Non-Verbal Communication in Nursing Home Settings

Background: People living with dementia in nursing homes commonly experience progressive impairments in cognition, communication, and functional ability, contributing to neuropsychiatric symptoms and reduced quality of life. As verbal communication declines, non-verbal communication (NVC) including facial expressions, gestures, eye contact, posture, and touch becomes increasingly important for maintaining meaningful interactions. Objectives: This study aims to explore current NVC practices between nursing home staff and residents living with dementia. Methods: A mixed methods, cross-sectional design was employed. NH staff completed an anonymous online questionnaire consisting of 13 items assessing NVC use and demographic characteristics. Quantitative items were rated using Likert scales, and qualitative responses were analysed using Giorgi's phenomenological approach. Results: Quantitative findings showed that residents most frequently relied on facial expressions, reported as used very often in 24 of 33 NHs, followed by eye contact in 17 NHs and touch in 16 NHs. NH staff also reported extensive use of NVC during care interactions, particularly facial expressions (very often in 79% of NHs), eye contact (82%), and hand gestures (76%). Qualitative findings underscored the central role of NVC in interpreting residents' needs, fostering emotional connection, and managing behavioural and psychological symptoms of dementia through subtle cues, visual prompts, and individualised strategies. Conclusions: Overall, the findings demonstrate that NVC is a fundamental component of communication and care delivery in dementia settings and highlight the need for structured training interventions to support staff in recognising and responding effectively to non-verbal signals.