Caring for Your Loved One With Dementia: Everyday Tips for Communication, Cognition, and Behavior

[En español]

Dementia is a general term for several brain diseases that affect these functions:

• communication
• cognition (thinking)
• behavior

Changes in each of these areas can vary significantly—and they typically intensify as the disease progresses. These changes often impact daily life and functioning—for the person with dementia as well as their care partner.

Although caring for someone with dementia can be difficult, the strategies below can help reduce challenging situations and improve quality of life for everyone involved.

It’s important to note that not all strategies will work for everyone, and the effectiveness often depends on how far the disease has advanced. Additionally, every person is unique: Use the techniques that seem to work best for that person (and for you).

Communication

People with dementia may experience changes in everyday conversation that include having trouble finding the right words, mixing up words, losing their train of thought, struggling to follow or stay on topic, and misunderstanding what others say.

Use these strategies to help improve communication:

• Create calm conversations. Approach the person from the front. Use their name—not familial names—because they may not recognize themselves as “grandma” or “uncle” any longer. Keep your tone friendly.
• Simplify communication. Speak slowly, and use shorter sentences, providing one idea or direction at a time.
• Address them as you would another adult. Don’t “talk down” to the person, and don’t speak to them as you would a child.
• Allow extra time for responses. Pause, and give them added time to process what you’re saying.
• Live in their reality. It’s more important to stay connected than to stay accurate. Say, “Tell me about that” instead of arguing or correcting them. Validate their feelings (“You sound worried”) even if you don’t understand or agree.
• Show—don’t quiz. Avoid asking “Do you remember . . . ?” questions. Instead, share a short story or a photo, and offer simple comments like “This was your garden last summer.”
• Talk about familiar topics. Discussing their favorite foods, recipes, music, or shows can spark conversation and connection.
• Offer choices instead of open-ended questions. For example, ask, “Do you want to wear the blue blouse or the green one?” instead of “Which shirt do you want to wear?”
• Use supportive nonverbal communication. Stay at their physical level when talking (if they’re sitting, sit down and address them at eye level). Maintain eye contact, smile, and provide gentle touch when it seems welcome.
• Handle repetition kindly. Rather than saying, “You just told me that,” redirect them gently to a new topic.

Cognition

Changes to memory and thinking skills are what most people associate with dementia. Cognitive symptoms may be mild at first but will worsen with time. How quickly cognition declines can vary significantly. The techniques and strategies below can help people maximize independence for as long as possible.

• Keep a routine. Keep daily activities—like meals, bathing, and bedtime—at the same time each day. Consistency can help reduce confusion. Prepare your loved one ahead of time for any changes to the routine.
• Use visual supports such as pictures, signs, and labels. These can be effective reminders, and they reduce frustration. Tape a picture of a toilet to the bathroom door, a picture of food on the pantry door, or a picture of a bowl on the cabinet where these dishes are stored. Use signs placed in strategic locations for important safety reminders, too—like posting a sign that says “Use your walker” next to their bed.
• Create helpful aids like memory books. Fill your homemade book with pictures and places that you can talk about together. Include photos of family members the person interacts with regularly (label the pictures with the person’s name). Go through it together to prepare them for an upcoming visit from a loved one or to reminisce (when it feels welcome).
• Make sure they’re using their assistive tools. Hearing aids, glasses, and other assistive tools help people stay connected to conversations and their surroundings. Try to ensure that devices are clean, are working properly, and are worn as recommended.
• Keep important items in the same place. Create a “home base” for items that the person needs every day. If an item gets lost consistently, consider attaching a small Bluetooth tracker to it.
• Use calendars and daily schedules. Keep a large, easy-to-read calendar in a central location. Review the day’s plans together each morning. Cross off days or events after they happen. Visual schedules can help people stay oriented to the day and stay informed about upcoming activities.
• Help the person stay as active as possible. Getting together with family and friends, playing games that they enjoy, and engaging in some realistic mental stimulation can keep the brain as active as possible—and can even slow dementia’s progression.

Behavior

Dementia is associated with many challenging behaviors—which can result from feelings of fear, confusion, agitation, sadness, shame, and embarrassment (among others). Although we can’t eliminate or control all behaviors, the tips below can reduce negative impacts on people with dementia and on those around them.

• Ensure that basic needs are being met. If a person is agitated, consider whether they are hungry or thirsty—or in pain. A medical issue may be causing them discomfort, but they might not be able to express it to you. If you think that this may be the case, check in with their doctor.
• Be mindful of your approach. A person with dementia often will mirror you and match the intensity of your energy or feeling. If you come in angry, they’ll likely respond with anger.
• Use soothing techniques. If a situation is escalating, turn to something that soothes the person. Play music, offer a comfortable blanket, or give them a warm glass of milk or a soothing cup of herbal tea.
• Engage the senses. Offer favorite foods and drinks. Have familiar scents on hand that spark nostalgia or a positive mood. Play music that they enjoy.
• Redirect actions and emotions. If something is agitating, upsetting, or scaring a person—or if they are trying to do something dangerous—try to redirect them. For example, if they want to go outside, rather than saying, “It’s nighttime; we can’t go outside,” try, “I have your favorite ice cream upstairs. Do you want to get a bowl?” If the person is crying, say, “You know what I was just thinking about . . .?” and bring up a happy memory.
• Allow them to be human. As explained above, you can try to redirect emotions such as sadness. However, know that it’s also okay to let them sit with negative emotions sometimes. Talk about it and relate to them: Ask them why they’re sad, and talk about how you also get sad sometimes.
• Know that it’s okay to walk away for a minute. If you’re having a difficult time, take a minute to excuse yourself—as long as the person is physically safe. In 5 minutes, they may be in a completely different frame of mind—and you may be, too.
• Honor their priorities. Consider what brings the person joy—for example, getting their nails or their hair done. Lean into those activities. Avoid skipping this type of activity—even if it doesn’t seem like a necessity to you.
• Avoid overdoing it. It’s important to be active, but don’t plan too much in one day—such as multiple medical appointments or errands. Try to schedule activities earlier in the day. Both can help reduce sundowning—a dementia-related term that describes the increased confusion that people living with dementia may experience as evening approaches.
• Build in moments of success. Choose activities that match your loved one’s current abilities—such as folding towels, doing simple crafts, or sorting tasks. Positive experiences can reduce frustration and improve mood.
• Practice good sleep hygiene. Ensure that they avoid naps during the day, limit their caffeine intake, and create a relaxing bedtime routine away from screens. Talk to their doctor if you think that their medications are affecting their sleep negatively.
• Limit overstimulation from surrounding environment. Too many people in their space and lots of competing noise from a television or other electronics can cause a person to be overwhelmed or even scared. Try to maintain a calm, quiet environment.
• Prioritize connection. We all want to feel connected to others—and that’s true for people who have dementia, as well. Look at family photos, draw together, or have them help you with a simple task. Any of these activities can feel comforting to them.

Additional Tips

• Optimize your home for safety. Don’t keep car keys or coats by the front door, which can provide temptation to leave. Minimize access to cash and credit cards. Have your loved one wear an ID bracelet. Lock up medications and other potentially hazardous items. Use technology for safety—such as using tracker software on their phone or smartwatches or installing doorbell cameras.
• Take care of yourself. Prioritizing your own health, wellness, and happiness is not selfish—it’s essential to maintaining your ability to care for your loved one. Practicing mindfulness, taking a walk, and talking on the phone or in person to a friend are just some ways to care for you. Give yourself grace even when your loved one is lashing out: Dementia is a disease that alters the brain—it’s not a reflection of you or the care that you’re providing.
• Seek additional help. Talk to professionals on your loved one’s care team about how to better manage this time. Reach out to their speech-language pathologist, social worker, and nurse. Connect with resources such as the National Caregiver Help Desk; the national 211 hotline; local aging and health agencies; and nonprofits that offer respite care grants, support groups, and other services, such as Hilarity for Charity.

If you have questions about dementia, a speech-language pathologist can help. To find one in your area, visit ASHA’s directory of professionals, ASHA ProFind: https://www.asha.org/profind/.