Recognizing Non-Verbal Signs of Discomfort (Visual and Verbal)
Introduction: Listening Beyond Words
Every caregiver knows that communication is more than words. But when working with someone who has dementia, this truth becomes essential.
As dementia progresses, the person may lose their ability to explain pain, confusion, or fear — yet their body, expressions, and tone still speak volumes.
When you truly pay attention, you’ll start to notice small signals that reveal big things.
A furrowed brow might say “I’m confused.”
A withdrawn silence might say “I’m tired.”
A raised hand might say “I’m scared.”
Recognizing and responding to these non-verbal signs helps prevent distress, promotes trust, and maintains dignity.
Your calm awareness can transform a moment of fear into one of comfort.
Key Term:
Non-Verbal Communication means any form of expression without spoken words. This includes:
Facial expressions (smiles, frowns, raised eyebrows)
Body movements (crossed arms, pacing, stillness)
Gestures or touch (reaching out, pulling away)
Tone of voice (softer, higher, shaky, loud)
Silence (sudden quiet or lack of response)
When a person with dementia communicates non-verbally, they are still communicating just in a different language.
Your goal is to learn to translate that language.
What Non-Verbal Signs of Discomfort Really Mean
When a person lives with dementia, their brain changes in ways that affect how they communicate, process sensations, and respond to their environment.
This means they may not always understand what’s happening around them, or they might feel discomfort but be unable to explain it clearly. Instead, their body becomes their language.
Understanding what these signs mean — and why they happen — is key to interpreting the message behind the behavior.
Why This Happens in Dementia
Non-verbal signs of discomfort are the result of changes in the brain’s communication and perception systems.
Here’s what’s happening behind the scenes:
Language Centers Are Affected:
As dementia progresses, areas in the brain responsible for speech and comprehension (especially the temporal and frontal lobes) become damaged. The person may know they feel something but cannot find the words to describe it.
Example: They may grimace or pull away instead of saying, “That hurts.”Sensory Processing Changes:
Dementia alters how the brain interprets touch, sound, temperature, and pain. Someone might feel overwhelmed by sensations that used to be comfortable — like bright lights or cold water — or not recognize pain until it’s severe.Emotional Regulation Shifts:
The parts of the brain that manage emotion (like the amygdala) become more sensitive. This can cause strong emotional reactions — fear, anger, or sadness — to even small changes or discomforts.Physical Pain Is Harder to Express:
Chronic illnesses (like arthritis, infections, or digestive issues) can cause real pain, but without verbal skills, the person may only show it through behavior, restlessness, or sound.Body Memory Takes Over:
When verbal memory fades, the body still “remembers” how to react to pain, fear, or cold. These automatic responses show up as flinching, crying, or resisting — even if the person can’t explain why.
Common Non-Verbal Signs and What They Tell Us
Non-verbal signs can be grouped into four main types: facial expressions, body movements, verbal/vocal cues, and behavioral changes.
Each of these tells us something different about what the person might be feeling.
Facial Expressions — The Window to Emotion
The face is often the first place discomfort appears. Even when language fades, facial muscles still respond automatically to sensations and emotions.
Common Signs:
Frowning or Grimacing:
A tight mouth, furrowed brow, or clenched jaw may signal pain, confusion, or frustration. It can happen suddenly when the person is touched or moved in a painful way.
Example: A caregiver lifts a person’s arm to put on a shirt, and they grimace — this may indicate shoulder pain, not stubbornness.Tight or Blank Expression:
Sometimes discomfort looks like “nothing.” A flat or distant look might mean the person is emotionally shutting down due to fatigue, sadness, or overstimulation.
Example: After a noisy group activity, a person sits quietly, staring into space — this could signal mental overload or exhaustion.Raised Eyebrows or Wincing:
Raised brows, squinting, or tightening around the eyes may reflect surprise, fear, or physical discomfort.
Example: When light suddenly shines in their face, they wince — this might mean the light is too bright or they have sensitive eyes.
Why It Happens:
The brain’s emotional centers remain active long after language fades. Facial expressions become an instinctive way to express what words no longer can. A trained caregiver can often read these small shifts to identify pain or fear early.
Body Movements — The Body Speaks Loudly
When words fail, the body starts to move in ways that reflect inner discomfort or confusion. Every action — from pacing to curling up — has meaning.
Common Signs:
Restlessness or Pacing:
This may look like “wandering,” but it can actually mean discomfort, pain, or an unmet need (like hunger or needing the bathroom).
Example: A person paces after dinner every night — not agitation, but indigestion or restlessness from sitting too long.
Why It Happens: The person feels uneasy but cannot explain why, so the body releases that tension through motion.Rocking or Repetitive Movements:
Rocking back and forth can be soothing, but it may also signal anxiety or physical pain.
Example: A woman rocks in her chair and hums — this may be her way of self-soothing when she’s tired or overstimulated.
Why It Happens: The body uses movement to comfort itself when the brain feels unsafe or confused.Pulling Away or Flinching:
When a caregiver reaches out and the person jerks back, it’s not rejection — it’s protection. They may associate touch with pain or feel startled by sudden movement.
Why It Happens: Dementia can cause sensory misinterpretation, so touch that feels gentle to you may feel rough or unexpected to them.Rigid or Stiff Posture:
Tension in the shoulders or limbs often points to discomfort, pain, or fear.
Example: During dressing, the person’s arms lock tightly at their sides — this may indicate arthritis or cold sensitivity.
Why It Happens:
As communication ability declines, the body becomes the main outlet for emotion. Muscle tension, movement, or stillness all become signals of what’s going on internally. The body tells the truth, even when words don’t.
Verbal and Vocal Cues — The Sound of Discomfort
Even people who can no longer hold conversations often make sounds that carry emotional meaning. The tone, pitch, and rhythm of these sounds often communicate more than words.
Common Signs:
Moaning, Groaning, or Sighing:
These sounds can express pain, fatigue, or distress. A low groan may mean physical discomfort, while a heavy sigh might indicate emotional exhaustion.
Example: A resident moans softly during repositioning — that could mean a sore spot needs attention.Repetitive Words or Phrases:
Saying “no,” “stop,” or “help me” again and again doesn’t always mean fear — it may mean confusion, pain, or a need for reassurance.
Why It Happens: The brain “sticks” on familiar words that once had meaning, especially when under stress.Crying or Yelling:
Strong emotions, frustration, or physical pain can trigger crying or shouting. Sometimes, tears come from fear or feeling misunderstood.
Example: A person suddenly cries during hair washing — it might remind them of a painful memory or make them feel exposed.Sudden Silence:
Silence can be just as meaningful as noise. When someone goes quiet, it may mean they are overwhelmed, ill, or shutting down emotionally.
Example: A talkative client stops speaking mid-task — this could be the first sign of discomfort, fatigue, or infection.
Why It Happens:
As language fades, vocal tone remains. These natural human sounds are reflexes — emotional messages that bypass speech. Listening to the music of their voice (not just the words) can tell you whether they feel calm, tense, or in pain.
Behavioral Changes — The Actions That Speak
Behavior is communication. What looks like “acting out” is often the body’s way of saying, “I need something.”
Common Signs:
Refusing Care or Meals:
Refusal isn’t defiance — it often means fear, discomfort, or confusion.
Example: A person pushes away a plate of food because it’s too hot, they don’t recognize it, or their dentures hurt.Agitation or Aggression:
Yelling, swatting, or hitting may come from pain or being startled.
Example: A man hits out when his arm is lifted — later, staff discover a bruised shoulder. The “aggression” was pain communication.Withdrawal or Isolation:
When someone stops talking or participating, it may mean fatigue, depression, or illness.
Example: A woman who once loved singing no longer joins in — she may be feeling unwell or losing hearing.Repeated Motions or Words:
Rocking, calling for someone, or repeating phrases can be the brain’s way of expressing unmet emotional needs like reassurance or familiarity.
Why It Happens:
When memory, speech, and logic decline, behavior becomes a primary communication tool. Each action carries an emotional or physical message — the caregiver’s job is to decode it with empathy and curiosity, not frustration.
Putting It Together: Reading the Whole Picture
Recognizing non-verbal discomfort isn’t about one sign — it’s about patterns.
A frown might mean confusion once, pain another time. But when paired with body tension or silence, it becomes clearer.
To interpret accurately, caregivers must observe, connect, and confirm:
Observe: Notice every cue — face, body, voice, behavior.
Connect: Look for when and where it happens.
Confirm: Try simple interventions — offer water, adjust the environment, pause care — and watch for change.
When you see improvement, you’ve understood their message.
Scenarios That Show the Power of Observation
Non-verbal communication can be subtle, complex, and easy to misread if we rush.
Every expression, gesture, or sound has meaning — but in dementia care, the meaning is rarely obvious.
The best caregivers don’t assume; they observe, pause, and decode what the person’s body is trying to say.
Below are real-world caregiving examples showing how observation and understanding can turn frustration into comfort.
Scenario 1: The Bath-Time Struggle
What Happened:
Mrs. Davis is an 82-year-old woman living with moderate dementia. Her caregiver tries to help her bathe in the morning. As soon as the caregiver turns on the water, Mrs. Davis stiffens. When the caregiver begins to undress her, she clenches her fists, pulls away, and shouts “No!” repeatedly. Her breathing becomes quick and shallow.
Possible Causes:
She may feel cold or exposed, which can create a sense of fear or vulnerability.
The sound or temperature of the water may be overwhelming to her brain’s sensory processing.
She may have pain when bending or moving due to arthritis or bruising.
She might not recognize the caregiver or understand what’s happening, thinking she’s being harmed.
Caregiver Response:
Stop the task immediately and make eye contact.
Use a calm tone: “You look uncomfortable, Mrs. Davis. Let’s take a break for a minute.”
Cover her with a towel or robe for warmth and modesty.
Show her the water with your hand first: “Look, warm water — nice and gentle.”
Try offering smaller steps: washing her hands or face first to build comfort.
Observe her reactions — if she relaxes, continue slowly.
Learning Point:
Bath refusal is not resistance — it’s communication. A calm environment, warmth, and clear reassurance can turn fear into cooperation.
Documentation Example:
“At 9:10 a.m., Mrs. Davis became tense and repeatedly said ‘no’ during bathing. Task paused, towel provided, and caregiver reassured her. Bath resumed after five minutes with no further distress.”
Scenario 2: The “No” That Meant “Too Bright”
What Happened:
Each morning, Ms. Torres says “No, no, no!” and waves her hands when her caregiver opens the blinds. She appears angry and squints her eyes but doesn’t explain what’s wrong.
Possible Causes:
The bright sunlight may hurt her eyes or overwhelm her senses.
She may be sensitive to sudden light changes due to aging vision or cataracts.
She might not understand why the light is being changed and think something unsafe is happening.
Caregiver Response:
Pause and speak softly: “The light is bright, isn’t it, Ms. Torres? Let’s open it slowly.”
Open one blind at a time or adjust the angle to filter sunlight.
Offer sunglasses or a shaded hat if sensitivity continues.
Encourage her to look away until the light balances.
Learning Point:
A repetitive “no” isn’t always defiance — it can be a sensory signal. Adjusting the environment is often more effective than insisting on compliance.
Scenario 3: The Silent Lunch
What Happened:
Ms. Patel, usually talkative, sits quietly during lunch. She eats a few bites, then pushes the plate away. Her caregiver notices she keeps touching her forehead and blinking slowly.
Possible Causes:
She could have a headache or be feeling unwell.
The dining area might be too loud, causing sensory overload.
She may be tired or overstimulated from earlier activity.
She may be losing appetite due to infection or medication side effects.
Caregiver Response:
Sit beside her calmly and lower your voice.
Ask gently: “You seem quiet today — do you feel okay?”
Offer a smaller portion or drink of water.
Dim nearby lights or move to a quieter area.
Monitor and report if symptoms persist.
Learning Point:
Withdrawal or quietness is communication. Silence can signal discomfort just as clearly as shouting can. Listening with your eyes is essential.
Scenario 4: The Smiling Pain
What Happened:
Mrs. Alvarez smiles and thanks her caregiver each morning but winces slightly when being helped to stand. She doesn’t complain and insists, “I’m fine,” even though her face tenses.
Possible Causes:
She may have hip or knee pain but doesn’t want to burden anyone.
Some people hide discomfort out of politeness or pride.
Fear of medical treatment may make her downplay symptoms.
Caregiver Response:
Observe the pattern — does the wince happen every time she stands?
Ask kindly: “It looks like your leg might hurt — does it feel sore?”
Support her movement slowly and offer mobility aids.
Report possible pain for medical assessment.
Learning Point:
Not all discomfort looks negative — sometimes people smile through pain. Always trust body cues over verbal denial when the two don’t match.
Scenario 5: The Restless Evening
What Happened:
Mr. Howard paces back and forth every evening after dinner. He rubs his lower back and mutters softly. The staff label him as “restless,” assuming it’s sundowning behavior.
Possible Causes:
He may have indigestion, gas, or muscle pain from sitting too long.
Could be looking for the bathroom but unable to say so.
Evening may trigger old routines — perhaps he used to take an evening walk after work.
Caregiver Response:
Approach slowly and make eye contact: “Mr. Howard, would you like to walk together for a bit?”
Offer to use the restroom.
Gently stretch or massage lower back if appropriate.
Afterward, guide him to a calm seat and provide warm tea or water.
Learning Point:
Repetitive pacing is not aimless wandering — it’s an unspoken request for comfort, movement, or relief. Routine-based behaviors often carry emotional memory.
Scenario 6: The Unexpected Tears
What Happened:
Mr. Lopez begins crying suddenly while being shaved. The caregiver stops, confused, as he repeats “Mama” softly and covers his face.
Possible Causes:
The act of shaving or the smell of soap may trigger a memory or emotion.
He may feel fear or sadness from sensory reminders.
Could also indicate physical pain or fatigue.
Caregiver Response:
Stop the task and remain calm.
Sit beside him: “It seems like something made you sad. I’m here with you.”
Allow him to express emotion without interruption.
Offer a tissue and reassurance before resuming grooming.
Learning Point:
Emotions live long after memory fades. Crying isn’t always bad — it can be emotional release. Validation builds safety and connection.
Scenario 7: The Aggressive Reaction
What Happened:
Mr. Rivera shouts “Stop!” and swats at the caregiver’s arm while being dressed. Staff initially assume he’s aggressive.
Possible Causes:
Pain when lifting his arm — possibly arthritis or frozen shoulder.
Feeling startled by sudden touch.
Confusion — he might not recognize the caregiver or understand the task.
Caregiver Response:
Step back immediately and lower your tone.
Reassure: “I didn’t mean to scare you. Let’s go slow, okay?”
Ask permission before continuing: “Can I help you with your sleeve now?”
Move gently and explain every step.
Learning Point:
Aggression is often a reaction to discomfort or confusion. Respect, patience, and explanation defuse fear faster than force or scolding.
Scenario 8: The Sleepless Night
What Happened:
Ms. Jenkins is awake all night, calling out and trying to get out of bed. Staff assume she’s confused and restless.
Possible Causes:
Pain when lying down, such as from arthritis or pressure sores.
Need to use the restroom.
Fear or disorientation in the dark.
Could be too hot, too cold, or hungry.
Caregiver Response:
Approach quietly and turn on a soft nightlight.
Ask gently: “You can’t sleep, huh? Let’s get comfortable.”
Offer a bathroom break, adjust pillows or blankets, and provide water.
If pain suspected, report for pain assessment or medication review.
Learning Point:
Nighttime behavior often reflects unmet needs, not insomnia. Gentle reassurance and environmental adjustments can prevent long nights of distress.
Scenario 9: The Repeated Call for “Home”
What Happened:
Mr. Thompson keeps saying, “I want to go home,” over and over. The caregiver knows he’s already home, and telling him so only makes him more upset.
Possible Causes:
“Home” may represent comfort and safety, not a physical place.
He could be anxious, lost, or lonely.
Might be expressing pain or fatigue indirectly through the phrase.
Caregiver Response:
Sit next to him and validate: “You miss home. Tell me about it.”
Let him share memories or feelings.
Use gentle redirection: “Your home sounds lovely. Would you like to look at some photos together?”
Learning Point:
Repetition is emotional communication. Validation (“You miss home”) works better than correction (“You are home!”).
Caregiver Reflection
Each of these stories shows that behavior is communication.
When caregivers take time to pause and interpret, they prevent frustration, increase trust, and improve the person’s well-being.
To practice this skill:
Think of one client whose behavior seems challenging.
Ask: What might they be trying to tell me through that behavior?
Identify at least one environmental or physical cause you can check next time.
Suggestions & Reminders for Caregivers
When caring for someone with dementia, recognizing discomfort isn’t just about noticing it’s about understanding.
Your ability to interpret subtle cues can make the difference between fear and peace, between agitation and comfort.
The following suggestions will help you build stronger awareness, patience, and confidence when responding to non-verbal signs of distress.
Pause Before You Act
Caregivers are helpers by nature — it’s instinctive to want to fix a problem immediately. But when someone with dementia shows distress, rushing in too quickly can make it worse.
When you pause before responding, you give yourself time to:
Observe the full situation instead of reacting emotionally.
Notice patterns in the person’s body language, tone, and environment.
Give the person a moment to calm down or process what’s happening.
Sometimes, what looks like resistance or aggression is simply confusion or fear.
A pause allows you to reset the moment.
Example:
Mrs. Davis becomes tense when her caregiver approaches with a washcloth. The caregiver starts to explain loudly, thinking she can’t hear — but that makes Mrs. Davis more agitated.
The next time, the caregiver pauses, takes a slow breath, kneels to eye level, and says softly, “I’ll go slow, okay?” The change in pace immediately reduces the tension.
Why It Matters:
People with dementia process information more slowly. Pausing allows their brain time to catch up and interpret what’s happening. It also gives you a chance to see if there’s an underlying issue (pain, fear, or fatigue) before reacting.
Caregiver Tip:
When in doubt, do nothing for a moment — breathe, watch, and listen. That calm pause often reveals the real message behind the behavior.
Check the Basics
Before assuming emotional distress or confusion, always check the simple things first.
Most discomfort in dementia care can be traced back to basic unmet needs — things that are easily overlooked when the person can’t express them verbally.
These include:
Pain: arthritis, injury, urinary tract infection, pressure sore, headache
Toileting Needs: needing to use the restroom, constipation, wet clothing
Hunger or Thirst: dehydration or poor appetite
Temperature: too hot, too cold, or uncomfortable bedding/clothing
Fatigue or Overstimulation: too much noise, activity, or bright lighting
Example:
Mr. Howard becomes agitated and starts pacing every evening. Staff assume “sundowning.” One day, a caregiver checks the basics and realizes he hasn’t used the restroom since lunch. After helping him, the pacing stops.
👉 Sometimes the answer is as simple as comfort, not control.
Why It Matters:
Dementia limits the person’s ability to connect sensations with solutions. They may feel something is wrong but not know what. When caregivers focus on the basics, they often solve the problem without conflict.
Caregiver Tip:
Use the “5-Check Rule” when distress appears:
Pain, Bathroom, Hunger, Temperature, Environment.
If all five are okay, move on to emotional or sensory causes.
Watch Patterns, Not Moments
Behaviors in dementia are rarely random. They often follow a pattern — tied to time of day, environment, or activity. Learning to recognize these patterns helps you prevent problems before they start.
Watching patterns means noticing:
When the behavior happens (morning, evening, during meals)
What’s happening just before it starts (task, environment, person present)
What helps or makes it worse
Example:
Ms. Patel refuses to brush her teeth each morning. Her caregiver notes that it happens right after breakfast, when her toothpaste tastes strong after orange juice. When she switches to a mild toothpaste and waits 15 minutes after eating, Ms. Patel brushes calmly.
👉 The behavior wasn’t resistance — it was a patterned reaction to a sensory experience.
Why It Matters:
Dementia care improves dramatically when caregivers look for causes, not just reactions. Patterns reveal meaning — they are the person’s body trying to express a need consistently.
Caregiver Tip:
Keep a simple observation log. Write down what happened, when, and what you tried. Over time, you’ll start to see patterns that guide your care decisions.
Respond with Compassion, Not Correction
When someone with dementia becomes agitated, frightened, or confused, correction rarely works — but compassion always does.
Trying to “prove” the person wrong (“You already ate!” or “You are home!”) can increase fear or shame. Instead, validate their feelings, even if the facts are incorrect.
Compassionate responses focus on emotion rather than logic.
You might not fix the confusion, but you can fix the feeling.
Example:
Mr. Thompson keeps saying, “I need to go home.” His caregiver used to respond, “You are home!” which made him upset. Now she says, “You miss your home. Tell me what it was like.” He smiles and describes his garden — his anxiety fades.
Why It Matters:
In dementia, emotional memory lasts longer than factual memory. The person might not remember what’s true, but they feel your tone and body language. When you respond with empathy, you tell their nervous system, “You’re safe.”
How to Show Compassion:
Speak softly, even when you’re tired.
Smile and make eye contact if appropriate.
Use slow, steady movements.
Don’t take their reactions personally — it’s the disease, not disrespect.
Caregiver Tip:
When in doubt, comfort first, correct never. You can’t control dementia, but you can control your presence — and that’s what they remember most.
Adjust the Environment
Sometimes the cause of discomfort isn’t the task — it’s the surroundings.
People with dementia can become overwhelmed by noise, bright lights, clutter, or fast movements. Their senses process information differently, which can make a normal environment feel chaotic or unsafe.
Environmental Triggers to Watch:
Loud televisions or multiple voices
Glare from lights or windows
Strong smells (cleaning products, food, perfume)
Busy patterns on walls or clothing
Sudden changes in temperature or lighting
Example:
Ms. Rivera begins yelling during dinner. Staff assume she’s angry. A caregiver notices the fluorescent light above her flickers slightly — something her sensitive eyes can’t tolerate. After moving her to a softer-lit table, she eats peacefully.
👉 The behavior disappeared because the environment changed, not the person.
Why It Matters:
Our surroundings directly affect comfort and confusion levels. A calm, consistent environment helps the brain feel safe, reducing the need for the body to “speak” through distress.
Caregiver Tip:
If behavior changes suddenly, look around before you look at the person. Ask yourself: What changed in this space? The answer is often there.
Report and Record What You See
Documenting non-verbal signs of discomfort is just as important as recognizing them.
Clear, factual reporting helps other caregivers, nurses, and families understand what’s happening — and ensures the person’s needs are met quickly.
When documenting:
Write what you see, hear, and do, not assumptions.
Avoid emotional language (“angry,” “mean”) — describe the behavior itself.
Note the time, trigger, and outcome.
Record any interventions that helped.
Example (Poor Documentation):
“Mr. Lopez was difficult during care.”
→ This gives no useful information.
Example (Strong Documentation):
“At 10:15 a.m., Mr. Lopez raised his voice and said ‘stop’ repeatedly while being shaved. Task paused, emotional support given. He resumed calmly after reassurance.”
Why It Matters:
Accurate notes paint a clear picture of the person’s daily comfort levels and patterns. It allows the care team to adjust medication, environment, or routines with evidence, not guesses.
Caregiver Tip:
Think like a reporter, not a judge. Your goal is to describe the story of what happened — who, what, when, where, and how it was resolved.
Be Patient with Yourself
Finally, remember: recognizing non-verbal communication is a skill that takes practice.
Even the best caregivers miss signals sometimes — what matters most is your willingness to learn and reflect.
You will get better at this over time as you build trust and familiarity with each person. Every small success — noticing a grimace, recognizing a sigh, or preventing agitation — adds to your skill and confidence.
Reflection Example:
“I used to think Mr. Chen was stubborn at mealtimes. Now I realize his dentures were hurting. Once I slowed down and observed, he ate comfortably again.”
Why It Matters:
Caregiving for people with dementia is not about perfection — it’s about presence. Your calm, patient attitude creates safety for them and emotional strength for you.
Caregiver Tip:
Give yourself grace. Every challenge you interpret correctly makes you a stronger, more compassionate caregiver.
Caregiver Reflection Exercise
Take a few minutes to think about a recent moment when a client or loved one seemed upset or withdrawn.
Ask yourself:
Did I pause before reacting?
Did I check the basics (pain, hunger, restroom, temperature)?
Did I notice any patterns or environmental changes?
How did I respond — with correction or compassion?
How could I document this more clearly next time?
Write your thoughts in a notebook. Reflection is how observation becomes insight.
Summary of Key Reminders
Caregiver Strategy: Pause Before You Act
Purpose: Slows reaction, prevents escalation
Real-World Example: Stopping when a client shouts “No” to observe their body language.
Caregiver Strategy: Check the Basics
Purpose: Identifies physical causes of discomfort
Real-World Example: Realizing Pacing is caused by needing the restroom.
Caregiver Strategy: Watch Patterns
Purpose: Reveals triggers and timing
Real-World Example: Behavior happens every day before lunch – hunger pattern
Caregiver Strategy: Respond with Compassion
Purpose: Builds trust and safety
Real-World Example: Saying “You miss home” instead of “You are home!”
Caregiver Strategy: Adjust Environment
Purpose: Reduces sensory distress
Real-World Example: Dim lighting or quiet noise to prevent agitation
Caregiver Strategy: Be Patient with Yourself
Purpose: Prevents burnout and builds skill
Real-World Example: Reflecting instead of self-blaming when signs are missed
Scenarios That Model Good Caregiving Responses
Sometimes, the most powerful lessons come from everyday caregiving moments.
When we learn to see discomfort as communication instead of “behavior,” we change the entire experience — for both the person living with dementia and the caregiver.
Below are four real-world examples showing how small choices can make a big difference.
Each one demonstrates the difference between reacting and responding with understanding.
Scenario 1: The Hair Brushing Hesitation
Situation:
It’s morning, and Mrs. Alvarez is sitting at her vanity while the caregiver gently begins to brush her hair. After a few strokes, Mrs. Alvarez flinches and raises her hand as if to block the brush. She doesn’t speak, but her breathing quickens and she looks away.
Non-Verbal Signs Observed:
Flinching, turning head away, hand raised defensively
Change in facial expression from relaxed to tense
Increase in breathing rate
Possible Meaning:
Pain from a tender scalp or pulling during brushing
Fear of being hurt — the motion may feel too fast or rough
Sensory overload from noise, light, or fast movements
How the Caregiver Responded:
Paused immediately — set the brush down and said softly, “I think that might have tugged a little, huh?”
Moved to eye level and smiled reassuringly.
Slowed movements, holding smaller sections of hair and showing the brush each time before using it.
Spoke gently throughout: “We’ll go slow and gentle; you look beautiful today.”
After finishing, thanked her: “Thank you for letting me help you — you did great.”
Why This Worked:
The caregiver validated Mrs. Alvarez’s reaction instead of dismissing it. By slowing down and showing empathy, she restored trust. Physical comfort and emotional reassurance go hand in hand in dementia care.
If Handled Incorrectly:
A rushed caregiver might have said, “Hold still — I’m almost done!” This would increase Mrs. Alvarez’s fear and make her more defensive next time.
Documentation Example:
“During morning grooming, Mrs. Alvarez flinched and turned away while hair brushing. Caregiver paused, reassured, and slowed pace. Task completed calmly without further distress.”
Scenario 2: The Lunch Refusal Turned Relief
Situation:
Mr. Chen sits at the table but refuses to eat. He folds his arms and turns his head away when his caregiver brings his plate. When encouraged to take a bite, he shakes his head and mutters something unclear.
Non-Verbal Signs Observed:
Turning head away, crossing arms
Refusal to eat
Tense body posture
Possible Meaning:
Pain in mouth, gums, or throat
Food too hot, too cold, or difficult to chew
Anxiety, nausea, or loss of appetite
How the Caregiver Responded:
Observed his movements closely — noticed he kept touching his jaw.
Sat beside him and said calmly, “It looks like your mouth might hurt. Should we check it together?”
Upon inspection, found a small sore near his gum line.
Offered a soft, cool food instead of the regular meal.
Informed the nurse for medical follow-up.
Why This Worked:
The caregiver focused on observation, not obedience. Instead of forcing the meal, she connected the refusal to a physical cause. This reduced distress, maintained dignity, and ensured appropriate care.
If Handled Incorrectly:
If the caregiver insisted — “Come on, you have to eat!” — it could have caused emotional distress and deepened his resistance, damaging trust.
Documentation Example:
“Mr. Chen refused lunch, turned head away, and rubbed his cheek. Small gum sore observed. Offered soft food alternative and notified nurse. Ate 50% of meal without further issue.”
Scenario 3: The “I Want to Go Home” Moment
Situation:
Mr. Thompson repeats, “I want to go home,” several times during the afternoon. The caregiver knows he’s been living at the facility for two years. Each time she tells him, “You are home,” he becomes louder and starts pacing.
Non-Verbal Signs Observed:
Repetitive verbal cue: “I want to go home.”
Pacing, frowning, raised voice
Facial tension, anxious movement
Possible Meaning:
Emotional need for comfort, safety, or familiarity
Confusion triggered by fatigue or time of day
Memory of his real home surfacing (emotional memory)
How the Caregiver Responded:
Stopped correcting and shifted to validation.
Sat beside him and said softly, “You miss your home. What do you remember about it?”
Allowed him to describe his house, his wife, and his garden.
After a few minutes, gently redirected: “Your garden sounds beautiful. Let’s take a little walk outside and get some fresh air.”
Stayed with him calmly until his anxiety passed.
Why This Worked:
The caregiver acknowledged the emotion — not the facts. Validation builds trust and calms the nervous system. By inviting reminiscence, she met his emotional need for connection, not correction.
If Handled Incorrectly:
Saying “You are home!” or “Stop saying that!” only creates frustration. Logic cannot compete with memory loss, but empathy always reaches through it.
Documentation Example:
“At 2:30 p.m., Mr. Thompson repeated ‘I want to go home’ several times. Caregiver validated feelings and engaged in reminiscence conversation. Anxiety reduced after 10 minutes of walking outdoors.”
Scenario 4: The Dressing Dilemma
Situation:
During the morning routine, Mr. Rivera shouts “Stop!” and pushes the caregiver’s hands away as she tries to help him put on a shirt. He looks frightened and pulls his arm close to his body.
Non-Verbal Signs Observed:
Yelling and pushing away
Protective posture (arm pulled inward)
Fearful expression, wide eyes
Possible Meaning:
Pain when moving the arm (arthritis, injury, or frozen shoulder)
Feeling rushed or startled by the caregiver’s quick movements
Lack of understanding about what’s happening — confusion
How the Caregiver Responded:
Immediately stepped back, giving him personal space.
Lowered tone and said softly, “I’m sorry, that might have hurt. Let’s go slower, okay?”
Waited a few moments for him to relax before continuing.
Asked permission: “Can I help lift your arm gently?”
Lifted his arm slowly while maintaining eye contact and explaining each step.
Why This Worked:
The caregiver respected his body language as communication instead of labeling it as aggression. She restored a sense of safety and control by seeking permission and pacing the care.
If Handled Incorrectly:
If the caregiver had forced the shirt on while scolding him for “being difficult,” he might have become more agitated — or even fearful of care in the future.
Documentation Example:
“During dressing, Mr. Rivera shouted ‘Stop!’ and held his arm protectively. Caregiver paused, reassured, and continued slowly with consent. Dressing completed without further distress.”
Key Takeaways from These Scenarios
Discomfort rarely looks the same twice. A smile, a shout, or silence can all mean pain, fear, or confusion.
The body always tells the truth even when words can’t.
Small adjustments create safety: slowing down, validating, changing tone, or simply pausing can completely change an outcome.
Documentation is communication. Accurate, neutral notes protect the client’s well-being and improve team coordination.
Quick Reflection
Think about a time when someone you cared for became upset or resistant.
Ask yourself:
Did I stop to observe their non-verbal signs?
What physical or emotional cause might have been behind it?
How did my response affect the outcome?
The more you reflect on these moments, the stronger your ability to “hear” what dementia can’t say out loud.
Communication and Observation
Accurate communication and careful observation are the backbone of quality dementia care.
When a person living with dementia cannot clearly express what they feel, their body becomes their language — and you become their interpreter.
Your ability to notice small changes, stay calm, and respond with patience can prevent distress, build trust, and create moments of comfort and connection.
Observation is not just about watching; it’s about understanding what behavior is trying to say — without taking it personally.
Why Communication and Observation Matter
1. It Protects the Person’s Comfort and Dignity
By noticing early signs like frowning, pulling away, or silence, you can prevent pain or emotional distress before it grows.
Even simple adjustments — lowering your tone, warming the room, slowing your pace — can make a huge difference.
2. It Improves Caregiver Confidence and Calm
When you learn to read non-verbal signals, you no longer have to guess or feel rejected.
You begin to understand that behavior is not personal — it’s communication.
3. It Builds Trust and Safety
Every time you respond to distress with patience instead of frustration, you show the person: “You’re safe with me.”
This sense of safety is what allows connection and cooperation.
4. It Shows Professionalism and Compassion
Being observant, calm, and kind — even when the person is confused or upset — reflects true caregiving skill.
It’s not about completing the task; it’s about preserving dignity while doing it.
What to Observe
Observation means seeing the whole person, not just the moment of behavior.
Look for physical, emotional, and environmental clues that may explain what’s happening.
Ask yourself:
What am I seeing or hearing right now?
When did it start, and what was happening right before it began?
What physical or emotional need could be behind this?
What changes when I adjust something (lighting, pace, tone, or touch)?
A. Facial Expressions
The face often reveals what words cannot.
Look for signs of pain, tension, or fear — grimacing, frowning, clenched jaw, or blank stares.
These can happen faster than words, often during movement or touch.
Example: “Winced when bending to sit” suggests pain more clearly than “looked upset.”
B. Body Movements
The body always tells a story.
Are they pacing, stiff, rocking, or pulling away?
These movements reflect internal feelings — anxiety, pain, cold, or fear.
Example: “Rubbed lower back repeatedly” may signal discomfort, not restlessness.
C. Verbal or Vocal Sounds
Tone often speaks louder than words.
Notice sighs, groans, humming, or repeating phrases like “no” or “help.”
These are emotional or physical cues, not random sounds.
Example: “Repeated ‘no’ during dressing” may mean fear or confusion, not defiance.
D. Behavior Patterns
Behavior always has a reason.
Ask yourself: does this happen at certain times — after meals, during care, or in noisy rooms?
Patterns reveal triggers and help prevent future distress.
Example: “Became agitated every evening before dinner” could point to hunger, routine change, or fatigue.
How to Observe Effectively
Observation takes patience, empathy, and self-control.
It’s about watching closely without reacting emotionally.
Think of it as collecting puzzle pieces — each clue helps you see the full picture.
Tips for Strong Observation:
Stay calm and neutral:
The person feels your energy. A calm caregiver gets clearer information.Avoid judgment or blame:
Don’t assume they’re “acting out.” Behavior is communication, not attitude.Notice change:
Compare behavior to what’s normal for that person. A quiet person pacing suddenly means something has shifted.Use all your senses:
Watch body movement, listen to tone, and feel the environment (too hot, too loud, too cold).Watch timing:
The “when” often reveals the “why.” Behavior that happens at the same time daily has a root cause.
Example of Observing Without Judgment
Observation Area: Facial Expression
What You See: Gimace while sitting
Possible Meaning: Hip or joint pain
Observation Area: Body Movement
What You See: Guarded right arm
Possible Meaning: Shoulder soreness or fear of movement
Observation Area: Vocal Cues
What You See: Sighing or repeating “no”
Possible Meaning: Fatigue or confusion
Observation Area: Behavior Pattern
What You See: Pacing before meals
Possible Meaning: Hunger or Anxiety
How to Respond After Observation
Observation means nothing without action. Once you recognize a non-verbal sign, use it to guide your next step.
Respond Gently and Purposefully:
Pause and acknowledge:
“It looks like something might be bothering you.”
This shows empathy and awareness.Adjust the moment:
Slow your pace, change lighting, offer comfort, or explain what’s happening.Reassure with tone and touch:
Speak softly, make gentle eye contact, and avoid sudden movement.Confirm what works:
Notice what calms the person — that’s your clue for next time.
Example in Action
Situation: Mrs. Davis becomes stiff during bathing and says “No” repeatedly.
Observation: She looks cold, shivers, and pulls away.
Response: Caregiver warms the room, pauses the task, and wraps her in a towel.
After a few minutes, Mrs. Davis relaxes and allows the caregiver to continue.
Result: The task was completed comfortably — no arguments, no fear.
Lesson: Observation led to understanding.
Instead of taking the reaction personally (“She won’t let me help her”), the caregiver saw it as communication (“She’s cold and scared”).
Common Caregiver Mistakes (and How to Avoid Them)
Mistake: Taking behavior personally
Why It’s a Problem: Leads to frustration or resentment
Better Approach: Remember, it's the disease, not the person
Mistake: Assuming the cause
Why It’s a Problem: May misread the real need
Better Approach: Observe first, adjust gently, and watch response
Mistake: Reacting emotionally
Why It’s a Problem: Increases fear or confusion
Better Approach: Stay calm, breathe, and soften your tone
Mistake: Ignoring small signs
Why It’s a Problem: Allows distress to grow
Better Approach: Small cues often reveal big problems
Mistake: Rushing tasks
Why It’s a Problem: Overwhelms or startles the person
Better Approach: Slow down let them feel safe and ready
Reflection for Caregivers
Take a quiet moment after your shift or visit.
Ask yourself:
What non-verbal signs did I notice today?
How did I respond — with correction or compassion?
Did my tone and pace help or hurt the situation?
What can I do differently next time to make care feel calmer?
Remember:
Every sigh, frown, or pause is a message — not a challenge.
When you learn to see those signs as communication, your stress goes down, and your compassion grows.
Quick Review Summary
Skill: Watch for facial changes
Purpose: Identify discomfort early
Example: Grimace = possible pain
Skill: Notice body movement
Purpose: Recognize restlessness or fear
Example: Pulling away = confusion or sensitivity
Skill: Listen to vocal tone
Purpose: Hear emotion beneath the words
Example: Repeated “no” = fear or distress
Skill: Observe timing and environment
Purpose: Find Triggers
Example: Agitation at night = overstimulation or routine change
Skill: Stay calm and neutral
Purpose: Prevent escalation
Example: Soft tone = safe space
Skill: Don’t take the behavior personally
Purpose: Maintain empathy
Example: It’s the disease, not you
Skill: Adjust and reassure
Purpose: Restore comfort and trust
Example: Slow movements, gentle explanation
Final Thought
Observation is compassion in action.
When you learn to listen with your eyes and respond with your heart, you transform difficult moments into connection.
“The behavior isn’t against you — it’s a message for you.” 💙
8. Quick Review Summary
Recognizing non-verbal signs of discomfort is one of the most vital skills in dementia care.
It transforms care from “doing tasks” to understanding people — meeting needs that are spoken through behavior, body, and emotion instead of words.
Use this summary as your “mental checklist” when working with anyone living with dementia.
Key Takeaways
Category: Facial Expressions
What to look for: Frowning, Grimacing, black stare, tightening jaw
What It Might Mean: Pain, Fear, confusion
Caregiver Response: Pause, speak softly, identify possible cause (pain, cold, fear)
Category: Body Movements
What to look for: Pacing, pulling away, stiffness, rocking
What It Might Mean: Pain, anxiety, need to use restroom discomfort
Caregiver Response: Slowdown, offer reassurance, check physical needs
Category: Verbal/Vocal Cues
What to look for: Moaning, sighing, repeating “no” crying, sudden silence
What It Might Mean: Fear, fatigue, confusion, sadness
Caregiver Response: Reassure, speak gently, validate emotions, offer comfort
Category: Behavioral Changes
What to look for: Refusing care, aggression, withdrawal, repetitive motions
What It Might Mean: Fear, pain, sensory overload, confusion
Caregiver Response: Pause task, check environment, validate feelings, try again slowly
Essential Rules to Remember
All behavior is communication. Every action, sound, and silence has meaning.
Pause before reacting. A moment of patience often reveals the real problem.
Check the basics first. Pain, hunger, temperature, toileting, or fatigue cause most discomforts.
Look for patterns. If it happens at the same time daily, there’s a reason.
Respond with compassion, not correction. People forget words, but never forget how you make them feel.
Adjust the environment. Light, sound, temperature, or clutter can trigger distress.
Document clearly and kindly. Facts, not feelings — what you saw, what you did, what changed.
You are the voice for comfort. Your awareness gives the person safety and dignity.
Pro Tip for Everyday Caregiving
“If their words fade, listen with your eyes.
If their behavior changes, look for the need.
If you’re not sure, choose kindness, it always translates.” 💙
Reflection & Continuing Learning Prompts
Learning to recognize non-verbal signs is not about memorizing symptoms — it’s about building empathy, attention, and connection.
Your observations give people with dementia something precious: the comfort of being understood.
Use the following reflection prompts to personalize what you’ve learned and strengthen your caregiving awareness.
Reflection Exercise: “Listening Without Words”
Take a few minutes to think about someone you care for — past or present — who struggles to express themselves.
Answer these questions honestly in a notebook or digital form:
What are three non-verbal signs this person shows when they’re uncomfortable?
What patterns have you noticed — certain times of day, activities, or environments?
What’s one thing you could try differently next time to reduce their distress?
How do you usually feel when they become upset — rushed, frustrated, patient, calm?
How might your own tone or pace affect them in those moments?
How can you share your observations with others on the care team to ensure consistency?
Remember: Every caregiver’s insight adds another layer of understanding to that person’s story.
Self-Evaluation Questions
Before moving on to the quiz, reflect on the following:
Can I describe at least four common visual signs of discomfort?
Can I identify three verbal or vocal cues that signal distress?
Do I know what steps to take before assuming “behavior” is just confusion?
Am I confident in writing objective, clear documentation of what I observe?
How comfortable am I using validation and empathy instead of correction?
If you can answer yes to most of these, you’re well on your way to mastering non-verbal communication in dementia care.
Continuing Learning Resources
To deepen your understanding, explore these caregiver-friendly resources:
Alzheimer’s Association: Understanding and Responding to Dementia-Related Behavior
Alzheimer’s Society (UK): Pain in Older Adults with Dementia
Teepa Snow Positive Approach® to Care Videos – Short, practical demonstrations of empathy-based interaction
The Dementia Caregiver’s Survival Guide – For additional strategies on behavior interpretation
Final Thought
Recognizing non-verbal signs isn’t just a skill — it’s a relationship.
Each gesture, sound, or facial change is an invitation to connect, to comfort, and to bring peace in a confusing world.
“You may not always understand their words, but your compassion speaks clearly every time.” 💙
