Supporting Multilingual Communication in Dementia Care

People who speak more than one language may communicate differently as dementia changes their word-finding or understanding. Some people begin using a language they learned earlier; others do not. The most helpful first step is to ask which language feels comfortable now, then follow the person’s lead.

The Alzheimer’s Society says language preferences can vary and suggests using the language the person usually communicates in. The Alzheimer’s Association also lists returning to a native language as one possible communication change. These changes do not happen to everyone and do not tell you a person’s stage.

Which language should I use?

Ask the person which language they want to use for this conversation. Their preference may change with the topic, setting or time of day. If they switch languages, do not treat it as a test or insist they continue in the language you understand.

If you speak the language they prefer, use familiar words and give them time to answer. If you only know a few words, be honest and use gestures, objects or pictures as well. The Alzheimer’s Society’s language guidance notes that language ability may vary from day to day and can be affected by tiredness, pain or illness.

What can help in an everyday conversation?

Keep the usual communication tips in mind, and add support that fits the person’s language:

• Use familiar words and names. Ask the person or someone they trust which words they use for everyday items, family members and routines.
• Show as well as say. Point to a cup, hold up two choices, or use a familiar photo or object. A gesture can help when the right word is hard to find.
• Wait. Give the person time to listen and respond. Do not finish every sentence or repeat the question in several languages at once.
• Keep one idea at a time. A long explanation may be difficult in any language. Use a short sentence, pause, then see whether they want more.
• Check hearing and vision. Glasses, hearing aids, good lighting and a quiet setting can make language easier to follow.

If the person prefers reading, ask whether important written information is available in their language. Do not rely on an automatic translation for a medical decision, consent or medication instruction; confirm important information with the care provider.

What if I do not speak the language the person prefers?

Ask if they would like a trusted bilingual friend or relative to join a routine conversation. Do not assume the person wants someone else to interpret; they may prefer gestures, pictures or a different language they both share.

For a medical appointment or another discussion that needs precise information, call the clinic or care service in advance. Tell them the person’s preferred language and ask what interpreter support is available. The U.S. Department of Health and Human Services explains that family and friends may not be able to interpret important medical information accurately; the service can explain its options and local requirements. The person may choose whether a supporter accompanies them, while the provider arranges any needed language assistance.

During the visit, address the person directly and allow time for the interpreter to speak. Check that the person understands the question and has a chance to answer in their own words. If you are supporting them, add context only when they want you to.

When should I seek medical advice?

Language difficulties can change over time, but a sudden change is different. The NHS advises getting medical help immediately when someone suddenly becomes confused. Do not assume a sudden loss of communication is simply part of dementia. If the person becomes suddenly confused, very unwell or difficult to wake, contact local urgent medical services.

For gradual changes, note what you notice and ask the person’s clinician for advice. Record which language they were using, what helped them communicate and whether they were tired or unwell. This is a description for a conversation, not a diagnosis. Our doctor-visit guide can help you prepare questions.

What can I tell other helpers?

With the person’s agreement, keep a short note for people they want involved. It could list the language or dialect they prefer for speaking and reading, familiar words or names, and what helps them follow a conversation. Ask whether they want anyone particular included in appointments or care updates. Avoid recording private details that are not needed for support, and tell the person who can see the note. A language note helps people start a conversation more comfortably; it does not replace an interpreter for a complex health discussion.

How can I support the person’s choices?

Language is part of how a person connects, but it is not the whole of who they are. Ask about their routines, interests, reading preferences and the people they want involved. If the person agrees, write down helpful words or phrases for other supporters and explain how to use them. Keep notes private and share only what the person has agreed to share.

Do not insist that the person practice, translate for others or prove what they understand. Some conversations may be easier in one language and others in another. The person’s comfort, privacy and choice matter more than keeping to one language.

Our communication tips cover speaking simply, listening and using pictures. For help with planning after diagnosis, see first steps after a dementia diagnosis.