PURPOSE: To discuss the influence of the social context of speech, language and hearing sciences with respect to the elderly with dementia. CASE REPORT: Presentation and analysis of the circumstances and results of the evaluation of 2 elderly women with dementia: S1, resided in a philanthropic home for the aged, and S2, resided with her husband and daughter. Interviews with both the elderly women were conducted and linguistic and cognitive data were obtained. Other aspects of speech, language and hearing sciences were evaluated in subsequent sessions. The initial contact with S1 was marked by unresolved dialogue issues because of confabulations and inaccurate answers and institutional questions (for example, incomplete health records). S1 had moderately severe hearing loss, difficulty in balancing, vocal quality suggestive of presbyphonia and reduced orofacial muscle tension. From the beginning, there were efficient negotiations between the S2 interviewer because of family participation. Her family members accompanied her to all evaluations, and had expectations from the results and future therapy. S2 also had moderately severe hearing loss, difficulty in balancing, vocal quality suggestive of presbyphonia and reduced orofacial muscle tension. CONCLUSION: Both elderly patients had similar speech, language and hearing characteristics however, institutionalized elderly patients tend to live alone and be introspective, without expectation from others regarding their status wich possibly hampers integrated care, whereas the elderly dementia patients who live with their families have opportunities for effective comprehensive care.