dementia, this mismatch creates confusion and fear. On the other hand, when words and body language work together, the message is crystal clear: You are safe. You are cared for.
Scenario 1: Mixed Signals
Wrong Approach: A caregiver says, “I’m not upset,” but their brow is furrowed, arms crossed tightly, and tone is sharp.
Resident’s Response: The resident becomes more anxious, sensing anger.
Better Approach: Caregiver takes a breath, unclenches posture, softens voice, and says, “It’s okay. I’m here with you,” while smiling gently.
Why It Works: The body reinforces the words, creating consistency and reassurance.
Scenario 2: “Where’s my mother?”
Wrong Approach: “She died years ago — don’t you remember?” The resident becomes distressed, feeling grief as if for the first time.
Better Approach: Caregiver sits beside her, offers a hand to hold, and says softly, “You miss her. What was she like?” The resident brightens and starts to reminisce.
Why It Works: The caregiver validates the feeling and redirects gently toward a safe memory.
Suggestions & Reminders
Your body speaks louder than words. Residents will believe your tone and posture over what you say.
Match your message. If you’re saying “You’re safe,” show it with a relaxed smile and gentle tone.
Sit close, not far away. Physical presence matters; distance can feel cold.
Take a pause before you speak. Check: Does your face, voice, and posture reflect calm?
Special Challenges
Definition:
Some situations in dementia care feel especially tough — when the person stops speaking, repeats endlessly, or when caregivers themselves become overwhelmed. These challenges require extra patience and creativity.When the Person Becomes Non-Verbal
Even when speech is gone, communication continues. People may use gestures, expressions, or behavior instead.
Scenario: A woman repeatedly tugs at her sweater. The caregiver realizes she’s overheated and helps her remove it. The fidgeting stops.
Why It Works: The caregiver looked beyond the action to the underlying need.
When Words Fail Entirely
Sometimes music, rhythm, and touch reach where speech cannot.
Scenario: A man no longer speaks, but when his caregiver hums an old hymn, he hums along and smiles. For a moment, they connect deeply without words.
Repeated Questions
Repetition often signals anxiety, not forgetfulness alone.
Scenario: A resident asks, “What time is dinner?” every 2 minutes.
Wrong Approach: “I told you already!” (leads to shame and agitation).
Better Approach: Caregiver points to a large note on the table: “Dinner at 6 — spaghetti tonight!” Each time, she smiles and calmly points to the note again.
Why It Works: Reassurance and a consistent response reduce fear.
Caregiver Stress
Caring for someone who cannot express themselves clearly can be exhausting. It is normal to feel frustration.
Scenario: A caregiver answers the same question for the 15th time and snaps, “I said already!” Later, guilt sets in.
Better Approach: The caregiver learns to pause, breathe, and step away for a moment, telling themselves, “He’s scared, not stubborn.”
Why It Works: Reframing turns frustration into empathy and allows caregivers to reset.
Suggestions & Reminders
Behaviors are messages. Tugging, pacing, or repeating are ways of speaking needs.
Consistency calms. Answer repeated questions in the same calm way each time.
Use creative tools. Music, pictures, and rhythm often succeed where words fail.
Care for yourself too. Step away when overwhelmed. A calm caregiver creates a calm environment.
Communicating with someone with dementia
Family Communication
Definition:
Family members often struggle when dementia changes how their loved one communicates. Some may unintentionally create stress by quizzing memory, while others may withdraw because they feel hurt. With guidance, families can reconnect in ways that feel safe and meaningful.
Memory Quizzing
Scenario: A granddaughter asks, “Do you remember me?” Grandma frowns, embarrassed that she cannot recall.
Better Approach: Granddaughter smiles, takes her hand, and says, “Hi Grandma, it’s Sarah. I brought your favorite cookies.”
Why It Works: Removes pressure, replaces it with comfort and recognition of love.
Overloading with Questions
Scenario: A brother visits and asks five questions at once: “How are you? Do you know who I am? What did you do today? Do you remember our trip?” The resident withdraws in silence.
Better Approach: Brother sits calmly, shows old photos, and says, “It’s good to see you. Look at this picture from our fishing trip.”
Why It Works: One clear message and a shared memory create connection without pressure.
Withdrawing Out of Sadness
Scenario: A daughter stops visiting because her mother doesn’t recognize her. She feels rejected.
Better Approach: She learns to focus on presence, not recognition. She visits, holds her mother’s hand, and listens to music together. Her mother hums along, and they share a moment of joy.
Why It Works: Connection exists even without memory.
Suggestions & Reminders for Families
Don’t test memory. Never ask, “Do you remember me?” — instead, introduce yourself warmly.
Keep it simple. Fewer words, more presence.
Bring shared joys. Music, photos, hobbies, or food create instant comfort.
Value silence. Sitting quietly together is still connection.
Focus on feelings, not facts. What matters is the bond, not whether details are remembered.
Wrap Up: Key Takeaways
Definition:
Communication in dementia care is not about perfect sentences or memory tests. It is about connection, reassurance, and respect.
Lessons to Carry Forward
Dementia changes language, but communication continues through tone, touch, music, and presence.
Simpler words reduce overwhelm; respectful tone preserves dignity.
Non-verbal cues (smile, eye contact, posture) often matter more than words.
Every “behavior” is a form of communication — ask what the action is trying to say.
Families and caregivers can maintain meaningful relationships even when memory fades.
Final Scenarios for Reflection
A man no longer speaks, but smiles when his daughter holds his hand. Communication lives in touch.
A woman grows agitated until her caregiver hums a hymn. She hums back. Communication lives in music.
A resident asks, “Where’s my mother?” The caregiver validates the feeling and listens to memories. Communication lives in love, not facts.
Suggestions & Reminders
Be the calm in their storm. Your body and voice set the tone.
Meet them where they are. Don’t force memory — focus on the moment.
Little things matter. A smile, a pause, a gentle word can change the whole day.
Connection never fades. Even without words, presence communicates love.
