Communication aids in dementia

For people with dementia, communication can change in surprising ways. A person may know what they want to say yet struggle to find the words. They may follow a conversation in the morning but lose the thread by the afternoon. They may mishear questions, misread facial expressions, or feel overwhelmed when more than one person speaks. There is a risk that needs can go unmet because of faltering communication, causing rapid distress.

Supportive communication doesn’t need to be expensive or complicated. Small, consistent adjustments can help someone understand what’s happening to them and around them, express choices, communicate needs and feel respected.

This guide is for carers and families supporting someone with dementia. It focuses on practical ways to make communication clearer and more manageable in everyday situations.

Communication difficulties in dementia explained

Dementia affects how a person understands, processes and expresses information. These changes can vary from day to day and are often influenced by the person’s environment and how they are feeling.

Memory problems can interrupt conversations. A person may lose track of what is being said, repeat themselves, or struggle to follow longer or more complex sentences. Finding the right word can also become harder, which may lead to pauses, vague language or substitutions.

Processing information can take longer. Even if someone hears the words, they may need more time to make sense of them, especially if there’s background noise or other distractions. Busy or unfamiliar environments can make this more difficult.

Dementia can also affect how a person interprets what they see. Changes in perception mean that shadows, patterns or poor lighting can be confusing and may alter how a situation is understood.

Emotional state has a strong impact on communication. When a person feels rushed, unsure or uncomfortable, their ability to understand and respond often reduces further.

These changes are not always obvious. A person may seem uncooperative or resistant when they have not understood what is being asked or feel uncertain about what is happening.

As dementia progresses, people often rely less on words to communicate. Meaning is still there, but it is more likely to come through tone, facial expression and body language. Paying attention to these cues becomes increasingly important.

Supporting communication starts with recognising these changes and adjusting how information is given. Clear language, a calm pace and a manageable environment can make conversations easier to follow and respond to.

Why are communication aids helpful in dementia?

Communication aids make it easier to understand and respond when words alone are not enough.

Dementia can affect memory, language and processing speed. This means spoken information can be missed, forgotten or hard to follow. Aids such as written cues, images or familiar objects give the person something more stable to rely on.

They also give alternative ways to communicate. When finding the right word is difficult, it’s often easier to point, gesture or choose between options.

Visual support can be especially helpful because it stays in place. Unlike speech, it does not disappear, so the person has more time to process what’s being communicated.

Used consistently, communication aids can reduce confusion and make interactions feel more predictable.

In the sections below, we’ll be looking at different kinds of dementia communication aids in detail.

Visual prompts and picture cards

Visual prompts can help when the person you are supporting finds spoken information hard to follow. They give them something concrete to look at, and they have time to process it slowly.

They also make it easier for the person to respond. Instead of relying on speech, they can point, look or gesture towards an option. This can reduce pressure and avoid frustration during everyday interactions.

Picture cards are some of the simplest tools. In many cases, real photos work better than generic images because they are more familiar.

To make picture cards clear and easy to recognise:

• Use one image per card – avoid combining multiple ideas in one image.
• Keep backgrounds simple – remove clutter and small details that may distract.
• Use familiar items – photos from the person’s own home or routine are easier to recognise.
• Make images easy to see – use a size that can be seen at a glance.
• Keep them durable – laminate cards or place them in a plastic wallet so they can be reused.

Practical ways to use picture cards

Picture cards can be used in everyday situations to support both understanding and choice.

• Offering choices – show two options, such as tea or water, using the actual cup or bottle where possible.
• Showing what’s next – use cards for activities like toilet, lunch or going outside.
• Supporting pain or discomfort – use a simple body outline so the person can indicate where they have pain.
• Preparing for who’s coming next – show a photo of the next carer or visitor to reduce uncertainty and help the person feel more at ease.

Making visuals more effective

How you introduce and use visuals also makes a difference.

• Use visuals alongside speech – say “Would you like tea or water?” while showing the cards, so the words and image connect.
• Allow time to respond – avoid repeating the question too quickly or removing the cards if there is no immediate answer.
• Keep choices simple – two options are usually enough, as more can make decisions harder.
• Use familiar images – photos from the person’s own life are easier to recognise than stock images.
• Place prompts where they are needed – for example, a toilet sign on the bathroom door or a drink prompt near where drinks are prepared, so the person does not have to rely on memory.

Useful categories for care settings

In care settings, it can help to organise cards into clear groups so they are easy to find and use.

• Basic needs – toilet, drink, food, tired, pain, hot, cold
• Comfort – blanket, music, quiet, sitting down, going for a walk
• People – key staff, family members, regular visitors
• Places – bedroom, bathroom, lounge, garden

Communication books and life story tools

Communication books and life story tools help you understand the person beyond how they may be presenting now. They bring together key information about the person’s background, preferences and routines so care can be true to the individual behind the condition and communication is based on what resonates with them.

A communication book is usually a small, personalised folder or album used in day-to-day interaction. It might include photos, names and simple prompts that support understanding and help the person respond.

Life story tools take a broader view. They record important aspects of the person’s life, such as their relationships, routines, work and interests.

These tools support communication by giving you shared reference points. Instead of relying on memory or guesswork, you can use what you know about the person to guide how you speak, what you ask and how you support them. In practice, they can be used in simple ways. A photo with names can help if someone cannot find a word. A familiar routine shown in pictures can guide what happens next. Knowing what matters to the person can help you choose an approach that feels comfortable and familiar.

To be useful, the content needs to be short, clear and relevant to care. For example:

• Who I am – preferred name and how the person likes to be addressed
• What matters to me – likes, dislikes and things that bring comfort
• People in my life – key relationships, with names and photos
• My routine – what the person usually does and when
• Choices – food, drink, music, clothing or activities they prefer
• Health and support needs – hearing aids, glasses, signs of pain or discomfort

The Alzheimer’s Society’s “This is me” leaflet is a widely used example. This short, structured document records key personal details for someone who may not be able to explain them themselves. It can be used at home, in hospital or in a care setting to help staff quickly understand the person and adjust their approach.

Tools like this are especially useful when care is shared between different people or settings. They help new or temporary staff understand the person more quickly, which can reduce confusion and distress.

Keep the focus on what helps with day-to-day care. A few clear points are more useful than a long life history that is difficult to use in practice.

Treat the information with care. Include what supports communication and understanding, and avoid sharing details the person would not want widely known.

Talking Mats and choice boards

Sometimes a person understands what is being offered but cannot express a clear choice in words. Structured visual tools can make these moments easier.

Choice boards and Talking Mats both present options in a way the person can see and respond to. Instead of relying on speech, they can point, move a symbol or look towards what they want.

Choice boards are the simplest option. They show a small number of choices using photos or symbols, often with a word label.

Talking Mats use a more structured layout. The person places symbols under headings such as “like”, “not sure” or “do not like”. This makes it easier to understand preferences, even when communication is limited.

You do not need specialist equipment to start. A printed sheet, a few photos and a way to move or point to options is enough. The focus is on clarity, not presentation.

How to use a choice board effectively

A clear structure makes these tools easier to use in everyday care.

• Keep to one topic – for example, breakfast, clothing or activities.
• Limit the number of options – two to four is usually manageable.
• Use familiar images – photos from the person’s own life are easier to recognise.
• Include a way to refuse – offer “no” or “not this” as a clear option.
• Confirm the choice – repeat it back and act on it, e.g., “Tea. I’ll make tea now.”

When to use choice boards

These tools work well in routine situations where decisions are needed.

• Meals – two meal options and a drink
• Personal care – choices about washing, dressing or timing
• Activities – music, TV, going outside or a simple task
• Comfort – blanket, quieter space, sitting or lying down

Talking Mats can also be used for more complex topics, such as how the person feels about a change in routine or an upcoming appointment. With support, some people can still sort options into simple preference groups.

As dementia progresses, keep an eye on fatigue. If the person becomes tired or overwhelmed, reduce the number of options or pause and return to them later. Keeping the approach consistent over time matters more than completing every interaction.

Memory aids – clocks, calendars & signage

Memory aids help make daily life easier to follow. They reduce uncertainty by showing what time it is, what is happening and where things are. This can ease anxiety and reduce repeated questions.

They work best when they are simple and easy to interpret. If something takes effort to understand, it may not help.

Common memory aids include:

• Clocks – clear, dementia-friendly clocks that show the day, date and time
• Calendars – large, easy-to-read layouts with only key information shown
• Daily schedules – simple routines using words or pictures
• Signs – for rooms such as the toilet or bedroom
• Labels – on drawers or cupboards, e.g., socks or underwear

Clocks and calendars support orientation. Knowing the time of day or what is coming next can make routines feel more predictable. This can help with transitions, such as moving from breakfast to getting dressed.

Signage helps the person move around more independently. It works best when it feels familiar rather than clinical. Use clear words, simple images and place signs where they are easy to see, such as at eye level or along common walking routes.

A few small details make a difference:

• Use contrast – dark text on a light background is easier to see.
• Avoid glare – shiny surfaces can reflect light and make signs harder to read.
• Keep wording simple – use everyday language.
• Add photo cues if helpful – for example, a photo of a toilet on the bathroom door.

Memory aids can also include objects of reference – everyday items used to signal what is about to happen.

For example:

• A towel to signal washing
• A cup to signal a drink
• Shoes to signal going out
• A remote control to signal TV time

Objects of reference can be especially useful in later stages of dementia, when recognising pictures or written words becomes more difficult. They work because they link directly to the action, without needing explanation.

Reminiscence items that support speech

Reminiscence can help when recent memory and word-finding are difficult. Many people with dementia can recall earlier experiences more easily than recent ones. Using those memories can open up conversation and make it easier for them to speak.

Reminiscence items are a good starting point. They provide something familiar to focus on, rather than expecting the person to generate topics or find the right words.

Useful items include:

• Photos from different life stages, labelled with names and places
• Music playlists from the person’s teens and 20s
• Objects linked to hobbies, such as knitting needles or a football programme
• Smells and textures, such as lavender, soap or familiar fabric
• Newspapers from a significant decade, used carefully and sensitively

How you use these items matters. Keep prompts open and simple. For example, “Tell me about this” or “What do you remember about this place?” is easier to respond to than questions that rely on specific facts.

Focus on the conversation rather than accuracy, avoiding the temptation to correct the person. This can interrupt the flow and make the person less willing to continue.

Reminiscence can also support care tasks. Starting a familiar conversation can make situations feel less abrupt. For example, talking about a past job or routine while preparing for washing can help the person stay engaged.

In group settings, reminiscence can encourage interaction, but it needs to be handled carefully. Some memories may cause people distress. Watch for changes in expression or behaviour, and be ready to shift the topic if needed.

Non-verbal communication cues to watch

As dementia progresses, non-verbal communication often becomes the main way a person expresses themselves. This includes facial expression, body language, tone of voice and behaviour.

Changes in behaviour are often a form of communication in themselves. The person may be showing a need, discomfort or emotion in a way that does not rely on words.

For example:

• Pulling at clothing may indicate discomfort, overheating or needing to use the toilet.
• Restlessness may suggest pain, anxiety, boredom or too much stimulation.
• Guarding a body part may indicate pain or injury.
• Refusing food may relate to mouth discomfort, fear, nausea or constipation.
• Turning away may suggest overload or a need for space.

Facial expression and breathing can give early signs. A tense face, frowning or widened eyes may show distress. Changes in breathing, such as faster breathing or holding the breath, can signal anxiety or pain.

It’s just as important to notice positive or “approach” cues. A person may lean forward, reach out, make eye contact or mirror your expression when they feel safe or want connection.

Non-verbal communication also depends on how you present yourself.

People with dementia are often highly sensitive to tone, facial expression and body language. They may not follow your words, but they will pick up whether you seem calm, rushed or frustrated.

A few small adjustments can make communication clearer and more reassuring:

• Position yourself so the person can see you clearly. Approach from the front and stay within their line of sight.
• Get to eye level rather than standing over them, as this can feel less intimidating.
• Use a calm tone and a steady pace, and allow time for the person to process what’s happening.
• Maintain gentle eye contact and a relaxed facial expression to help convey attention and reassurance.
• Use touch where appropriate, such as a light touch on the hand or arm, while watching how the person responds.

Try to be aware of your own signals. Folding your arms, sighing or rushing can be picked up quickly and may increase anxiety or agitation.

Over time, build a clear picture of the person’s individual cues. Recording these in the care plan and sharing them at handover helps everyone respond in a consistent way.

Hearing and vision support checklist

Many communication difficulties become worse when someone can’t see or hear clearly. In some cases, the issue is simple, such as a flat hearing aid battery or unclean glasses.

Hearing loss can make speech harder to follow and increase fatigue. It can also lead to confusion or withdrawal from conversation. Vision problems can affect how a person reads facial expressions, recognises objects or moves safely around their environment.

Start with basic hearing checks. Small adjustments can make a noticeable difference.

• Are hearing aids in place, clean, and switched on?
• Are the batteries charged or replaced?
• Are the ears sore, blocked or painful?
• Is background noise reduced during conversation?
• Are you facing the person with good light on your face?
• Are you speaking clearly without shouting?

Vision should be checked in the same way. Clear sight supports recognition, orientation and safe movement.

• Are glasses clean and within reach?
• Are the correct glasses being used for the task, such as reading or distance?
• Is the lighting bright enough without glare?
• Are key objects in high contrast against their background?
• Are patterned floors or busy wallpapers causing visual confusion?
• Are signs large, simple and placed at eye level?

Making simple changes to the environment often has the biggest impact. Turning off the TV during a conversation can improve understanding straight away. Positioning yourself so light falls on your face can make it easier for the person to follow what you are saying.

If you notice a change in hearing or vision, arrange an assessment and record it in the care plan. This helps ensure communication is adapted while support is being put in place.

Communication tips during personal care

Personal care can be one of the most sensitive parts of the day. It involves a lot of trust. If the person does not understand what’s happening, they may feel threatened.

A calm, predictable approach helps reduce this.

Approach the person at a steady pace and use their preferred name. Position yourself where they can see you clearly. Explain what is about to happen in a short, simple sentence, then pause. Give time for a response, even if it is non-verbal.

During care, small adjustments can make the interaction feel more manageable:

• Give a clear preview of what will happen next, e.g., “In a moment, we’ll wash your hands.”
• Offer a genuine choice where possible, such as between two towels or two times.
• Use familiar items from the person’s own routine.
• Break the task into small steps and move at a steady pace.
• Maintain dignity by covering areas not being washed.
• Ask before touching and watch how the person responds.
• Pause or stop if the person becomes tired or unsettled.

If the person resists, treat this as communication rather than refusal. Step back and consider what might be making them uncomfortable.

Check the environment; water temperature, lighting, noise and timing can all affect how the person feels. Pain, fatigue or unfamiliar equipment can also play a role.

It can also help to keep the person involved in what’s happening. Simple prompts, choices or familiar objects can provide structure. For example, showing a towel before washing, or using a two-step visual prompt such as “wash” then “dry”.

Consistency matters. Using the same approach, words and sequence each day can make personal care feel more predictable and easier to accept.

For those working in care or nursing roles, it’s also important to link communication to consent and capacity. The Mental Capacity Act 2005 Code of Practice sets out how to support decision-making and act in a person’s best interests when they cannot give clear consent.

Supporting communication at mealtimes

Mealtimes can become more difficult. There may be background noise, people moving around, and several things happening at once. Eating itself can also become harder, as dementia can affect coordination, appetite and swallowing.

Communication support at mealtimes aims to reduce pressure and make cues clearer.

Start with the environment. A calm, well-lit space helps the person focus on eating.

• Reduce background noise, such as TV or loud conversations.
• Seat the person where they can see the table and what is happening.
• Choose a quieter table or time if the room feels busy.
• Make sure that the lighting is good so food and utensils are easy to see.

Next, make food and drink easier to recognise and respond to.

• Show the plate or cup rather than only describing it.
• Offer one item at a time rather than presenting everything at once.
• Use contrast between the food and plate so that items stand out.
• Offer finger foods or adapted cutlery if needed.

Support choice, but keep it manageable.

• Offer one or two options at a time.
• Use familiar meals where possible.
• Keep portions small and offer more if wanted.
• Return later if the person is not ready to eat.

Simple communication aids can help structure the interaction without adding pressure. For example:

• A drink choice card with familiar options
• A “more” and “finished” prompt
• A visual cue for “toilet” before or after meals
• A simple sequence, such as sit → eat → drink → wipe → rest

Hydration often needs active support. Some people drink less because the cup is out of reach, they forget, or they are worried about accidents.

• Keep drinks within easy reach.
• Offer small amounts regularly rather than large drinks.
• Link drinks to routine moments, such as medication or snacks.

Watch for signs that eating or drinking is becoming difficult. The Royal College of Speech and Language Therapists highlights signs such as coughing, choking, a wet or gurgly voice, or frequent throat clearing. These may indicate swallowing difficulties and should be followed up with appropriate assessment.

Technology aids – tablets and voice assistants

Technology can support communication when it’s simple, familiar and built into the person’s routine. When it is too complex or changes often, it can increase confusion. The aim is to make communication and daily tasks easier, not introduce new steps.

Common technology supports include:

• Tablets used for photo albums, simple apps or short videos
• Digital photo frames showing familiar people, places and routines
• Simple music players with large buttons or one-touch playlists
• Video calls with family or friends, with support where needed
• Voice assistants for reminders, music and simple daily prompts

Photos and short videos are often the most useful. They can help explain what is happening or who is involved, using familiar faces and situations.

Setting technology up

Keep things as simple as possible:

• Remove unnecessary apps and turn off notifications.
• Use a clear home screen with only a few options.
• Keep the device in a consistent place.
• Use the same steps each time.

Voice assistants can support routine by providing prompts, such as reminders to drink, take medication or get ready for an activity. They can also be used for simple tasks like playing music.

Introducing technology

Technology works best when it is introduced gradually and supported over time.

• Start with one clear use, such as playing music.
• Show how to use it rather than expecting independent use.
• Keep the experience consistent so it becomes familiar.

Adjust the setup to the person. Larger icons, touchscreens and simple layouts can make devices easier to use.

Technology is not always the right choice. Some people find screens confusing or tiring. In those cases, simpler options such as printed photos, written prompts or objects may work better.

In care settings, consider privacy and consent. Devices that listen or record should only be used in line with policy and with agreement from the person or those supporting them.

Recording communication needs in care plans

Communication support must be consistent. Clear, practical notes in the care plan help staff respond in the same way across shifts and settings.

Focus on what helps, not just what is difficult. Write in simple, actionable terms. For example, “Offer two drink options and wait 10 seconds” is more useful than “Gets confused easily”.

Include key information that supports day-to-day interaction:

• Preferred name and how to greet the person
• How they best understand information, e.g., short sentences or visual cues
• Words or phrases that help, and those to avoid
• Hearing and vision needs, including where aids are kept
• Non-verbal cues that may signal pain, anxiety or toileting needs
• Communication tools used, such as picture cards or a communication book
• How to offer choices, including the number of options and pacing
• Personal care preferences, including modesty and step-by-step support

A one-page “communication passport” makes it easier for new or temporary staff to understand the person quickly, especially during transitions between home, hospital or care settings.

Where possible, include clear examples:

• “Offer two options rather than open questions.”
• “Face him when speaking so he can lip read.”
• “Use large print prompts for key choices.”
• “Ask before touching and wait for a response.”

This kind of detail supports more consistent, person-centred care.

When to refer to speech and language therapy

Speech and language therapists support both communication and swallowing in people with dementia. Referral can help at any stage, especially when changes begin to affect safety, understanding or day-to-day care.

Consider making a referral if:

• The person has ongoing difficulty expressing needs, leading to distress.
• Staff struggle to understand their speech or usual signals.
• There is a noticeable change after illness, injury or a fall.
• Speech becomes hesitant or difficult to plan, with frequent starts and stops.
• There are signs of swallowing difficulty, such as coughing, a wet voice or weight loss.
• The person finds it harder to make choices and needs more structured support.
• The team needs guidance on communication tools or approaches.

Referral routes vary. In care homes, this may go through a GP or community service. In hospital, the ward team can refer directly. For more complex situations, a multidisciplinary review can help bring different professionals together.

While waiting for input, continue with basic communication support:

• Make sure hearing and vision aids are in use.
• Reduce background noise and avoid rushing.
• Use short sentences and one-step prompts.
• Support with pictures or objects where helpful.
• Record what works and share it with the team.

Summing up

Dementia changes how people take in and express information. As words become harder to use, communication shifts towards visual cues, routine and non-verbal signals. Small changes in how you speak and set up the environment can make conversations easier to follow.

What matters most is consistency. When communication is familiar and predictable, people are more likely to understand what is happening and respond in a way that works for them. Tools can help, but they only work when they are used in a way that fits the person’s daily life.

Further guidance and resources:

• Understanding and supporting a person with dementia, Alzheimer’s Society 
• How to communicate with a person with dementia, Alzheimer’s Society 
• Communicating with someone with dementia, NHS 
• Information and support, Dementia UK 
• Resources for People with Dementia and Dementia Carers, Age UK 
• Dementia, Social Care Institute for Excellence (SCIE)
• Royal National Institute for Deaf People (RNID)
• Royal National Institute of Blind People (RNIB)
• Mental Capacity Act Code of Practice, GOV.UK 
• Eating, drinking and swallowing, Royal College of Speech and Language Therapists (RCSLT) 
• AbilityNet