Nonverbal Communication Strategies

As dementia progresses, nonverbal communication becomes increasingly important, often conveying more meaning than words. In advanced dementia, nonverbal communication may become the primary mode of interaction.

Body Language and Positioning

How we position ourselves and use body language significantly affects communication success:

Physical Positioning

• Position yourself at eye level (sit if the person is seated)
• Face the person directly
• Maintain an appropriate distance (typically 3-6 feet, but respect cultural and personal preferences)
• Ensure you are visible (especially important for those with visual field cuts)
• Position yourself on the person’s better side if they have unilateral sensory impairments
• Avoid standing over or behind the person, which can feel intimidating

Gestures and Movements

• Use natural, purposeful gestures to reinforce verbal messages
• Demonstrate actions you’re describing
• Point to objects being discussed
• Move at a calm, unhurried pace
• Avoid sudden movements that might startle the person
• Be aware that some individuals may misinterpret certain gestures

Facial Expressions

• Maintain a pleasant, attentive facial expression
• Exaggerate facial expressions slightly if needed for clarity
• Smile appropriately to convey warmth
• Match your expression to the emotional content of the conversation
• Be aware that some individuals with dementia may have difficulty interpreting facial expressions

Research by Kontos et al. emphasizes the importance of congruence between verbal and nonverbal communication. When these channels are incongruent (e.g., saying “I’m not upset” while displaying tense body language), people with dementia tend to respond to the nonverbal message rather than the verbal content (Kontos et al. 1007).

Touch and Physical Contact

Touch can be a powerful communication tool when used appropriately:

Therapeutic Touch

• Begin with socially acceptable touches (handshake, touch on forearm)
• Observe for signs of comfort or discomfort with touch
• Use firm, warm touches rather than light touches, which can be startling
• Signal your intention to touch before doing so
• Use touch to direct attention or guide movements
• Consider cultural and personal preferences regarding touch

Types of Touch for Different Purposes

• Instrumental touch: Used during care tasks (requires explanation)
• Expressive touch: Communicates emotional support and connection
• Orienting touch: Helps direct attention or guide movement
• Procedural touch: Prepares the person for an activity or transition

Considerations for Touch

• Be aware of trauma history that may affect response to touch
• Respect personal and cultural differences in touch preferences
• Recognize that some individuals may become more sensitive to touch as dementia progresses
• Document positive and negative responses to different types of touch

Research indicates that appropriate touch can reduce agitation, improve mood, and enhance engagement in people with dementia. A study by Burgio et al. found that gentle touch combined with verbal reassurance reduced care-resistant behaviors by 35% during personal care activities (Burgio et al. 150).

Visual Cues and Environmental Communication

Visual information often remains accessible longer than verbal information:

Written Cues

• Use large, bold print for written messages
• Employ simple signs with both words and pictures
• Create visual schedules for daily routines
• Write single, clear instructions for tasks
• Use white paper with black text for maximum contrast
• Avoid decorative fonts that may be difficult to read

Demonstration and Modeling

• Show while telling when giving instructions
• Use hand-over-hand guidance for complex motor tasks
• Demonstrate the first step of a task to prompt procedural memory
• Use mirroring techniques (performing the action alongside the person)
• Allow time for observation before expecting imitation

Environmental Cues

• Use consistent visual cues for wayfinding
• Employ color-coding for important items or locations
• Remove visual distractions during communication
• Ensure adequate lighting without glare
• Use real objects rather than pictures when possible
• Create contrast between important objects and backgrounds

These visual approaches support “environmental communication,” where the environment itself facilitates understanding and orientation (Vasse et al. 893).

Reading Nonverbal Expressions in People with Dementia

Developing skill in interpreting nonverbal communication from people with dementia is essential:

Facial Expressions

As verbal abilities decline, facial expressions often become more pronounced. Common expressions to monitor include:

• Furrowed brow (may indicate confusion, concentration, or pain)
• Clenched jaw (may indicate tension or pain)
• Mouth movements (pursing, chewing, grimacing may indicate needs or discomfort)
• Eye contact patterns (avoidance may indicate discomfort or disinterest)
• Rapid blinking (may indicate stress or sensory overload)

Body Movements and Postures

Body language can communicate needs, emotions, and responses:

• Leaning forward (may indicate interest or attempt to hear better)
• Leaning away (may indicate discomfort or desire for more space)
• Restless movements (may indicate pain, need for toileting, or anxiety)
• Repetitive movements (may be self-soothing or indicate unmet needs)
• Closed posture (arms folded, turned away may indicate discomfort)
• Tension in shoulders or hands (may indicate stress or pain)

Vocalizations

Non-speech sounds often communicate emotional states:

• Tone of voice (often communicates emotional state even when words are unclear)
• Volume changes (increased volume may indicate frustration or hearing difficulty)
• Pace of speech (rapid speech may indicate anxiety)
• Sounds like sighing, moaning, or humming (may indicate pain, boredom, or self-soothing)
• Laughing or crying (emotional expressions that may not match the apparent situation)

Research by Kontos et al. on embodied selfhood demonstrates that even in advanced dementia, the body continues to express preferences, needs, and selfhood through movements, gestures, and expressions that reflect lifelong habits and dispositions (Kontos et al. 1008).