2021 Blog Post

Non-Verbal Communication in Dementia Care

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By VHA
Elder couple sitting on a couch, smiling, laughing
As a loved one progresses through the stages of dementia, what may begin with struggling to find the right words or forgetting what was just said, can lead to only making sounds, repeating isolated words or the loss of verbal communication entirely. This decline in communication skills, known as aphasia, changes the way your loved one hears, processes and responds to information and can be one of the most difficult symptoms for people living with dementia and for their caregivers. Communication challenges can lead to increased depression, anxiety, confusion and anger in dementia patients and make it especially challenging for caregivers to understand and meet their loved one’s needs. If you are caring for someone who is non-verbal or has limited language skills, here are some communication strategies to help you better understand each other and find alternate ways to connect:
  • Stay calm and positive. If your loved one has lost their verbal skills they will naturally focus on the tone of your voice, your body language and facial expressions as they try to understand you. While not always easy, stay as relaxed as possible knowing that sudden movements, a tense face or frustrated tone can cause your loved one to feel distressed. If you are struggling with challenging behaviours, walk away, take deep breaths and return when you feel calmer.
  • Use visuals, gestures and limit options. To get your message across more clearly, try adding actions or illustrations to your conversations. If you want to go for a walk, demonstrate the movement with arm motions and by bringing out their coat and shoes. Cue cards, picture books or dementia-specific apps can help you figure out what your loved one wants or needs through images. Use short, simple sentences and ‘yes’ or ‘no’ or closed-ended choice questions like,  ‘Are you hungry?’ or ‘Would you like pasta or rice?’ Continue to observe non-verbal cues watching for signs of anger, fear or discomfort so you can adjust your response and care as needed.
  • Remain respectful. When someone is non-verbal, people tend to talk about them as if they aren’t in the room. Instead, involve the person you are caring for in your decision making, include them in your conversations and remind others to do the same. Avoid childish language, make consistent eye contact at eye-level so you’re less intimidating and always approach your loved one from the front with an introduction so they see you coming.
  • Get comfortable with silence. It can feel strange or awkward to have a conversation with  someone who may not understand you or be able to respond, but with practice you can get better at carrying a one-sided conversation. Talk about your day, what’s going on with other family members or friends or reminisce about past memories you enjoyed together. These conversations can be especially beneficial during daily tasks like hair brushing, bathing or feeding.
  • Connect through touch. Our desire for connection never goes away and physical touch can be very comforting—especially if you aren’t able to communicate in traditional ways. If it feels appropriate, hold or shake your loved ones’ hand, pat their shoulder or give them a hug. Just watch their body language to make sure that they are comfortable as they can fluctuate between appreciating your touch and needing space. Before any hands-on care, tell your loved one what you are going to do and check in. For example, ‘I’m going to give you a hug because I love you,’ or ‘I’m going to put lotion on your feet, does that feel okay?’
  • Be creative. Find alternate ways to communicate and connect with your loved through activities that don’t require words. Listen to music, draw or paint, look through old photo albums, read a book or cook together and be sure to smell the ingredients. These types of outlets that involve other senses can help a person in the late stages of dementia express themselves, communicate their mood and feelings, spark happy memories and create moments of joy.
Everyone’s dementia experience is different and you may find that your loved ones’ communication skills change depending on their stress levels, nutrition and quality of sleep. Approaches that work one day may not be successful on another and it can be heartbreaking to feel so disconnected from someone you love. If you are struggling with the very difficult demands of caregiving, talk to a friend, family member, support group or a professional counsellor.