Author:
Kim Warchol, OTR/L, Founder of Dementia Care Specialists
Words matter. When communicating with someone with Alzheimer’s disease or another dementia type, we must be very mindful of the reaction we create with the words we use. That’s right- the reaction WE create.
Often people with dementia are blamed if they express resistance or anger or display a threatening response. But the fact of the matter is there are two people involved in every communication. What the sender communicates is processed and responded to by the receiver. The outcome of every communication is dependent on both the sender and the receiver and thus we must understand our responsibility in the responses we observe.
In fact, this principle applies to communicating with someone with or without dementia. What we say, and how we say it tees up an emotional response. Was what someone said to you pleasant, leading to your positive reaction or was it rude, controlling, or threatening, inciting a negative response?
Wouldn’t you say, “Hey you, get over here!” sends a vastly different message than, “Hello, would you mind coming over here?” I am sure you can imagine how you would respond differently in each scenario.
Although I focus on word selection in this blog, I suggest you are also very aware of the messages your nonverbal communications send, including your tone of voice and body language. These are just as impactful as the words you use.
Ok, let’s explore ten things you should avoid saying to a person with dementia. And I will include the primary reason these are considered communications that could provoke a negative response.
Don’t say things such as:
- “Stop! Leave that alone!”
- “No, do it like this!”
- “Come with me!”
Why? These are words that take control away. This does not show the person that you respect them or their choices. Worse yet, they can feel devalued, or even threatened, creating a resistive reaction.
Instead: Ask permission and give choices such as “Would you mind waiting here?”
Don’t use open ended questions, such as:
- “What would you like to do today?”
- “What do you want to wear?”
Why? Abstract thinking is not a strength in dementia, and open-ended questions challenge cognition because the response options are so limitless. There is a plethora of potential answers to any one question and that will overwhelm and disable someone with dementia.
Instead: Ask simple, close ended questions, giving a choice of two, which minimizes the cognitive challenge such as, “Would you like to wear this blue sweater or this yellow shirt?”
Don’t say things such as:
- “We already had this discussion. What did I tell you about that yesterday?”
- This type of question is often followed by the dreaded, “Don’t you remember?” such as “Dad, don’t you remember I came to visit yesterday? What did we do?”
Why: These questions test and challenge creating agitation. If the caregiver notices the person with dementia having difficulty recalling a situation or event, questions that test and challenge can create significant anxiety and distress for someone with memory loss. This type of questioning may represent a caregiver’s denial and inability to accept the dementia condition.
Instead: Understand and accept a person’s memory limitations as part of the disease. Don’t take it personally. Be patient and supportive. As examples:
Give the information again, remind and prompt, and then gently ask a question if needed such as:
- “Millie, yesterday I showed you where I put your toothbrush. It is right here in this cabinet. Can you get it out?”
- “Dad, yesterday I came to visit, and we had a wonderful time playing cards. Would you like to play cards again today?”
Don’t communicate in lengthy sentences such as:
- “Find your seat in the dining room, set your things down, then go and get your plate by the end of the buffet line.”
Why? Attention and memory decline making a two or three step direction too challenging. They may lose their focus during the sentence (this is a problem with their attention and concentration) or may not recall what you said at the beginning of the sentence (a problem with their memory).
Instead: Keep sentences short and use a one to two step direction. Let the person respond and then continue to another step, if required. Keeping it short and assuring their understanding of each single step is the best way to communicate.
Don’t use pronouns, such as:
- “She, he, or it.”
Why? To use a pronoun, someone must have incredibly good short-term memory, and dementia impacts short term memory early in the disease. When someone has dementia, pronouns are disabling.
Let me explain this further. At some point earlier in the conversation the sender defined the pronoun “he” such as, “Bob is coming later today to see you. HE said he would be here for dinner.” For an individual with memory loss to know who “he” is, they must be able to recall what the sender said a few seconds or even minutes ago.
Instead: Always use the noun in place of the pronoun (e.g., “Bob” instead of “he”), no matter how redundant this may sound. In this example we would say, “Bob is coming later today to see you. Bob said he would be here for dinner.”
Don’t say things such as:
- “Why are you looking for (a specific person or a pet)? They are dead.”
Why? This is called reality orientation, and it creates distress for those with dementia. Aligning someone with dementia to the facts is not always necessary or helpful.
Even if the above statement about someone being dead was true, it will cause emotional pain. They don’t recall the death, so it is as if the person is hearing this news for the very first time. If they did not remember, they likely will not remember in the future, and thus there is no benefit to using reality orientation.
Instead: Enter the person’s reality, joining them where they are in their truths and in their emotional state. If they are looking for someone beloved or a precious pet that has passed, the best approach is to validate and then to try to fill the want or the need the deceased once filled.
If for example, a pet brought comfort and companionship, you could say, “I know how much you loved Fido and Fido loved you.” Follow this compassionate validation by doing something to try to fill the emotional void left by the deceased, if able.
Bottom line is do not correct the person. Instead, attempt to diminish their anxiety and confusion and offer emotional support. Then redirect to someone or something that gives them an opportunity for meaningful connection and a sense of security.
BONUS: I will end this blog with a question I often receive which is, “Should I tell my loved one they have dementia?”
I believe there is no right or wrong answer. Instead, the decision to tell them or not should relate back to who the individual has always been. Do you think they are the type of person who would rather know or prefer to be shielded from learning difficult news? I would use the answer to that question as my guide. Person-centered care is the best tool to help make this decision.
If you do decide to tell the person they have been diagnosed with dementia, be sure to make this a team approach by having your trusted medical professional and/or loved ones available for support. It is a tough conversation and all will need support.
Closing
One of the most important skills that should be developed in dementia training is communication. We need to know what to say, how to say it, and to understand the impact of our words on how the person with dementia feels and how they react. If your words seem to illicit greater confusion or a negative reaction, start over and try to address the suspected problem with your communication approach.
In this blog I covered ten things to avoid saying to someone with dementia. Obviously that list cannot address everything. Therefore, I hope you found it helpful to understand the reasons to avoid saying certain things. This understanding can help you to identify many more examples of what not to say- and better yet- what to say, to get the best outcome for all.
When compassion, patience, and skill combine in your communication, there is strong potential to enable those who are living with dementia to thrive. You, and your words, are powerful!
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Originally published June 8, 2026.
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