Communicating With a Loved One Who Has Dementia: Do’s and Don’ts

This topic is always top of mind for me, as dementia has touched so many of our clients and their families over the years. Watching the progression of this disease is never easy. For family members, caregivers, and most importantly, the individual living with dementia, life can feel as though it is rapidly changing in ways that are difficult to understand or accept.

We have seen many different expressions of dementia- resultant behaviors. Dementia is a progressive disease with stages, characterized by gradual worsening behaviors over periods of time, yet every patient has their individualized progress. Some patients become combative and will punch, kick, or even bite; some stay quiet, pleasant and calm; while others become withdrawn and often at loss of words.

Emotions from both patients and their family caregivers can run high in situations involving dementia, as our loved ones can behave like a total stranger or out of character to our familiarity. They may talk illogically, or behave erratically and aggressively. One client of ours that was a high-level diplomat his entire career, once dementia developed, often cursed and swore loudly at his beloved wife, whenever agitation hit. Another client, a university professor who developed frontotemporal dementia, frequently attempted inappropriate touching towards female caregivers. A client that was an accomplished writer and journalist, regularly walked incessantly in mid-afternoon in the downtown area of Los Altos, sometimes trying to go across Foothill Expressway without following the traffic lights; when reminded and held back by the accompanying caregivers for her safety, she bit their arms and hands out of frustration.

In all situations, however, there is a common thread: the person often has little to no situational awareness of their behaviors, or the consequences of their behaviors. This loss of awareness often deepens as the disease advances, making communication especially challenging. Families often feel helpless, unsure of what to say or how to say it. Yet small changes in how we approach these conversations can bring comfort and reduce stress for everyone involved.

Here are some simple but effective do’s and don’ts when communicating with a loved one who has dementia:

Do’s:

• Be patient. Listen and acknowledge their communication, like the first time you hear it, even though you may have heard the same five times in the past 30 minutes.
• Use short, clear sentences. Speak slowly and simply, avoiding complicated explanations.
• Maintain eye contact and gentle body language. Nonverbal communication often speaks louder than words.
• Validate their feelings. Even if their reality isn’t yours, acknowledging emotions (“I see you’re upset” or “That sounds frustrating”) can calm anxiety.
• Offer reassurance. Familiar phrases like “You’re safe” or “I’m here with you” go a long way.
• Redirect gently. If agitation rises, change the subject to something soothing, such as a favorite activity, song, photo, or memory.

Don’ts:

• Don’t argue or correct. Trying to convince someone with dementia that they are wrong usually causes more confusion and distress.
• Don’t overwhelm with too many choices. Instead of “What do you want for lunch?” try “Would you like soup or a sandwich?”
• Don’t raise your voice. Frustration can unintentionally escalate the situation.
• Don’t take aggression personally. Remember, it’s the disease, not your loved one, causing the behavior.

Above all, patience and empathy are essential. Dementia takes away many abilities, but the need for dignity, love, and human connection never fades. By adjusting how we communicate, families can preserve moments of trust and tenderness even in the hardest stages of the illness.

Caring for someone with dementia is difficult, but with the right tools, understanding and patience, we can ease the journey for the person affected, for their caregivers, and for the family members who love them most.