Pronouns and Dementia: Respecting Identity
A trans resident in his 60s with early-stage dementia is admitted. Some staff think pronouns “don’t matter anymore.” His family disagrees.
The scenario
Mr. Okafor is 68. He is a trans man — assigned female at birth, living as a man for over 40 years. He uses he/him and the name Daniel. He was diagnosed with early-stage dementia last year and moved into your memory care unit a month ago. On good days he is clear about who he is. On harder days he is confused about time and place, but he still responds to “Daniel” and “he.”
At a care conference, his sister — his substitute decision-maker — is firm: “Daniel is who he is. He has been Daniel longer than I have been alive, almost. Please use his name and pronouns always, even when he is confused. This is core to who he is.” A PSW at the meeting shifts uncomfortably and says, “No disrespect, but if he forgets his own pronouns sometimes, does it really matter? We have got bigger things to worry about.”
The next week, a new agency nurse refers to Daniel as “she” and “Ms. [birth surname]” in front of two other residents. Daniel looks startled but says nothing. His sister, visiting later, overhears a PSW say “her room” and leaves in tears.
The challenge
What makes this hard—and what is at stake.
The dilemma is real: dementia changes how a person experiences their own identity, and staff are genuinely unsure what “respect” looks like when memory is unreliable. The PSW’s question is not malicious — it comes from being overwhelmed and not understanding why this matters when there are so many other demands.
But here is the stake: Daniel’s identity does not disappear because his memory does. He has lived as a man for four decades. Using his old name and pronouns is not neutral — it is a reversal of his whole life, and on his clear days he feels it. The family is asking the team to hold onto something the disease is taking. That is hard, meaningful work, and it deserves a clear answer, not a shrug.
Your response
What would you do in this moment?
Take a moment to think about how you would respond. There is no “right” answer—just your thoughtful response. Type it below before you look at the possible approaches.
The fact that you are thinking about this shows you care.
Possible responses
Not “right” vs “wrong”—more helpful and less helpful. Reveal them one at a time, or all at once.
People are trying their best—including the staff in the less helpful approaches. Learning takes practice. You are doing the right thing by thinking this through.
What matters most
Key takeaways
- Dementia changes memory, not identity. A person’s name and pronouns belong to them for life.
- Answer the genuine question (“does it matter?”) with a real reason, not a rebuke. Staff who ask are often the ones most willing to learn.
- Write the standard in the care plan and brief every agency and casual nurse at sign-in. Consistency is what makes it real.
- Hold the person’s identity steady when they cannot. That is one of the most dignifying things a memory care team can do.
Reflection & discussion
Conversation starters for your team huddle
These are not interrogations—they are ways to talk together about what would help.
- How would you explain to a new colleague why pronouns still matter when a resident has dementia?
- Have you seen a family’s request about identity get treated as optional? What happened?
- What would help your team brief agency staff consistently, even on busy days?
- How could you follow up with Daniel’s sister so she knows the standard is holding?
Related resources
FAQs
Tools
Keep practicing
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