How to Communicate with Someone who can’t Speak

By Jane Verity © dementiacareinternational

Communicating with someone who can no longer speak in words or sentences can sometimes seem like a tough task.

The Good News

People with dementia still do communicate, even if they can no longer use words or sentences. Today we know that most people with dementia retain the ability to communicate, at least in one-syllable words, such as yes or no.

The only exceptions to this rule are people in the final stage of dementia or who have suffered a stroke or similar condition that may have affected their “speech circuitry”.

A Yes or No answer can be given in 3 different ways by:

1. Saying the words out loud.

2. Shaking or nodding the head to indicate a response.

3. Using facial expressions e.g. looking up and making eye contact; smiling or looking down for a Yes, or: looking straight into space or giving no reaction at all for a No.

Research has shown that words are not our only means of communication. We use three components when communicating a message:

1. Words – which make up 7%

2. Tone of voice – which makes up 38% and

3. Body language – which makes up 55%

This means that 93% of our communication is non-verbal, and it is in our tone of voice and body language that meaning is conveyed. We can say a word or sentence, but give it a completely opposite meaning through our tone of voice and the look on our face. The reality is that people with dementia who have ‘lost’ their speech (only 7% of their communication) still retain the ability to share all their emotions by communicating non-verbally in actions and sounds.

A Good Listener

The objective of communicating with someone who can’t put words or sentences together is to help the person make sense of what is going on inside his or her mind and to express it.

The first essential to being a good listener is to listen with your heart; to listen with feeling. Ask yourself:

  • What is the person attempting to communicate?
  • What is the need that is not fulfilled?

Use your body language to show the person you are listening – really listening. Think of yourself as a “servant friend” and to do this:

  • Bend or kneel down so that you are at the same eye level.
  • Look the person in the eyes in a warm, open and welcoming way.
  • Bend forward to show you are there 100%.
  • Place your hand on their hand, arm or knee or around their shoulder to give comfort and to show that you genuinely care.

When you use touch you need to remember to be completely honest with yourself. Acknowledge your own and the other person’s boundaries.


Use your intuition as a guide to help you guess what the person is attempting to communicate.

Intuition is our lightning fast ability to take in information and process it in relation to anything we have learned previously or experienced. It gives us our initial response to a question. To do this incredibly fast processing, our intuition makes use of both hemispheres of the brain.

Your logical, rational thinking then sets in with its response. Often you may experience this as a dialogue inside your head between the two hemispheres where logic rational thinking will try and convince you why its answer is correct and why your intuitive answer is not. Interestingly, logical rational thinking only makes use of half of your brain capacity.

If you have ever played Trivial Pursuit you may have had the experience where, as soon as you heard the question, you instantly had the answer – your intuitive response. Then, before you actually said it, another thought came into your mind – your logical rational response; a thought that challenged your initial intuitive answer.

As you have most likely been taught to listen to your logical rational responses you chose this answer above the intuitive one, only to find that it was incorrect. Your first answer – the intuitive one – was the right one.

This example shows how smart and quick your intuition works for you. It is why you are bound to make the best and most precise guesses when you allow yourself to listen to that lightning fast first thought that comes to mind. Hold on to that thought – to that guess.

Questions to Ask

Once we have guessed what the person is attempting to communicate, we need to acknowledge the need or feeling that is being expressed; then check this “guessed” need or feeling with the person.

  • Check by asking the kind of questions that seek only a Yes or No answer. If the person is expressing what you have interpreted as sadness, you could say:
  • You look sad. Is that how you feel?
  • You sound sad. Is that how you feel?
  • I sense you are sad. Is that how you are feeling?

Here are some other examples using the same principles. This time you repeat what says or does, then check your “guessed” interpretation.

  • When you are looking for your mum – are you looking for love? (In this case love is the feeling you have intuitively guessed.)
  • When you say you want to go home – are you feeling lonely? (In this case loneliness is the feeling you have intuitively guessed.)
  • When you are tapping your fingers hard on the armrest – are you feeling angry? (In this case anger is the feeling you have intuitively guessed.)

The lesson here is that we need to ask the question: Are you…? We can always use this in some way because it only seeks a Yes or No answer, which are the easiest possible responses for a person with dementia to give.

A huge bonus to this technique is that it has no negative side effects. The worst thing that can happen is that your guess is not correct and then all you need to do is to ask another question. Simple!

Once you have discovered the need or feeling the person is expressing, it’s then a matter of finding a way to meet that need.

Your Role

Think of the person with dementia as forming a close partnership with you so that together you find the answer to what they are attempting to communicate. You can’t do it on your own because you are relying on the directions given by them. Whenever people with dementia say, Yes it means you are on the right track; when they say, No you are at a dead end and need to choose a new path to explore. They can’t do it on their own because they rely on you to articulate their feelings and needs.

Be a Good Communicator

In communicating with a person with dementia, it is always the responsibility of the communicator to ensure the message gets through. So no more, ‘I told you so!’ or ‘I‘ve already told you twice!’ or ‘Haven’t you been listening properly?

Instead, invest the time and effort to ensure the other person truly understands that you will partner them in the process of communicating.

To do this:

  • Use the same body language techniques that you use to be a good listener.
  • Make sure you have eye contact before you begin to talk.
  • Use short simple sentences.
  • Use your own body language to be expressive and to underline your message.
  • Offer only two choices at a time.
  • Pace yourself to match the person’s pace.
A Final Note

It is our hope that this editorial will help you discover the huge joy in being able to still speak with a person who communicates in actions and sounds, rather than in words and sentences.

It is also our hope that you will become an active advocate for these people and help share the message that they have not lost their ability to communicate – they just communicate differently!

Contrary to myths, people with dementia do know how they feel and what their needs are. They simply express them differently, and it is our obligation to tune into their special ways of sharing their needs and feelings.

Here’s to great communicating!

Further reading – Click topic

  • The Bus Stop Band-aid  – Jane Verity (Discover the emotions & reasons behind the words, ‘I want to go home’; learn positive ways to fulfill unmet needs & proven strategies to remove the necessity for the bus stop & other band-aid solutions. Also, learn why ‘Best’ is the enemy of greatness.)
  • My Neighbour is Trying to Kill Me!  –  Reveals the deep symbolism behind this once ‘seemingly’ delusional accusation.
  • Hugs not Drugs  – Jane Verity (Discover 3 factors behind attention-seeking behaviour, the 5 secrets to ‘great’ hugs & 5 hints to check if a hug is creating discomfort in another person plus a wonderful non-threatening excuse for exchanging a big hug.)

Relevant Resources:

How to Communicate with a Person who can’t Speak – A3 poster – Visit our Product page
10 Tips for Best Communication – A3 poster – Visit our Product page
5 Universal Emotional Needs – A3 poster – Visit our Product page
Hug Heart Balloons – small, red heart shaped balloons to exchange for hugs – Visit our Product page