Tips for Engaging a Person With Dementia in Conversation

People with Alzheimer’s or other types of dementia often struggle with initiating and maintaining conversations. As speech-language pathologists, we can help them by leading, prompting and guiding discussions using simple statements and questions. This technique engages the person in meaningful interactions and can yield relevant information. In turn, SLPs can share these details, along with practical tips, to family members and caregivers to help them engage in conversations with their loved one.

The goal of treatment for people with dementia involves maintaining their engagement in life, and improving an individual’s ability to communicate is an important part of that engagement. Conversations connect people. Having one’s words acknowledged and shared by another person promotes a feeling of well-being. When a person’s ability to speak becomes limited, try creating and recognizing other ways to connect. A meaningful utterance, shared smile or even just direct eye contact might be worth a thousand words.

Try these suggestions to engage clients with dementia in conversation:

1. Look directly at the person when you speak.
2. Introduce yourself before starting a conversation. State your name and/or role.
3. Start conversations by introducing the topic. Do not wait for the individual to start talking. For example, “Let’s look at your family photos.”
4. Speak in a loving manner.
5. Offer one idea at a time.
6. Use simple words and short sentences.
7. Speak slowly and clearly.
8. Use hand gestures and facial expressions to accentuate your words.
9. Ask short yes-or-no questions instead of open-ended questions.
10. Use multiple-choice questions: “Would you like tea or coffee? Do not ask “What do you want to drink?”
11. Use picture cards and picture books as topics of conversation.
12. When necessary, use written questions and statements to help the person understand what you’re saying.

Some tips on what to avoid when speaking with a person with dementia.

1. Don’t address the individual as a child. Speak in an adult manner.
2. Don’t yell. The loud volume and angry facial expression will agitate and confuse the person.
3. Don’t interrupt. Give the person time to complete their thoughts.
4. Don’t talk about the person in their presence as if they aren't there. Respect the person’s dignity.
5. Don’t ask lengthy, complex questions.
6. Don’t ask questions that require the person to recall names.
7. Don’t speak to the person unless they're facing you.
8. Don’t try to engage a person in conversation in a noisy environment.
9. Don’t argue. Instead, change the subject.
10. Don’t whisper or speak too quickly.
11. Don’t demand verbal responses. Accept attentive listening, facial expressions, hand gestures and good eye contact as acceptable responses.
12. Don’t give up!

If you or the client’s caregivers get frustrated with unsuccessful attempts to initiate conversations, try focusing on the person’s favorite topics. Someone once said, “The advantage of a bad memory is that—several times over—one enjoys the same good things for the first time.”

Eisner shares her experience of her mother's Alzheimer's diagnosis: After decades of creating therapeutic strategies, an SLP uses these skills when her mother develops dementia.

Eileen Eisner, ME, CCC-SLP (Ret), has more than 45 years of experience as a clinician, school principal, special educator and supervisor of teachers. She has expertise in and has written books on children’s language-learning disorders and Alzheimer’s-related communication disorders, including “Engaging and Communication With People Who Have Dementia: Finding and Using Their Strengths.” [email protected]