Verbal Communication Strategies

Effective verbal communication with people who have dementia requires thoughtful adaptation of our language and speaking style. The following evidence-based strategies can enhance verbal communication across different stages of dementia.

Language Simplification

As cognitive processing becomes more challenging, simplifying language becomes increasingly important:

Vocabulary and Sentence Structure

• Use simple, concrete words rather than abstract terms
• Choose common words over specialized terminology
• Keep sentences short (5-7 words per sentence in late-stage dementia)
• Use active rather than passive voice
• Present one idea or question at a time
• Avoid complex grammatical structures

Research by Small et al. demonstrated that using shorter, simpler sentences significantly improved comprehension in individuals with moderate to severe dementia, with comprehension rates increasing from 62% with complex sentences to 91% with simplified sentences (Small et al. 771).

Formulating Questions

How questions are phrased can significantly impact the person’s ability to respond:

• Use closed-ended questions when open-ended questions cause frustration
• Offer binary choices rather than multiple options (“Would you like coffee or tea?” rather than “What would you like to drink?”)
• Avoid questions that rely heavily on recent memory
• Frame questions positively (“Would you like to sit here?” rather than “Don’t you want to sit down?”)
• Avoid testing questions that may cause embarrassment (“Do you remember my name?”)

Giving Instructions

When providing directions or instructions:

• Break down tasks into single steps
• Provide one direction at a time
• Use visual cues alongside verbal instructions
• Demonstrate what you’re asking the person to do
• Allow ample time for processing before repeating
• Use the same wording if repetition is necessary

Speaking Techniques

How we deliver verbal information significantly affects comprehension:

Rate and Pacing

• Speak slowly and clearly, but naturally (not exaggerated)
• Allow 4-6 seconds for processing before expecting a response
• Insert pauses between sentences
• Watch for signs of processing and comprehension before continuing
• Match your pace to the person’s cognitive processing speed

Tone and Volume

• Use a warm, respectful tone
• Maintain a low pitch (especially important for men, as high-pitched voices can be more difficult to process)
• Avoid raising your voice unless the person has hearing loss
• If volume adjustment is needed, speak more clearly rather than just louder
• Vary your intonation naturally to maintain interest

Repetition and Rephrasing

• Repeat key information as needed
• If repetition doesn’t work, try rephrasing the message
• Use different words to express the same idea if not understood
• Summarize important points at the end of conversations
• Check for understanding by watching nonverbal cues

Topic Management

Managing conversation topics effectively supports successful interactions:

Starting Conversations

• Begin with a clear greeting and identify yourself
• Use touch appropriately to gain attention (if culturally and personally acceptable)
• Start with familiar, pleasant topics
• Use environmental cues or objects to initiate conversation
• Match topics to the person’s interests and life history

Maintaining Conversations

• Follow the person’s conversational lead when possible
• Build on topics they introduce
• Use continuers like “Tell me more about that” to encourage elaboration
• Provide verbal prompts if the person loses track
• Accept tangential remarks as valid contributions

Ending Conversations

• Signal conversation endings clearly
• Summarize key points discussed
• Thank the person for the conversation
• Indicate what will happen next
• Avoid abrupt departures

Supportive Communication Techniques

Several specific techniques can enhance verbal communication:

Elderspeak Avoidance

“Elderspeak” refers to a patronizing speech style characterized by simplified vocabulary, exaggerated intonation, inappropriate terms of endearment, and collective pronouns (“Are we ready for our bath?”). Research shows that elderspeak can increase resistiveness to care and agitation. Avoiding elderspeak by maintaining adult speech patterns while adapting communication appropriately demonstrates respect (Williams et al., as cited in Burgio et al. 147).

Reminiscence

Engaging in conversations about long-term memories can be particularly successful, as these memories often remain intact longer than recent ones:

• Use open-ended questions about the past
• Incorporate memory triggers like photographs or music
• Focus on positive past experiences
• Allow the person to be the expert on their own life
• Listen with genuine interest to repeated stories

Positive Communication

Maintaining a positive emotional tone supports successful communication:

• Use affirmations and encouragement
• Express appreciation for communication attempts
• Acknowledge emotions before content
• Find opportunities for humor when appropriate
• End interactions on a positive note

Research by Savundranayagam and colleagues found that positive communication strategies were associated with decreased agitation and increased cooperation during care activities, with a 44% reduction in care refusals when these techniques were consistently applied (Savundranayagam et al. 147).