Everyday conversation in dementia: a review of the literature to inform research and practice

Abstract

BackgroundThere has been increasing interest in dementia care in recent years, including how practitioners, service providers and society in general can help individuals to live well with the condition. An important aspect to this is provision of advice to ensure conversation partners effectively support the person with dementia in conversation.AimsTo provide a descriptive review of the literature examining everyday conversation in dementia in order to inform practice and research.Methods & ProceduresThis review used a method specifically developed for reviewing conversation analytic and related literature. A range of databases were searched using key words and explicitly described inclusion criteria leading to a final corpus of 50 titles. Using this qualitative methodology, each paper was examined and data extracted. The contribution of each of these is described and the implications for practice and research are outlined.Main ContributionThis review examined studies into conversation in Alzheimer’s disease, vascular dementia and Lewy body dementia, grouping these into: early influential studies; work drawing on positioning theory; studies using social and linguistic approaches; collaborative storytelling; formulaic language; studies specifically using conversation analysis; and conversation as a target for individualized therapy. In addition, more recent work examining primary progressive aphasia and behavioural variant frontotemporal dementia was explored. Overall, this review indicates that research examining conversation in natural settings provides a rich source of data to explore not just the challenges within conversation for those taking part, but also the skills retained by the person with dementia. An important aspect of this understanding is the notion that these skills relate not only to information exchange but also aspects of social interaction. The role of others in scaffolding the conversation abilities of the person with dementia and the potential of this for developing interventions are discussed.Conclusions & ImplicationsThe review indicates that interventions targeting conversation in dementia are often advocated in the literature but currently such approaches remain to be systematically evaluated. In addition, many of the important insights arising from these studies have yet to inform multidisciplinary dementia care practice.

Communication training interventions for family and professional carers of people living with dementia: a systematic review of effectiveness, acceptability and conceptual basis

“…For people living with all types of dementia, their cognitive impairments can affect their ability to communicate in varying ways; such as finding words to express their intentions, retrieving memories or processing the contextual information they need to understand the motivations of others (Schrauf & Muller, 2014). This can make it difficult to sustain the everyday conversations that support their social relationships (Kindell, Keady, Sage, & Wilkinson, 2016) and exacerbate the feelings of social isolation and exclusion (Ablitt, Jones, & Muers, 2009). Family and professional (paid) carers also find these communication impairments very challenging as they contribute to relationship stress (Dooley, Bailey, & McCabe, 2015;Jones, Edwards, & Hounsome, 2014).…”

Familiar communication partners’ facilitation of topic management in conversations with individuals with dementia

“…Resultant declines in communication skills may also impact individuals’ ability to maintain their sense of ‘self’ (Kindell et al . ). Furthermore, these communication impairments affect the communication partners of individuals with dementia (Small and Perry ).…”

Facing dementia as a we: Investigating couples’ challenges and communicative strategies for managing dementia

“…Webb (2017) specifically highlights collaborative aspects which could challenge the previous concept of a person-centred perspective involving people with dementia, and how this perspective is used. Kindell et al (2017) also emphasise the importance of other aspects of interaction involving people with dementia, such as just being together. In regard to this study and couples living with dementia, multimodal resources can be useful in terms of experiencing and expressing closeness or we-ness in interaction.…”

“…In a research review, Kindell, Keady, Sage and Wilkinson (2017) suggest that this knowledge of strategies originates in micro-level analysis (such as CA and positioning theory), in which remaining competencies can be acknowledged as well as competencies rooted in relationships. It has also been argued that CA is beneficial in analysing interaction involving older people (Olaison & Cedersund, 2009) and people with dementia (Webb, 2017).…”

“…Occasionally people's behaviour and interaction with others may have negative consequences for people with dementia (Jones, 2015;Kindell et al, 2017). In some cases, challenges in interaction are more a result of not acknowledging or tuning in to the same life world as the person with dementia (Hydén & Samuelsson, 2018), or as proposed by Jones (2015:557) when expressing that "[t]he misalignment of intersubjectivity, or shared understandings between interlocutors, has profound implications for interaction and lies at the heart of the communicative challenges faced by people with Alzheimer's disease and their family".…”