1. Marshall, Katherine DNP, NP, PMHCNS-BC, CNE
  2. Hale, Deborah MSN, RN, ACNS-BC

Article Content

More than six million Americans are living with a dementia and this number is projected to rise to 13 million by 2050 (Alzheimer's Association, 2022). Home healthcare clinicians will be faced with a growing case load of individuals with neurocognitive disorders and their families who are struggling to cope with caregiving.


A therapeutic rapport is a high priority for each clinician/patient dyad, but communication is complicated by progressive deterioration of the brain that impacts processing, comprehension, word retrieval, and speech. In addition, sensory limitations such as hearing, and vision loss can impair the individual's ability to take in information. Difficulty with communicating can be very frustrating for the individual, resulting in withdrawal, depression, and/or anxiety. Caregivers will need to be educated on the best strategies to communicate with the person, and the clinician must model the behaviors and techniques that promote effective communication.


People with dementia may have multiple difficulties in communication, from remembering words to pronouncing them clearly. Some of these patterns may include substituting words, difficulty finding the intended word, losing their train of thought, repeating words, questions, or stories, describing an object rather than naming it, speaking less often, mixing phrases or unrelated ideas, or reverting to their primary language (Mayo Clinic, 2021).


Speaking and listening strategies can help with communication. Patience and the use of appropriate strategies are key. Take time to listen and allow the individual to complete their thought. Attempt to understand the individual based on the context of the conversation; offer a guess to help them communicate their idea. Make eye contact, lean forward, and call the person by name. Offer comfort if they are struggling, let them know it is OK and provide encouragement. Demonstrate respect by avoiding use of child-like phrases. Never speak about the individual as if they are not present. Find a quiet place to talk and avoid distractions such as loud television or radio. Use simple short sentences that communicate one idea and break the conversation into steps. As the disease progresses, give the individual questions that require a simple yes or no answer. Avoid criticizing, correcting, or challenging what the person is saying.


Offer visual clues and gestures such as pointing to the bathroom or television or showing them a drink. Repeat information or use a prop or picture to describe the concept. Be observant of behavioral clues as they may help you to understand what the person is trying to communicate. Restlessness may suggest a need to go to the toilet or the need for a position change to relieve pain or discomfort. Continue to speak with the individual even when they no longer talk. Be positive and provide them with information they would enjoy, that is, what the grandchildren are doing or the standing of their favorite sport team. Be mindful of their ability to tolerate stimulation. If the individual with dementia reacts negatively to conversation by demonstrating anxiety or irritability, limit or stop the conversation.


Communicating with patients who have neurocognitive disorders can be challenging, but an array of communication strategies can improve the self-esteem and care of these patients. Teaching these strategies to caregivers and family members can improve the patient-caregiver relationship and enhance the quality of care.




Alzheimer's Association. (2022). Quick facts. In Alzheimer's disease facts and figures.[Context Link]


Mayo Clinic. (March, 2021). Alzheimer's and dementia: Tips for better communication. In Healthy lifestyle: Caregivers.[Context Link]