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How to Talk to Those with Dementia so They Can Hear You


Study Finds Talking Down to Patients Increases Disruptive Behavior

Have you noticed how loudly some people talk when attempting to communicate with a person who doesn’t speak English? They seem to think turning up the volume will bridge the language gap. Similarly it is common for many, including trained professional caregivers, to use “elderspeak” with people who are old and infirm. It sounds a lot like baby talk, with simplified grammar and vocabulary and liberal use of terms of endearment, such as honey, sweetie and dearie. Though it may be done with the best intentions, a new study finds that when elderly patients are spoken to in this way, they often become angry, less responsive and harder to care for.

The study, led by researcher Kristine N. Williams, RN, PhD, an associate professor at the University of Kansas School of Nursing, videotaped interactions between caregivers (nursing assistants, nurses, therapists and social workers) and 20 nursing home residents with moderate dementia. Using a measure called the “Resistiveness to Care Scale” to quantify the intensity of care-disrupting behaviors (acts of withdrawal or aggression, such as grabbing onto a person or pulling one’s own limbs tightly into the body, hitting, crying and kicking), researchers reviewed the tapes. When they witnessed such episodes, they rewound the tapes to see what kind of communications occurred in the preceding seven seconds. Often (55% of the time), it turned out that the caregivers had been using “elderspeak,” compared with the 26% of the time these behaviors arose when caregivers used normal adult communication. It seemed that the elders objected to being talked to in this child-like way. The researchers hypothesized that this form of communication sends a negative message of incompetence, which ends up irritating rather than soothing listeners.


The National Institute on Aging and Dr. Williams offer these tips for communicating with those who have Alzheimer’s disease or dementia…

  • Before speaking, gain the person’s full attention. Use his/her name.
  • While interacting, turn off distractions such as the TV or radio.
  • Speak in a tone that is calm and gentle, without infantilizing. Dr. Williams also points out that nonverbal cues such as establishing eye contact convey your focus and willingness to communicate.
  • Use simple words and short, clear sentences — but not baby talk.
  • If someone is having trouble finding the right words, it’s fine to help him/her out by gently making suggestions.
  • Be patient, providing ample time to think and respond. It is important to give people with dementia time to compose and communicate their thoughts, says Dr. Williams. When you are patient, it shows you believe that what they have to say is important and that you are paying attention to them.
  • Do not talk about a person with AD or dementia in front of him/her as if he/she was not present.

It’s not so hard, actually — doesn’t it really come down to using the same good manners we should be using anyway?

Source: Kristine N. Williams, RN, PhD, associate professor, University of Kansas School of Nursing, Kansas City, Kansas. Date: October 28, 2008 Publication: Bottom Line Health
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