Learning from the Talk of Persons with Dementia: A Practical Guide to Interaction and Interactional Research (The Language of Mental Health)

This book offers an in depth analysis of the interactional challenges that arise due to various dementias and in a variety of social contexts. By assessing conversations between persons with dementia and their family members, caregivers, and clinicians, it shares insights into both the language and actions selected by the participants. Using several different research methods, authors highlight competencies and areas of struggle, as well as choices that ease interactions along with those that seem to complicate them. Each chapter provides practical strategies to help readers better navigate day-to-day interactions with persons with dementia. The book is part of a continuing effort to offer guidance and hope to those for whom such conversations have become part of their daily lives. It presents concrete recommendations for specific groups such as family members, caregivers, and clinicians; it will also be of interest to researchers in the field of dementia and early career scholars interested in the methodologies discussed. Trini Stickle is Assistant Professor of English at Western Kentucky University, USA. She chiefly publishes on the linguistic and interactional competencies of persons with dementia and autism. Additionally, she creates curricula using US dialect data from the Dictionary of American Regional English for linguistic, literature, and history courses Acknowledgments 7 Contents 9 Contributors 12 Abbreviations 14 List of Figures 16 List of Tables 17 1 Introduction 18 Aims and Objectives 18 Methodological Approaches to Dementia 19 Discourse Analysis 20 Conversation Analysis 21 Ethnography 21 Syntactic Analysis 22 Limitations 22 Chapter Overviews 23 Understanding the Transcription System 27 References 29 Part I The Talk of Persons with Dementia: What Can It Tell Us? 30 2 Dementia, Etiologies, and Implications on Communication 31 Learning Objectives 31 Introduction 32 Some Preliminaries: Clinical Description of Dementia 33 A Brief Look at Common Dementia Etiologies 34 Diagnostic Procedures 34 A Closer Look at the Individual Etiologies of Dementia 35 Alzheimer’s Disease 35 Neurocognitive Causes and Changes 36 Demographic Factors 36 Prognostic Information 37 AD Symptoms 37 Lewy Body Dementia 38 DLB Causes 39 Language Effects of DLB 39 Frontotemporal Dementias 40 FTDs Cause and Predispositions 40 FTDs Behavioral Effects 40 Language Effects of FTDs 41 Vascular Dementia 41 VaD Causes and Predisposition 42 VaD Prevention 42 Language Effects of VaD 42 Discussion 44 References 45 3 Challenges in Collecting Real-World Dementia Discourse 47 Learning Objectives 47 Introduction 48 Purposes 48 Collection Protocols 54 Implications 58 References 58 4 Why Use Interactional Data to Better Understand the Effects of Dementia? 63 Learning Objectives 63 Perspectives on Cognition 64 Sense-Making in Interaction 68 Conclusion and Outlook 73 References 74 Part II Learning from the Talk of Persons with Dementia: Practical Steps for Doing and Applying Linguistic and Social Interactional Research 77 5 Signposts, Guideposts, and Stalls: Pragmatic and Discourse Markers in Dementia Discourse 78 Learning Objectives 78 Introduction 79 Data 80 But 81 But in Initial Position 82 But in Final Position 84 Wayfinding 85 Topic Change and Topic Resumption 86 But—Summary 89 So 89 So in Initial Position in an Utterance 90 So in Final Position in an Utterance 91 So–Summary 93 Summary 95 References 96 6 Making Sense of Syntactic Error in Conversations Between Persons with Dementia and Their Non-impaired Co-participants 99 Learning Objectives 99 Introduction 100 Preliminaries: Our Participants and Methods of Discovery 101 Investigating Syntactic Patterns Post Dementia Diagnoses 103 Greater Linguistic Loss and Collaborative Meaning Making 108 Language, Communication, and Personhood Loss: Co-participant Strategies 112 Being an Empathetic Recipient 114 Restoring Self and Sense to the Interaction 116 Summary 118 References 120 7 Foregrounding Competence in Interaction with a Person with Dementia: Co-participant Responses to Disordered Talk 124 Learning Objectives 124 Introduction 125 Data 125 Methods 126 Overview 127 Interlocutor Responses to Disordered Talk: Alignment 127 Minimal Response 127 Generalized Response 128 Colluding Response 129 Interlocutor Responses to Disordered Talk: Delays and Repair Initiation 132 Self-Repair 132 Self-Repair Following a Delayed Response 133 Other-Initiated Repair 134 Interlocutor Responses to Disordered Talk: Correction 137 Summary 143 References 145 8 Meaningfulness at the Intersection of Knowledge and Environmental Objects: Investigating Interactions in Art Galleries and Residences Involving Persons with Dementia and Their Carers 148 Learning Objectives 148 Introduction 149 Background 150 Data 153 Methods 154 Section 1: Interactional Agency and Authoritative Knowledge Among Participants in Art Gallery Tours 155 Intersection (b): Questions Initiated by Art Gallery Visitors Regarding Knowledge in Which Guides Maintain Greater Knowledge Authority 156 Intersection (c): Questions Initiated by Art Gallery Guides Involving the Visitors’ Knowledge Domain 159 Summary of Section 1 162 Section 2: From the Art Gallery to the Home: The Reader’s Turn to Apply and Analyze 163 Pedagogical Exercises: Application and Analysis in Home Settings Using Local Objects 163 Conclusion 170 Appendix 172 References 172 9 Disagreements in Assessment Sequences with Persons Diagnosed with Frontotemporal Dementia 177 Learning Objectives 177 Introduction 178 Frontotemporal Dementia 178 Assessments 179 Data and Methods 181 Analysis 182 Second Assessments in the Talk of a Person with FTD 182 Summary 192 References 195 10 Dementia and the Life Course: Examining Cognitive Decline in a Slowly Progressing Degenerative Illness 197 Learning Objectives 197 Introduction 198 “A Different Normal”: The Pre-Symptomatic Phase of HD 200 “I’m Not Disabled, I’m Under-Employed”: Emergence of Initial HD Symptoms 202 “He Needs a Long Time to Digest”: Pronounced Symptoms in HD 207 “I Shouldn’t Be Here”: Advanced HD Symptoms 212 Summary 217 References 219 11 Public and Private Spaces in Residential Care for Older People 221 Learning Objectives 221 Introduction 222 Data 226 Ethical Considerations 227 The Ambiguous Space of the Bathroom 228 Maintaining Spatial Privacy 229 Managing the Spatial Ordering of the Body 234 The Ambiguous Space of the Common Living Room 242 Summary 248 Practical Implications 248 References 249 Part III Conclusion: Keeping the Conversation Going 253 12 Conclusion: Keeping the Conversation Going 254 What We Have Learned 254 Research Guidance and Resources 256 The Carolinas Conversation Collection 256 The Portal of Geriatrics Online Education (POGOe) 257 Dementia Research Networks 257 References 258 Glossary 259 Index 263 Front Matter ....Pages i-xix Introduction (Trini Stickle)....Pages 1-12 Front Matter ....Pages 13-13 Dementia, Etiologies, and Implications on Communication (Cary J. Kohlenberg, Nathaniel J. Kohlenberg)....Pages 15-30 Challenges in Collecting Real-World Dementia Discourse (Boyd H. Davis, Charlene Pope)....Pages 31-46 Why Use Interactional Data to Better Understand the Effects of Dementia? (Nicole Müller)....Pages 47-60 Front Matter ....Pages 61-61 Signposts, Guideposts, and Stalls: Pragmatic and Discourse Markers in Dementia Discourse (Boyd H. Davis, Margaret Maclagan)....Pages 63-83 Making Sense of Syntactic Error in Conversations Between Persons with Dementia and Their Non-impaired Co-participants (Trini Stickle, Anja Wanner)....Pages 85-109 Foregrounding Competence in Interaction with a Person with Dementia: Co-participant Responses to Disordered Talk (Lyndsay Lindley)....Pages 111-134 Meaningfulness at the Intersection of Knowledge and Environmental Objects: Investigating Interactions in Art Galleries and Residences Involving Persons with Dementia and Their Carers (Adrienne R. Isaac, Heidi E. Hamilton)....Pages 135-163 Disagreements in Assessment Sequences with Persons Diagnosed with Frontotemporal Dementia (Michael Sean Smith)....Pages 165-184 Dementia and the Life Course: Examining Cognitive Decline in a Slowly Progressing Degenerative Illness (Michael Halpin, Norann Richard)....Pages 185-208 Public and Private Spaces in Residential Care for Older People (Gunilla Jansson)....Pages 209-240 Front Matter ....Pages 241-241 Conclusion: Keeping the Conversation Going (Trini Stickle)....Pages 243-247 Back Matter ....Pages 249-255