What Is the 90-Second Rule for Dementia?
Read time: 11 minutes
Key takeaways
- The 90-second rule means waiting up to 90 seconds after you ask a question or give an instruction before you repeat, rephrase or step in, because dementia slows how quickly the brain processes language.¹ ²
- Repeating too soon restarts the person’s processing and often raises frustration; a calm pause, eye contact and one short sentence gives them the best chance to respond.
- If there is still no response after 90 seconds, switch to a gesture, a demonstration or a smaller step, and avoid phrases that quiz, correct or talk down to the person.³ ⁴
You ask your mother if she would like tea. She looks at you and says nothing. Five seconds pass, so you ask again, louder. Then you offer coffee instead. She frowns and turns away.
It can feel like she didn’t hear you or doesn’t care. More often, she was still working out the first question when the second and third arrived. That gap between hearing and answering is what the 90-second rule is designed to protect.
What is the 90-second rule for dementia?
The 90-second rule is a communication guideline: after you ask a question or give a simple instruction, wait up to 90 seconds before repeating it, rewording it or doing the task for the person. Dementia educators teach it because people living with dementia often need 60 to 90 seconds to take in a request and form a reply.¹ Family-caregiver training programs give the same rule of thumb: allow about 90 seconds before you repeat or rephrase.²
It is worth being clear about what the rule is not. Ninety seconds is a practical guideline drawn from caregiving experience, not a precise clinical measurement. Some people will answer in ten seconds; others, especially in later stages or on a tired afternoon, may need the full minute and a half. The point is not the stopwatch. The point is to stop filling the silence.
Why waiting works
Dementia affects the parts of the brain that decode speech, find words and plan a response. Each of those steps takes longer than it used to. When you repeat a question or add a new one, the person often has to start the whole process again. A second version of the question is not a helpful hint; it is new information arriving before the first piece has landed.
Rushing has an emotional cost too. Being hurried, corrected or answered for can leave a person feeling embarrassed or cornered, and that distress can show up as withdrawal, irritation or refusal. A calm pause sends the opposite message: you have time, and they are worth waiting for.
Two different “90-second rules”
There are actually two versions of the 90-second rule. Both are useful, but they solve different problems.
| The dementia communication rule | The emotional “90-second rule” | |
| Who it’s for | The person living with dementia | The caregiver |
| What it says | Wait up to 90 seconds for a response before repeating or stepping in | The chemical surge behind an emotion like anger passes in about 90 seconds if you don’t feed it |
| Where it comes from | Dementia care and occupational therapy practice ¹ ² | Neuroanatomist Dr. Jill Bolte Taylor’s book My Stroke of Insight⁶ |
| When to use it | Every time you ask a question or give an instruction | When you feel your own frustration rising |
In a hard moment, you may need both: a pause for them to process, and a pause for you to reset before you speak again.
How to use the 90-second rule, step by step
Start by setting up the moment. Turn off the TV, approach from the front and get down to eye level, and check that glasses and hearing aids are in. The Alzheimer Society of Canada recommends reducing distractions and talking face to face.³ Say the person’s name and wait for eye contact before you ask anything.
Then ask one thing, in one short sentence. “Would you like tea?” works far better than “Do you want tea or coffee, and should I bring a biscuit?” Now comes the hard part: pause and count silently. Keep a relaxed face and an open posture, and resist the urge to repeat, reword or answer for them.
While you wait, watch for signs that they are working on it. A change in expression, moving lips, a glance toward the kettle or the start of a gesture all mean an answer is on its way. When it comes, accept it. A partial answer, a nod or a word that is close enough still counts, so respond to what they mean rather than the exact words they used.
If there’s no response after 90 seconds
Don’t simply say the same sentence louder. Change the way you communicate instead.
Showing often works when telling doesn’t: hold up the mug, or point to the jacket while you say “jacket.” You can also offer two choices the person can see, such as holding up two sweaters and asking, “This one or this one?” If the request has several parts, break it down. “Let’s get ready for bed” becomes “Let’s go to the bathroom,” and the next step follows once that one is done. A light hand on the arm, if it’s welcome, can help someone reconnect with you.
And if the person seems tired, upset or overwhelmed, step back and try again in 10 to 15 minutes. A fresh moment usually works better than a repeated request.
Where the rule helps most
The pause matters most in the moments that tend to go wrong. Personal care, such as bathing, dressing and toileting, is where rushing most quickly turns into resistance. Mealtimes involve a string of small decisions, from choosing food to taking medication. Transitions like leaving the house, getting into the car or moving to bed ask a lot of someone in a short time. And everyday conversation, especially on visits and phone or video calls, is where pauses feel most awkward and family members are most tempted to fill them.
Communication tips that work alongside the pause
The 90-second rule gives the person time. A few everyday habits make that time count.
Lean on what you know about the person. Familiar names, routines and interests make a conversation easier to follow.³ Keep questions simple, too: “Do you want the blue sweater?” is much easier to answer than “What do you want to wear?” Use the same words each time, so if it’s always been “the bathroom,” don’t switch to “the washroom.”
As words become harder to follow, your tone and facial expression carry more of the message, so keep both warm and make sure your face matches what you’re saying.⁴ It also helps to respond to the feeling behind the words. If your father says he needs to get to work, the need underneath may be purpose or worry. “You’ve always worked so hard” connects better than “You retired years ago.”
Finally, include the person in conversations about them, even when they say little. The Public Health Agency of Canada’s guidance stresses that people living with dementia still feel emotions, have a sense of self and want to connect.⁵ If they are searching for a word and look to you for help, offer it gently, or invite them to point to it or describe it.⁵
What to avoid saying, and what to say instead
Many common phrases put the person on the spot or quietly signal that they are failing. Small changes in wording remove that pressure.⁴
| Instead of | Try | Why |
| “Do you remember…?” | “I was thinking about the time we….” | Quizzing memory can cause embarrassment; sharing the story invites them in |
| “I just told you that.” | Answer again, calmly, as if it’s the first time. | The question is new to them; pointing out the repeat adds shame, not memory |
| “No, that’s wrong.” / “That’s not true.” | “Tell me more about that.” | Correcting rarely changes the belief and often causes distress. |
| “Your husband died years ago.” | “You miss him. Tell me about him.” | Repeated bad news can feel like hearing it for the first time. |
| “What did you have for lunch?” | “Lunch looked good today. Did you enjoy the soup?” | Open recall questions are hard; a gentle prompt gives them something to respond to |
| “Come on, hurry up.” | “We have plenty of time. Let’s put on your shoes.” | Pressure slows processing and raises anxiety. |
| “Good girl” / “Okay, sweetie” (to an adult) | Use their name and adult language | Talking down erodes dignity and can trigger frustration |
| Several questions in a row | One question, then the pause | Each new question restarts processing |
The pause is for you, too
Waiting 90 seconds in silence is harder than it sounds, especially when you’re tired, running late or hearing the same question for the tenth time. Expect it to feel awkward at first. It gets easier with practice, and many caregivers find that days go more smoothly once the pause becomes a habit.
When you feel frustration rising, use the other 90-second rule: step back, breathe and let the feeling pass before you respond. The Alzheimer Society of Canada’s advice is simple: how you feel comes through in your tone and body language, so take a breather when you need one.³
When to get more support
Communication changes are a normal part of dementia, but some changes are worth raising with the person’s doctor or care team.
A sudden drop in speech or understanding over hours or days can signal delirium, an infection or a problem with medication, and needs prompt attention. New or worsening hearing and vision problems are also worth checking, since they make every conversation harder. Speak up, too, if distress, agitation or refusal of care continues despite a calm approach, or if you are starting to feel burned out as a caregiver.
In British Columbia, the Alzheimer Society of B.C.’s First Link® Dementia Helpline offers free information and support for people living with dementia, families and care partners.⁷
English support is available at 1-800-936-6033. Cantonese and Mandarin speakers can call 1-833-674-5007, and Punjabi, Hindi and Urdu speakers can call 1-833-674-5003; both lines run Monday to Friday, 9 a.m. to 4 p.m.
How myCareBase can help
Patient, consistent communication is easier when the same trusted caregiver is there day to day. myCareBase helps BC families find experienced caregivers who understand dementia care, so the person you love gets time, dignity and familiar routines, and you get some time back for yourself. Learn how myCareBase works →
References
- Skinner, L. “Common Communication Challenges in Dementia Caregiving.” Truth, Lies & Alzheimer’s podcast, July 22, 2026. Listen
- HumanGood. “Communication Strategies for Family Members.” humangood.org
- Alzheimer Society of Canada. “5 communication tips for conversations with people living with dementia.” alzheimer.ca
- Alzheimer’s Society (UK). “What not to say to somebody with dementia.” alzheimers.org.uk
- Public Health Agency of Canada. “Dementia: Tips on how you can help.” canada.ca
- Taylor, J. B. My Stroke of Insight: A Brain Scientist’s Personal Journey. Viking, 2008.
- Alzheimer Society of B.C. First Link® Dementia Helpline. alzheimerbc.tovuti.io/help
Looking for more content – here are some of our recent blog posts.