Aims and Objectives
Learning from the Talk of Persons with Dementia: A Practical Guide to Interaction and Interactional Research aims to provide readers with an understanding of how social-oriented research can bring to light certain conversational practices that may assist clinicians, caregivers, and family members in their interactions with persons with dementia. Our object of study is the conversation between persons with dementia and those with whom they interact. Our goals are to identify, better understand, and share those conversation strategies used by clinicians, caregivers, and family that may prove more conducive than others to building and maintaining relationships with those afflicted by dementia. We might consider, for instance, whether there are certain ways a caregiver can start a conversation that is more likely to elicit a response. In other cases, we observe the value of continuing a conversation despite unexpected and occasionally jarring or confusing language from the person with dementia. This interactional approach differs from the clinical and biological types of work with which many may be more familiar. Work such as that on the neurocellular characteristics or potential genetic dispositions of the disease is valuable, indeed crucial, in their own right. But such work can offer little advice on how we might best navigate day-to-day interactions with persons with dementia. We offer this work as part of a continuing effort to provide guidance and hope, if only in some yet small way, to those for whom such conversations have become part of their daily lives.
As the book provides practical guidance to those who interact with persons with dementia, that guidance may take the form of concrete recommendations to specific groups such as caregivers or family members; additionally, it may inform novice researchers who are considering employing any of the methodologies used. Given the potentially wide audience, we have balanced the analyses and sometimes necessary technical terms with pedagogically-oriented sections in each chapter that should prove useful to those coming from backgrounds different from the respective authors. Even if you are not a specialist in some area related to dementia work, rest assured, these sections were written with you also in mind.
Each chapter, for instance, begins with clearly stated learning objectives that largely steer clear of technical jargon. At frequent points throughout the book, you will find various aids to assist your understanding. Some authors use “Thinking Point” boxes to share vignettes and questions for consideration; others use these to summarize and reinforce the chief lessons from the detailed analyses. Some contributors use “Activity” boxes to suggest helpful exercises for use in the classroom, home, and workplace. And, finally, each chapter closes with “Practical Highlights” that summarize the key “take away” messages of that chapter.
Methodological Approaches to Dementia
Before turning to an overview of the individual chapters, I want to first briefly review the methodological approaches you will encounter. The social-interactional research reported here focuses on discourse, or language in use, as the social phenomenon in which meanings are collaboratively made and actions are achieved (see Edwards & Potter, 1992). The term “language in use” may seem unusual, at first. For our purposes, it refers to spoken language used in the “real world” day-to-day. (This stands in contrast to the oftentimes more theoretical study of language conducted by some linguists and philosophers.) Put simply, through our use of language, in conversation with others, we arrive at various understandings of both the larger social world and our conversation partners, and our conversations can allow us to move to other social activities. More specifically, we study the language used in conversation to draw conclusions about the mechanics of language, about how linguistic structures are employed within actual interaction, and to identify how language use helps achieve actions (e.g., accept an invitation, acknowledge a compliment, arrange a meeting).
The methods described below share an emphasis on “language in use.” Each, for instance, may combine audio and/or video recordings with detailed transcription of naturally occurring interactions; through this “talk,” patterns organically emerge. But the methods oftentimes differ in the way they contextualize the conversation interactions, the importance they place on the environment in which the conversation occurs and the nonlanguage elements of that environment, and in the degree to which they generalize their findings to broader social patterns. Some core elements of those differences follow, but in practice, the methods can overlap significantly.
Discourse Analysis
Discourse analysis (DA) is a close examination of the patterns, themes, and functions of language in use as it occurs within particular social contexts. Within the broader social science realm, for instance, discourse analysts might look at how language in use enacts or constructs larger issues of social structure such as identity, power relations, and knowledge. The connection of discourse to social structures and medical or health-related situations has a robust history (e.g., perhaps most notably in Foucault’s study of madness, 1972). While some discourse analysts emphasize these broader social issues, others turn greater attention to the ways that language use may function within a conversation beyond its traditional grammatical classifications. In Chapter 5, for example, Davis and Maclagan take this more focused approach and look at how persons with dementia who are exhibiting language impairment can use the words but and so that a traditional grammarian might simply classify as “conjunctions” and put them to other uses.
Conversation Analysis
Whereas the emphasis in Chapter 5 is on two specific words and their use, many of the other contributors in this volume focus on the interconnectedness of participants’ turn of talk within conversation. They emphasize ways in which one “turn” of talk, with its construction from lexical, syntactic, and prosodic features, engenders another participant’s turn—and its unfolding linguistic construction—in the emerging collaborative process of sense making and action. These conversation analytic (CA) methods have been employed profitably in studying, for example, interaction between clinicians and patients (e.g., Goodwin, 2003; Maynard, 2003) and, in the same series as this book, interaction with children with autism (e.g., O’Reilly, Lester, & Muskett, 2016). We find CA methods applied in most of the chapters from Part II.
Ethnography
Ethnography is founded on the principles that social life is meaningful and that social actors create meaning through their interactions, largely, but not exclusively, through language use and the observations of people’s behaviors—individually and within group actions. Elements that factor into meaning making are participants’ identities, the context of the interaction, and the culture in which the interaction occurs. Data collection traditionally involves observations and subsequent researcher field notes, but technologies such as audio and video recordings are now also used regularly. Some ethnographers also seek insights directly from the participants themselves, employing a series of interviews or collected narratives focused on the research question. Understanding this emic, or insider, perspective allows for another data point from which to look at the relevant issue. This attention to culture and behavior with little or no concern for the turn taking within conversation or the discrete uses of specific words sharply contrasts ethnography from the CA and DA described earlier. However, many of our authors combine elements of the other methods with ethnography. We find an example of the interview approach in Chapter 10, and of ethnography, more generally, in Chapters 7, 8, 9, and 11.
Syntactic Analysis
Syntactic analysis of persons with dementia and other neurocognitive disorders is often conducted on the written, verbal, or computer-mediated responses acquired from the participant through elicitation tasks (see Obler & De Santi, 2000). What is different about the work presented in Chapter 6 is that the syntactic anal...