1.6. Guidelines for communicating with the cognitively impaired client


How to communicate with impaired clients or/and elders? As a caregiver you may provide care to a client who has physical disabilities or impairments that may interfere with communication. The following are some techniques to use in those situations.

        Blind or Visually Impaired
  • Get the person attention before talking;
  • Identify yourself when entering the room;
  • Say their name;
  • Use common sounds, such as ringing a bell, whistling, etc.;
  •  Explain what you are doing as you do it;
  •  Ask for feedback to check for understanding;
  •  Make sure eyeglasses have up-to-date prescriptions and are clean;
  •  Print in big, bold letters when necessary.


Deaf or Hearing Impaired
  • Make sure you face the client who reads lips;
  • Use visual actions to communicate;
  • Get their attention before talking to them;
  • Face them when you are talking. Maintain eye contact; avoid turning or looking away while you are talking;
  • Talk at a normal pace;
  • Raise your voice some and lower your tone. DON’T yell. Speak to the side where hearing is best;
  • If necessary, use paper and pencil to write messages;
  • Get rid of other noises – TV, radio, etc.;
  • Make sure hearing aides are working and are properly inserted;
  • Write down messages;
  • Ask for feedback to determine understanding.


Speech Impaired, Aphasic (Aphasia-Trouble speaking or understanding, often   result of a stroke)
  • Ø Address the person by name;
  • Ø Keep communication simple and clear. Speak slowly and use simple words;
  • Ø Ask questions that can be answered with yes or no;
  • Ø Make message clear, emphasizing key words, limiting details;
  • Ø Eliminate unnecessary background noises (to help the client concentrate on what is being said);
  • Ø Be patient. Give the client enough time to respond to you. At least 10 seconds is the recommendation. (Time yourself for 10 seconds so you can see how long it is. You’ll be surprised!);
  • Ø Use visual devices like a message board, pictures, or gestures;
  • Ø Be supportive and positive, avoiding criticism/corrections;
  • Ø Pay attention to body language;
  • Ø Ask the person to repeat if necessary, rather than pretending you understand.


        Cognitive impairment refers to difficulty in processing information. There are numerous diseases that cause cognitive impairment, such as Alzheimer’s, Parkinson’s, Multi-Infarct Dementia, and AIDS. All of these diseases affect the brain in different ways to cause the impairment. Care recipients with any of these conditions will require unique caregiving in order to deal with some of the problems present. The symptoms presented will vary from person to person and will depend on the stage of the disease. Some of the common symptoms associated with dementia are as follows, with some examples:
  • Gradual memory loss;
  • Inability to perform routine tasks–dressing, cooking, cleaning;
  • Disorientation in time and space – don’t know what day it is or where they are;
  • Personality changes;
  • Unable to learn new information;
  • Judgment is impaired – doesn’t know if something is safe or is unable to make choices;
  •  Loss of language skills – can’t remember words, etc.

General Guidelines


        The following are some simple guidelines that should help you in dealing with care recipients who have cognitive impairments:
  • Speak slowly;
  • Keep conversations short and simple;
  • Do NOT argue or reason with the care recipient;
  • Write down instructions, keeping them simple and step-by-step;
  • Do tasks one-step at a time?
  • Provide objects that make things easier, such as slip-on shoes, finger foods, etc.
  • Maintain a routine. Change of routine adds confusion;
  • Use the memory loss to your advantage to distract the care recipient;
  • Provide a safe living environment;
  • Label drawers, cupboards, and doors;
  • Encourage as much independence as possible;
  • Approach the care recipient slowly from the front;
  • Limit the choices the care recipient has to decide among;
  • Play music since it is therapeutic. Make tapes.


        Avoid the following behaviors that are emotional barriers to communication:
  • Acting impatient, irritated, or annoyed;
  • Ignoring, acting bored;
  • Threatening, shouting, or using harsh language;
  • Judging or giving advice;
  • Arguing;
  • Interrupting;
  • Changing the subject;
  • Belittling;
  • Being defensive;
  • Forcing.