The Three Golden Rules of Dementia Care: A Compassionate Approach

The SPECAL method highlights three key communication principles when supporting a person with dementia:

1. Avoid Direct Questions

Asking questions might seem like a natural part of conversation, but for someone with dementia, it can be overwhelming. Memory loss makes it difficult to recall facts, and being asked to retrieve information can lead to frustration, anxiety, or withdrawal.

Instead of asking questions that require factual recall, conversations should be structured to allow engagement without pressure. For example:

• Instead of asking, “What did you have for breakfast?”, try saying, “Breakfast was delicious today, the toast was lovely.”
• Rather than, “Do you remember where we went yesterday?”, try, “We had a lovely outing yesterday; the weather was wonderful.”

By shaping conversations in this way, individuals with dementia can feel more included and less anxious about struggling to find answers.

2. Listen to the Expert – The Person with Dementia

Even though dementia affects memory, emotions remain strong. People with dementia may repeat questions or statements as they try to make sense of their surroundings. Rather than correcting them, listening carefully and responding with reassurance can provide comfort.

Observing which responses bring peace can help caregivers maintain a consistent, calming approach. For example:

• If a person repeatedly asks about a loved one, a reassuring response like, “They are thinking of you and looking forward to seeing you soon,” is more comforting than explaining they are unavailable.
• If they believe they need to complete a task, such as going to work, a gentle response like, “Everything is taken care of today, you can relax,” is more effective than correcting them.

This approach reduces distress and helps to create a sense of security.

3. Do Not Contradict

As dementia progresses, individuals may increasingly rely on past memories to interpret present situations. They might refer to people, places, or events from years ago as if they are happening now. Correcting them can cause confusion and upset, so it is kinder to follow their lead.

For example:

• If someone insists they need to pick up their children from school, rather than saying, “Your children are grown now,” it is more reassuring to say, “Everything is sorted, you don’t need to worry.”
• If they believe they are still living in a past home, rather than saying, “You moved years ago,” it is better to respond with, “You’re safe here, and everything is just the way it should be.”

By avoiding contradiction, caregivers can help maintain a calm, positive environment.

Applying the three golden rules of dementia care creates a more supportive environment by:

• Reducing anxiety – Avoiding direct questions removes pressure.
• Encouraging engagement – Listening and responding with consistency fosters security.
• Promoting dignity – Respecting the person’s perspective helps them feel valued.
• Improving emotional well-being – Creating an understanding atmosphere enhances quality of life.

Dementia is a progressive condition, and there may come a time when additional help is required. Some signs that extra support might be beneficial include:

• Increased confusion or disorientation – Difficulty recognising familiar places or people.
• Challenges with personal care – Struggles with dressing, eating, or managing hygiene.
• Safety concerns – Wandering, increased risk of falls, or difficulty managing medication.
• Emotional distress – Frequent agitation, withdrawal from social activities, or increased anxiety.

Seeking professional care can provide reassurance while ensuring safety and well-being.