Working with dementia patients can take a great physical toll on caregivers, but a new study finds that communication causes more physical strain than any lifting or transfer challenges.

Nurses aides at three nursing facilities in western Sweden related their dementia-care experiences in a recent edition of The Scandinavian Journal of Care Sciences. While a resident’s weight and the equipment available for person transfers contributed to their physical stress, caregivers reported that communication problems and misunderstandings were the biggest cause of the stress. Caregivers said they were able to make person transfers easier by using patient-specific approaches, such as knowing what tone of voice to use with which patient, and being able to assess which patients had greater mobility.

Besides cognitive decline, many patients with dementia also experience decreased mobility and motor skills. Researchers say the results of the survey could help guide physiotherapists in training nurse aides for patient transfers.