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Graham Stokes: 'Words can mask meanings in dementia: listen to understand'


People living with dementia have something to say. Develop your communication skills to maintain meaningful connections, advises Graham Stokes

When you’re caring for someone who is living with dementia, some skills are obviously essential – kindness, patience and sensitivity, to name a few. Arguably, an even greater skill that’s needed is the ability to maintain meaningful connections as the disease progresses. Being able to listen and engage can make the difference between meaningless words and meaningful interactions.

I have never forgotten being puzzled by an older woman who, in the midst of her dementia, would sit wringing her hands and repeating over and over the phrase “man like me”. All became clear when her brother visited – she calmed down, and her eyes brightened as she recognised him. He was the “man” who was most “like me”.

The challenge for us all in such a situation is to see beyond the words to decipher the concealed message behind them. It’s no secret that it can be very difficult to communicate with a person who has advanced dementia; the content of their words is often sparse, repetitive, disjointed and frequently incomprehensible.

This communication challenge is the same for care assistants and nurses as it is for relatives looking after people with dementia. As their ability to communicate deteriorates as their dementia progresses, more effort is needed to stay connected to them to help maintain their quality of life.

“Look for the emotion behind the words, rather than focus on the words themselves”

Bupa has recently published guidance to help friends, relatives and carers overcome the stigma of communicating with people with dementia. Our Talking Toolkit contains practical advice on honing communication skills to enable carers to maintain meaningful connections. It includes the following advice.

Think as you listen: concentrate on what you hear, think about what the words might represent and follow that line of enquiry. Look for the emotion behind the words, rather than focus on the words themselves. Seemingly confused statements like “I need to go to work” are often the way a person is trying to voice an unmet need, such as a need to feel useful or valuable.

Show you are listening: this will often prompt a person. It can be easy to look away, be distracted or respond inappropriately to perceived “ramblings”. This will close down communication, as the person with dementia – like any of us – will sense the lack of interest. Instead, make sure you face the person and maintain eye contact; a smile will convey warmth and interest, and a gentle tone of voice will reassure and encourage them to continue.

Keep it simple: rather than introduce new content to the conversation, repeat back to the person what you have heard them say and your understanding about how they are feeling. Repeated phrases or key words act as stepping stones to help the person with dementia to say more. If you use questions to develop the conversation, keep them straightforward, and ensure they can be answered with “yes” or “no”.

Be patient: take time to reflect on what you’ve heard and accept that pauses in conversation do not need to be filled with words; allow time for the person to digest what you have said and gather their thoughts so that they can respond.

People living with dementia have something to say, and they do say it, but their words often hide what they actually mean. Apply yourself to listening, rather than just hearing, and you’ll start to appreciate the meanings and feelings behind words. These meaningful moments of communication can bridge the emotional distance that this debilitating condition creates.

● The full Talking Toolkit is free at

Graham Stokes is director of dementia care at Bupa Care Homes


Readers' comments (2)

  • Kindness, patience and sensitivity, as well as appropriate non-verbal communication are of course essential in caring for those with dementia. The rest however is largely speculation.

    Engagement and meaningful connections are two way processes about which even the dementia suffers level of awareness is often impossible to judge. As for the interpretation nurses and carers place on repeated phrases or apparent emotion, they are just that – your subjective interpretation, remember it may bear no relation to the persons reality.

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  • I can't tell you how many times a dear friend with AD has made a comment later in the day about things that were going or being said while everyone thought he was "asleep" or "out of it".
    PLEASE be be kind --that "catnapping" patient may be listening to everything you are saying, and while they may not be able to process every word you say, they will very often understand emotion and you respect for them (or lack of it).
    Supposedly, emotions are often the last thing to go in Alzheimers....

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