This study employed the essential phases of the systematic review process to compile a significant body of relevant literature. The process began with the identification of keywords, followed by the utilization of dictionaries, thesauri, encyclopedias, and prior research to refine the search. All pertinent terms were identified, and search strings were formulated for the Web of Science and Scopus databases, as outlined in Table 1. During the initial phase of the systematic review, a total of 715 publications related to the study’s topic were retrieved from these two databases. The search strategy is summarized in Table 1.

During the screening phase, potentially relevant study items are evaluated to ensure their alignment with the specified research subject or topics. In this phase, the terms “caregiver, elderly, dementia, communication” are commonly used to select study topics. Duplicate papers are also removed at this stage. Initially, 582 articles were excluded, leaving 133 for further review based on specific inclusion and exclusion criteria (refer to Table 2). The primary criterion was the literature, as it serves as the main source of practical guidance. This category excludes book reviews, book series, meta-syntheses, meta-analyses, conference proceedings, and chapters that were not part of the most recent research. The review was restricted to English-language publications released between 2022 until 2025. A total of 130 publications were ultimately retained after removing duplicates. The inclusion/exclusion criteria are presented in Table 2.

In the third step, known as the eligibility phase, a total of 130 papers were prepared for examination. During this stage, the titles and key components of each article were carefully reviewed to ensure they met the inclusion criteria and aligned with the objectives of the current study. Consequently, 105 papers were disqualified for reasons such as being outside the scope of the study, having irrelevant titles, featuring abstracts unrelated to the study’s purpose, lacking full-text access, or not being supported by empirical evidence linked to the study’s goals. As a result, 25 manuscripts remained for further evaluation.

Data abstraction and analysis were conducted using a structured and iterative synthesis process adapted from established systematic review methodologies ( Abouzahra et al., 2020; Azwani et al., 2024; Haron et al., 2025; Kitchenham, 2007). Following study selection, relevant data were independently extracted from each included article, focusing on study objectives, research design, communication context, key findings, and methodological characteristics. To ensure analytical rigor, an inductive thematic synthesis approach was employed. Initial codes were generated through repeated reading of the selected studies, after which related codes were grouped into higher-order categories. These categories were progressively refined into overarching themes that reflected recurring patterns across the literature. Throughout the analysis process, regular discussions were held among the authors to compare interpretations and resolve discrepancies. An audit trail was maintained to document analytical decisions, reflections, and emerging insights, thereby enhancing transparency and reproducibility. This integrative approach enabled the synthesis of evidence across diverse study designs while preserving the contextual richness of each contribution. The study selection process is illustrated in Figure 1.

Cognitive decline in persons living with dementia creates significant barriers to effective communication, often manifesting as difficulty in verbal expression and comprehension challenges. These fundamental impairments lead to secondary issues such as behavioral resistance during care activities ( McHugh et al., 2024), which are further compounded when care occurs in clinical environments. Hospital settings prove particularly problematic due to their unfamiliar nature, time constraints, and frequent lack of staff training in dementia-specific communication approaches ( Moody et al., 2024). The communication challenges intensify when hearing loss coexists with dementia, creating a dual sensory-cognitive barrier that requires care partners to actively mediate medical interactions to ensure accurate information exchange ( Powell et al., 2023).

These communication barriers extend into daily care activities, particularly around nutritional management. Caregivers frequently struggle with feeding difficulties due to both cognitive impairments and their own lack of training in appropriate communication techniques, often resulting in preventable health complications ( Sarmiento-González et al., 2025). In response to these multifaceted challenges, caregivers across different cultural contexts have developed adaptive communication strategies. Ghanaian family caregivers, for instance, employ humor and positive reinforcement alongside spiritual support to maintain meaningful connections while simultaneously reducing their own caregiving stress ( Duodu et al., 2024). Similarly, in clinical discussions about medication management, communication proves more effective when focused on immediate risks and cognitive impacts rather than abstract long-term prognosis, as this approach aligns with caregivers’ priorities regarding current quality of life ( Fasth et al., 2025).

The development of structured communication frameworks has provided more systematic approaches to specific behavioral challenges. The CALM guideline offers a methodical process for managing hoarding behaviors through gradual decluttering paired with communication techniques carefully adapted to the individual’s cognitive abilities ( Lin, Chiu, and Chou, 2025). Even the unpredictable moments of lucidity that occasionally occur in dementia can be leveraged for meaningful connection when caregivers are prepared to recognize and respond to these fleeting opportunities while maintaining realistic expectations about disease progression ( Ramirez et al., 2024). However, these individual strategies often encounter systemic barriers within healthcare environments that fail to accommodate the unique communication needs of dementia care.

Care transitions, particularly following emergency department visits, frequently break down due to inadequate communication protocols, leaving caregivers unprepared for follow-up care responsibilities ( McHugh et al., 2024). In long-term care settings, staff often struggle with extreme behavioral symptoms, sometimes persisting with ineffective communication approaches or abandoning attempts altogether due to frustration and lack of standardized protocols ( Veldwijk-Rouwenhorst et al., 2022). These systemic shortcomings occur despite evidence that proper support structures can significantly improve outcomes. Caregivers who receive adequate social support and develop positive perceptions of their role typically experience reduced burden, though many still lack access to formal training in therapeutic communication techniques ( Nemcikova et al., 2023). Even the physical environment of care facilities plays a crucial role in communication success, as noisy, unfamiliar spaces tend to increase disorientation and challenging behaviors among persons with dementia ( Moody et al., 2024).

Addressing these interconnected challenges requires comprehensive reforms across multiple levels of dementia care. Healthcare providers need specialized training in communication techniques that account for cognitive fluctuations and sensory impairments ( Powell et al., 2023), while caregivers require both practical strategies for daily interactions and emotional support to maintain their own wellbeing ( Duodu et al., 2024). At an institutional level, policies must prioritize care continuity through standardized communication protocols, particularly for transitions between care settings ( McHugh et al., 2024). Future interventions should simultaneously address the technical aspects of communication and the emotional needs of all parties involved in dementia care ( Ramirez et al., 2024).

Policy communication tools, technologies, and interventions are essential in addressing the complex needs of individuals with dementia and their caregivers. The development of interactive web-based tools has been highlighted as a promising avenue to stimulate reflection and communication about advance care planning (ACP). Monnet et al. (2024) evaluated two such tools: the ‘Thinking Now About Later’ tool and the digital version of the ‘Life Wishes Cards’. These tools were found to be helpful in facilitating conversations between people with dementia and their family caregivers, though barriers to independent use by individuals with dementia were noted. Similarly, Berry et al. (2024) adapted the Serious Illness Conversation Guide (SICG) for dementia care, emphasizing values-based ACP conversations that involve patient-caregiver-clinician triadic communication. Both studies underscore the importance of caregiver involvement in guiding the use of these tools and ensuring their effectiveness. Furthermore, Zhuo et al. (2025) demonstrated the potential of creative expressive art-based interventions in improving communication abilities and reducing behavioral symptoms in dementia patients, reinforcing the role of structured interventions in enhancing communication.

Technological advancements have also introduced innovative solutions to address communication challenges faced by individuals with dementia. Kase (2024) explored the effectiveness of communication robots equipped with reminiscence methods to prevent social isolation among people with dementia. The study highlighted the potential of commercially available robots like Pepper and Robohon, which were modified with AI models to support meaningful interactions. These findings align with Gleason et al. (2023) investigation into the use of patient portals among older adults with dementia and their care partners. The study revealed that care partners often authored messages using patient identity credentials, suggesting that technological tools must be designed to accommodate shared access and proxy use. Together, these studies emphasize the need for user-friendly technologies that can be seamlessly integrated into daily caregiving routines while addressing the unique communication needs of dementia patients.

Interventions aimed at improving communication in dementia care extend beyond technology to include psychoeducational programs and community-based initiatives. Cintoli et al. (2024) examined the impact of psychoeducational interventions on informal caregivers, demonstrating significant improvements in caregiver burden, stress management, and communication skills. These findings resonate with Eastham et al. (2025) exploration of the Empowered Conversations course, an online communication program for carers of people with dementia. Participants reported enhanced understanding of dementia and improved interpersonal communication, highlighting the value of structured educational programs in empowering caregivers. Additionally, Richards et al. (2025) adapted the “Listen N Talk” app to facilitate communication between care staff and culturally and linguistically diverse residents in aged care settings. This initiative underscores the importance of personalized communication tools tailored to individual contexts and cultural backgrounds.

The integration of policy communication tools, technologies, and interventions requires a multidisciplinary approach to ensure their accessibility and effectiveness. For instance, Dooley et al. (2025) validated the Profiling Communication Ability in Dementia (P-CAD) tool, which provides a comprehensive assessment of communication abilities in individuals with dementia. This tool complements the work of Reiff et al. (2023), who adapted the Quality of Communication (QOC) questionnaire to assess communication needs in primary care settings for patients with cognitive impairment and their caregivers. Both studies highlight the necessity of developing reliable instruments to guide interventions and evaluate outcomes. Moreover, the studies by Monnet et al. (2024) and Berry et al. (2024) demonstrate the importance of involving stakeholders, including patients, caregivers, and clinicians, in the design and implementation of communication tools to ensure their relevance and usability.

Ethical, cultural, and system-level influences play a pivotal role in shaping communication dynamics for individuals with dementia and their caregivers. Ethical considerations are particularly evident in the context of discussing sensitive topics such as end-of-life care or shifting roles within families. Skov et al., (2024) explored how literature-based interventions facilitated conversations on ethical issues among home-dwelling individuals with dementia and their family members. The study highlighted that using excerpts from dementia-related literature enabled participants to deliberate on complex ethical dilemmas like disclosing the diagnosis or transitioning to nursing homes. Similarly, Monnet et al. (2024) emphasized the importance of advance care planning (ACP) tools in fostering ethical discussions about future care preferences. These findings resonate with Berry et al. (2024), who adapted the Serious Illness Conversation Guide (SICG) for dementia care, focusing on values-based ACP conversations. Together, these studies underscore the necessity of structured interventions to address ethical challenges while ensuring that communication remains respectful and patient-centered.

Cultural factors significantly influence communication patterns, especially in diverse caregiving environments. Richards et al. (2025) investigated the adaptation of the “Listen N Talk” app to support communication between care staff and culturally and linguistically diverse residents in aged care settings. The study revealed that personalized phrase-based apps could facilitate interactions during medical emergencies and daily routines, emphasizing the need for culturally tailored solutions. This aligns with Chary et al. (2024) exploration of emergency department communication with caregivers and persons living with dementia from minoritized racial and ethnic groups. The research identified language barriers as a critical issue, particularly for non-English-speaking patients, where caregiver advocacy became central to effective communication. Furthermore, Khanassov et al. (2025) examined virtual primary care for dementia in Canada, highlighting disparities in access based on urbanicity and support systems. These studies collectively demonstrate the importance of addressing linguistic and cultural diversity in designing communication strategies for dementia care.

System-level influences, including institutional policies and technological infrastructure, also shape communication practices. Gleason et al. (2023) analyzed the use of patient portals among older adults with dementia and their care partners, revealing that organizational efforts to facilitate shared access could enhance support systems. Care partners often authored messages using patient credentials, indicating the need for policies that promote proxy access. Similarly, Puente-Fernández et al. (2023) conducted a mixed-methods study to assess the quality of dying among elderly people diagnosed with dementia in nursing homes. The findings highlighted insufficient end-of-life communication, suggesting systemic gaps in training and tools for healthcare professionals. These insights are complemented by Kase (2024) exploration of communication robots, which proposed multidisciplinary approaches to integrate AI models into commercially available robots. Such innovations could mitigate caregiver shortages and improve social connectivity for individuals with dementia, provided systemic barriers like usability and accessibility are addressed.

The interplay of ethical, cultural, and system-level factors necessitates comprehensive frameworks to guide communication in dementia care. Cintoli et al. (2024) evaluated psychoeducational interventions for informal caregivers, demonstrating significant improvements in stress management and communication skills. These programs were effective both online and on-site, underscoring the adaptability of interventions to different contexts. Eastham et al. (2025) further supported this through their investigation of the Empowered Conversations course, an online program for carers of people with dementia. Participants reported enhanced understanding of dementia and improved interpersonal communication, reflecting the value of structured educational initiatives. Additionally, Reiff et al. (2023) fielded the Quality of Communication questionnaire among primary care patients with cognitive impairment and their families, identifying the need for cognitive accessibility in communication tools. These studies collectively emphasize the importance of integrating ethical considerations, cultural sensitivity, and systemic support into communication strategies.