What does dementia look like?

Not figuratively—but literally?

When you picture a person with dementia, who do you picture?

Typically, we think of frail old people, looking confused, completely dependent on others, living in nursing homes, unable to carry on a conversation.

We rely on stereotypes to decide what certain groups “look like,” and people living with dementia are no different.

You should know that 10% of those with dementia are under the age of 65. Only about 20% live in a nursing home, assisted living, or memory care at a given time.

Some are in the workplace. Many are serving our communities with purpose and living lives of meaning. Some people with dementia have depression, but others do not.

They are just as diverse as the rest of us.

I remember a holiday season about 25 years ago. We were visiting my grandmother. She was working at a liquor store. She came home from work on Christmas Eve and let us know that–for the first time–she had some gay customers at the liquor store.

My grandmother was open-minded. She was not at all bothered about her gay customers, but she was really convinced that this was the first time she had gay customers.

She had a picture in her mind of how gay people would appear, and apparently this was the first time anyone fit into the box. Statistically, it would have been virtually impossible that these were her first gay customers.

I’ve had people who are waiters in restaurants tell me that they’ve never waited on anyone living with dementia. At one point, I tried to convince the owner of a bookstore to make his business dementia friendly. He told me that no one with dementia had ever been to his bookstore.

And there was the time that I had a conversation with a manager at a hotel about ways to make travel more dementia friendly.

“It’s not like people with dementia actually travel. I’ve never seen one at this hotel,” he said.

We still lack understanding that there are people with dementia living in our communities–just doing their thing. They aren’t wearing special bracelets and they aren’t labeled with tattoos.

They are just people, like the rest of us.

My team is passionate about doing dementia education for those who work in residential senior care.

But it can’t end there.

We need communities to start understanding that people living with dementia are among their residents.

They’re not really unique or special. We should not patronize or underestimate them. A diagnosis does not erase a person’s values or humanity.

When we talk over them or assume incompetence, we create barriers that are as limiting (more limiting) than the condition itself.

I get frustrated with the “before and after” dementia narratives. Those stories reduce a person to a single decline arc and imply that everything meaningful existed only in the past–before the dementia. A more honest approach focuses on adaptation: what has changed, what remains, and what kinds of support are helpful.

That same thinking shows up in how we expect dementia to be visible and obvious. When we rely on decline-based narratives, we also start looking for a certain “look” to confirm our own expectations.

Dementia does not have a look.

The sooner we stop searching for visual markers and start assuming variability, the closer we get to communities that actually know how to include people living with dementia.