relationship between speaking english as a second language and agitation in people with dementia living in care homes results from the marque managing agitation and raising quality of life english national care home survey objective as not speaking english as a first language may lead to increased difficulties in communication with staff and other residents we 1 tested our primary hypotheses that care home residents with dementia speaking english as a second language experience more agitation and overall neuropsychiatric symptoms and 2 explored qualitatively how staff consider that residents language ethnicity and culture might impact on how they manage agitationmethods we interviewed staff residents with dementia and their family carers from 86 care homes 20142015 about residents neuropsychiatric symptoms agitation life quality and dementia severity we qualitatively interviewed 25 staffresults seventyone out of 1420 5 of care home residents with dementia interviewed spoke english as a second language after controlling for dementia severity age and sex and accounting for care home and staff proxy clustering speaking english as a second language compared with as a first language was associated with significantly higher cohenmansfield agitation inventory adjusted difference in means 83 95 confidence interval 41 to 125 and neuropsychiatric inventory scores 41 065 to 75 staff narratives described how linguistic and culturally isolating being in a care home where no residents or staff share your culture or language could be for people with dementia and how this sometimes caused or worsened agitationconclusions considering a person with dementias need to be understood when selecting a care home and developing technology resources to enable dementiafriendly translation services could be important strategies for reducing distress of people with dementia from minority ethnic groups who live in care homes