Communicate More Effectively With the Cognitively Impaired

One of the most frustrating aspects of caring for a patient with stroke or dementia is the difficulty in achieving effective two-way communication.

Speech and language pathologist, Robin Earley; social worker, Sharon Doyle; and creative arts therapist, Eileen Chodos-Beth-all of Hebrew Rehabilitation Center for Aged (HCRA), Boston provide some time-honored, practical tips for communicating with someone with speech or cognitive disorders:

  • Use concrete, short sentences.
  • Ask only one question at a time.
  • Choose conversation topics the patient was interested in prior to his or her illness.
  • Use body language and facial gestures to augment the verbal message.
  • Use a “yes” or “no” format whenever possible, so it will be easier for the patient to answer.
  • Never speak for the person with a communication disorder unless requested.
  • If verbal/auditory messages are not effective, use other options, such as writing, gestures, or pictures, to communicate.

According to the HCRA team, trying to discern the meaning behind a patient’s repeated questions or statements can be more fruitful than responding literally.  For instance, if a patient keeps asking, “Where is my mother?”  It might be because she is feeling lonely or frightened.  Content of the sentence is not as important as the emotion being expressed.

Other tips include:

  • Don’t argue, ever.  Try distractions instead of confrontation if the patient becomes increasingly anxious.
  • Use direct and literal speech, and enunciate clearly.
  • Use positive body language-smile, hug, and hold hands.
  • Bring favorite foods or old photographs to evoke memories and elicit positive responses.


Reproduced from Long-Term Care Quality Advisor,

@ 2000 Opus Communications, Inc., a division of HCPro, 200 Hoods Lane, Marblehead, MA 0195. 781/639-1872. Used with permission.




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