The World Health Organization (WHO, 2012) has identified dementia as a global health priority urging major improvements to awareness and understanding the needs of people with dementia and their caregivers. The growing prevalence of dementia (Alzheimer’s Disease International, 2015) makes provision of care a pressing concern. A goal for people affected by dementia is to maintain independence by living well for longer, maintaining social interaction and contributing to the community (Department of Health, 2009). Since the majority of people diagnosed with dementia are living in their own homes (WHO, 2012), there is a need for research to improve understanding of good care and communication for community-dwelling people with informal caregivers. The findings of this study contribute to existing knowledge of how communication can support independence and well-being when living with dementia.
Adopting a competence-based model (Coupland, Coupland and Giles, 1991) of life with dementia, this unique investigation has revealed positive interactional practices to sustain social interaction and involvement in family and community life. Despite episodes of memory lapse, confusion and delusion, the person with dementia demonstrates authority, expertise and wisdom.
This study investigates the interactional practices of a woman diagnosed with dementia (7 years prior to participation in this project) in conversation with a variety of interlocutors including family caregivers, teenage grandchildren and community service providers. Drawing on a corpus of 15 hours of conversation, recorded in a range of naturally occurring settings, the interaction is explored primarily through applied conversation analysis and supported by caregiver interviews and extensive ethnographic observations.
The findings of this study demonstrated that a significant amount of repetition generated in interaction with a person with dementia is entirely typical in character. For example, repetition is pervasive in typical talk (interaction not involving persons with known cognitive impairment), where it is used in greetings, repair and humour as well as marking the boundaries of discourse, claiming authority and building social solidarity (Schegloff, 1996, 1997, 2011; Heritage and Raymond, 2005; Tovares, 2005;
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Curl, Local and Walker, 2006; Tannen, 2007; Bolden, 2009). Furthermore, it is found that repetitious questions produced by the person with dementia can be self-scaffolding devices, helping to orient the person in the here-and-now.
The overwhelming character of the conversations in these data is that the person with dementia is competent and assertive. The study reveals how the social environment empowers the person with dementia to demonstrate her competence and expertise and that the practices of the conversational partners enable and support this. Where previous studies have focused on how conversational partners can collaborate in co- constructing competence, this study additionally demonstrates evidence that the person with dementia has the ability to negotiate epistemic authority and often re-orient herself following episodes of disorder.
Although the person with dementia at the centre of this case study is a ‘very special lady’ (in the words of her daughter-in-law), she represents countless people with dementia who wish to be taken seriously and to feel empowered to take an active part in their community (Department of Health, 2009; Sabat and Lee, 2011). This thesis makes an original contribution to understanding competence in everyday interaction when living with dementia
