This research was designed to examine how pastoral communication can be enhanced with confused elderly people. The model under-pinning this research is one which acknowledges the dynamic inter-relationship between theory and practice. It brings theoretical understanding from practical theology, pastoral care and speech and language therapy to bear on the experience of offering pastoral care to the confused elderly individual. The relating of theory and practice in this way demanded that a variety of methods be used in the gathering and interpretation of data. The triangulation of qualitative and quantitative methods fosters a more complete description and understanding of practice. The research design was of five inter-related stages. These stages take the form of literature review, structured interviews with speech therapists, structured interviews with people involved with the care of confused elderly people, a postal questionnaire sent to pastors, and in-depth interviews with 11 of the respondents to the questionnaire. This investigation examines issues which include theological perspectives on dementia, speech and language characteristics of the dementia's, the purpose of pastoral care and the spiritual needs of a person with dementia. The evidence is that in addition to the well documented linguistic changes, dementia also results in spiritual changes. The nature of that change is discussed and related to the spirituality of the confused person. The large amount of information which was elicited by the research, is correlated with pastoral, theological and linguistic perspectives and a model and method for the pastoral care of confused elderly people is developed. Rooted in pastoral experience, and refined by theological reflection, it is maintained that this model and method will be a practical tool for pastors, ordained and lay, useful both for recognising the significant spiritual needs of the confused elderly person and as a means of offering sensitive pastoral care in this context.