New connections – communication and relationships in dementia

Dementia changes many things – memories, orientation, language, behaviour. What remains, however, is the need for relationships. Communication is much more than just words. It is evident in eye contact, touch, tone of voice, patience and presence.

For relatives, the change in communication is one of the biggest challenges. How can I reach someone who seems to be sinking deeper and deeper into their own world? How can closeness develop when conversations become fragmented or speech is lost altogether? The answer lies less in the right technique than in a change of attitude. Relationships are still possible even with advancing dementia – if we are willing to reconnect.

When realities diverge

As the disease progresses, people with dementia increasingly live in their own world of feelings and experiences. This often no longer corresponds to the reality of their relatives. A father wants to go “home” even though he has been living there for years. A mother waits for her long-dead sister. A partner is convinced that something has been taken away from her.

This can be painful, irritating or exhausting for relatives. The impulse to correct or set the record straight is understandable. But this is precisely where a crucial change of perspective comes in: it is not the person with the illness who can adapt to our reality – we are called upon to engage with their experience. This does not mean confirming untruths. It means taking the feelings behind the statements seriously.

Validation – acknowledging feelings

Validation is a proven approach when dealing with people with dementia. It means accepting statements, actions and views without checking them against your own reality or correcting them.

When a mother says, “I have to go home, my children are waiting,” she is rarely referring to a specific address. Often, there is an underlying need to be needed or to take on responsibility. A possible response could be: “You have always lovingly cared for your children.”

Validation creates access to the emotional world and takes into account the person’s biography. It conveys appreciation and acceptance. The goal is not to be right, but to enable relationships. Especially in cases of confusion or repeated statements, it helps to focus less on the content and more on the emotional signals. Needs for security, closeness or orientation are often at the forefront.

The growing importance of non-verbal communication

As the disease progresses, non-verbal communication becomes increasingly important. Speech recedes into the background, and emotions become the primary means of expression. People with dementia often mirror the behaviour of those around them. Tension creates unrest, while calmness conveys security. A quiet tone of voice, a friendly look or a gentle touch can be more effective than lengthy explanations.

In later stages, wishes and feelings can often only be expressed through body language. Then closeness, rituals and familiar stimuli become more important. Music, familiar songs or looking at photos together can create a connection. Sometimes it is enough just to be there and hold a hand. Dementia changes the perception of the environment – but not the need for security.

Basic attitudes for successful communication

In everyday life, a few key principles help to make conversations respectful and understandable:

• Do not contradict or confront, but accept.
• Respond with empathetic understanding and reflect feelings.
• Remain authentic and show genuine affection.

This attitude forms the basis for trust. People with dementia are sensitive to mood and authenticity. Remaining calm and attentive creates emotional security.

Conversation skills in everyday life

Clear, simple language makes it easier to understand. Long, convoluted sentences or multiple pieces of information in one sentence can be overwhelming. Short statements with only one message are better. Yes/no questions are often easier to answer than complex questions. W questions such as “who” or “what” can also be helpful. However, “why” questions should be avoided, as they require logical explanations that are often no longer possible.

It is also important to allow sufficient time for responses. Impatience or hasty additions increase pressure. Statements should be repeated if necessary, but not constantly rephrased. The following aspects are particularly helpful in conversation:

• Address the person directly and maintain eye contact
• Use their name and speak calmly
• Use gestures and facial expressions to support what you are saying
• Use touch in a targeted manner to convey confidence
• Use “I” statements instead of generalised phrases

It is equally important to avoid certain behaviours. Irony, scolding or arguing rarely achieve the desired result. Provocative words such as “no” or “hospital” can cause anxiety. Baby talk is demeaning and should be avoided. Conversations should always be calm, clear and respectful – on equal terms and without pressure.

The ABCs of communication

The so-called ABC of communication provides an easy-to-remember guide. It summarises three key principles:

• A stands for ‘Avoid confrontation’. Discussions about right and wrong usually lead to a dead end.
• B stands for ‘Be practical’. Practical action is often more helpful than long explanations. Showing, accompanying and demonstrating replaces complicated words.
• C stands for ‘Clarify the feelings and comfort’. Identifying feelings and offering comfort creates emotional stability. A sentence such as ‘That’s scary for you right now’ can be more effective than any factual explanation.

The emotional dimension for relatives

Caring for someone with dementia is a demanding task. It requires patience, flexibility and a constant willingness to let go of expectations. Relatives often experience a gradual loss of familiar conversations and shared memories. Sadness, feeling overwhelmed or even frustration are natural reactions.

It is important to take these feelings seriously and seek support – whether through counselling, support groups or professional guidance. Only those who take care of their own stability can provide sustainable support in the long term. Self-care is not selfishness, but a necessary resource.

Newly connected – relationship in the here and now

Dementia forces us to redefine communication. Away from discussion and correction, towards empathy, patience and presence. Perhaps words become fewer. Perhaps sentences are repeated. Perhaps in the end, only looks, gestures or a smile remain. But it is precisely in the here and now that a special form of closeness can develop.

Being newly connected means providing security instead of correction, comfort instead of argumentation, and warmth instead of judgement. It means respecting the other person’s world of experience and building a relationship within it. Because even when memories fade, the need for love, appreciation and security remains. Communication is relationship. And relationship is possible even with dementia.