Background Physiotherapists need to use pedagogical approaches and strategies in their work. However, there is no previous definition of what a pedagogical approach in physiotherapy means neither in general nor specifically to dementia. The purpose of this study was therefore to gain greater insight into physiotherapists’ pedagogical approach to dementia by investigating physiotherapists’ views and working methods in contact with older people with dementia, relatives, and nursing staff in elderly care. Methods This was a qualitative study with an inductive approach. Semi-structured individual interviews were conducted with 15 physiotherapists with experience of working with older people with dementia in elderly care. The interviews were analyzed with qualitative content analysis. Results The term “pedagogical approach” could sometimes be experienced as “vague” or “hard to grasp”. Our research nonetheless identified one overarching theme To see, meet and adapt which is based on insights from the interviews grouped in to five categories. This theme can be seen as an expression of the physiotherapists’ pedagogical approach in contact with older people with dementia, relatives, and nursing staff. It captures the participants’ desire to always see the person in front of them, meet them where they are and adapt their own way of working accordingly. Creating a trusting relationship was described as important and made it easier for the participants to adapt their working methods. The participants’ adaptations could apply to the way they communicated with people with dementia, and how they organized tutoring/education of relatives and nursing staff to maximize learning. Learning through experience and reflection was described as a key to advancing the pedagogical approach and the participants experienced their own learning as constantly ongoing. Conclusions This study provides increased understanding into physiotherapists’ pedagogical approach in contact with older people with dementia, relatives, and nursing staff in elderly care and shows that learning through experience and reflection can contribute to the development of the pedagogical approach. Thus, opportunity for reflection should be accommodated in the physiotherapists’ work. The importance of more pedagogical education for physiotherapists both in bachelor and master level were also highlighted. Increasing mobility and physical activity in older people with dementia is important since physical inactivity and sedentary behavior is common. Future research may be directed at further exploring physiotherapists’ pedagogical approach in tutoring/education of nursing staff, with the aim of increasing physical activity among older people with dementia.