It is the level of functioning, rather than the presence of a brain disorder diagnosis, which predicts costs. ADLs are better explanatory variables of costs than Mini mental state examination. Most people in a population-based cohort are zero users of care.

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This article investigates how the elderly with dementia and their professional caregivers use laughter as a device to deal with problems related to language production and comprehension. The data consist of two game-playing situations, used to engage the elderly people in memory work. The article shows how the elderly patients recurrently laugh to acknowledge communication difficulties and to show awareness of their potential non-competency. The professional caregivers are shown to use slightly different strategies for responding to laughter segments initiated by the patients, either making the shortcomings part of the conversation or avoiding referring to the lapse explicitly. The laughter strategies used by the patients are compared to those reported in the CA-literature on laughter. It is well known that laughter is used in sequences of trouble and delicacy in both ordinary and institutional contexts, but my study shows that speakers with dementia laugh when they encounter problems related to language production and comprehension. This functional expansion in relation to premorbid occurrence is evidence that laughter fits the definition of compensatory behaviour utilized to overcome communication barriers. Certain conversational skills are preserved in individuals with dementia, but due to their cognitive impairment these resources are utilized in a slightly different way than by healthy speakers.

Some types of formulaic (routine and familiar) language seem to remain fairly intact in people with language and memory disturbances, making it a useful tool for both testing language skills and supporting language retention and use. Proverbs can reasonably be considered a subset of formulaic language, and while it is known that the ability to understand proverbs is compromised in dementia, completing them ought to be relatively easy, if proverbs are stored holistically like other kinds of formulaic language. However, this study reports how three people with dementia often struggled to complete proverbs in a game used in a day-care centre to stimulate the memory and language skills. By examining their responses and relating them to the causes of formulaic language patterns, it is argued that these games are not as appropriate a tool for stimulating memory and language skills as might be first thought. Although they do provide a much-needed opportunity for sustained patient-carer interaction that transcends the basic delivery of physical care needs, the games contravene some of the guidelines offered by Orange (2001) regarding the best way to support people with Alzheimer’s Disease in constructive interaction.

This article deals with multi-unit questioning turns used in different genres of institutional interactions. Analyzing in detail a corpus of about 400 multiunit questions from health care interactions, court trials, police interrogations, and social welfare office talks from Sweden and Finland (all in the Swedish language), a number of sequential patterns are established. Some of these sequential organizations revolve around the interplay between declarative and interrogative units. Several interrogatives in a series usually narrow down questions, for example, by suggesting candidate answers to the initial more general questions. However, many multi-unit questioning turns are concluded with an appended generalizing question.The communicative functions of these different question delivery structures are summarized. We argue that the theory must be sensitive to differences between communicative activity types. However, on the general level, we propose that designing a multi-unit question is an attempt at solving a complex communicative task, which typically involves several, possibly mutually conflicting, demands on the speaker. For example, in court trials, the avoidance of leading questions must be balanced against the need for precise answers. At the same time, the use of an appended generalizing unit might be formulated to secure anything that could count as an acceptable response.

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This paper investigates how two ideologies of mental health rehabilitation-recovery ideology and communal approach-are realized in interactional practices associated with psychosocial rehabilitation. More spesifically, the paper discusses employee selection in the context of the Clubhousecreated Transitional Employment (TE) programme, which offers employment opportunities for rehabilitants. The paper describes how joint decisions are established during the moment-by-moment interactional processes at the Clubhouse. Drawing from the data set of 29 video-recorded rehabilitation group meetings, and Conversation Analysis as a method, the paper analyzes two questions: (1) How do the participants talk about the decision-making process associated with the TE on a ''meta'' level? And (2) how are the TE employees actually selected in the turn-by-turn sequential unfolding of interaction? When discussing the TE employee selection procedure on a ''meta'' level, the values of recovery ideology focusing on client empowerment and selfdetermination are prevalent. Also, the central ideals of the communal approach-openness and collaboration-are defended as decision-making guidelines. However, in the meetings where decisions on the TE employees are concretely made, there is a mismatch between the two ideological approaches to rehabilitation and the actual practices observable in the relevant interactional encounters. Keywords Rehabilitation Á Professional ideology Á Joint decision-making Á Conversation analysis Á Social interaction ''We made a democratic selection with the members who were interested in the job. It was a joint decision and the selection process went really well.''-Support worker evaluates a selection process of a transitional employment worker.