‘There’s a letter called ef’ on Challenges and Repair in Interpreter-Mediated Tests of Cognitive Functioning in Dementia Evaluations: A Case Study

Abstract

In the Scandinavian countries Sweden, Denmark, Norway, and Finland, the number of first generation migrants reaching an old age, who will be in need of age-related health-care, is rapidly increasing. This situation poses new demands on health-care facilities, such as memory clinics, where patients with memory problems and other dementia symptoms are referred for examination and evaluation. Very many elderly people with a foreign background require the assistance of an interpreter in their encounter with health-care facilities. The use of, and work by an interpreter is crucial in facilitating a smooth assessment. However, interpreters, clinicians, as well as patients and their companions, may be faced with many challenges during the evaluation procedure. The aim of this case-study is to highlight some of the challenges that occur in relation to a specific activity within the dementia evaluation, namely the test of cognitive functioning. Special attention will be paid to the phenomenon 'repair', i.e., participants' joint attempts to solve upcoming difficulties during the course of interaction. Results show that sources of trouble may be related to the lack of cultural, linguistic, and educational adaptation of the test to the patient, and to interpreter and clinician practises. Findings will be discussed in terms of test-validity, clinician and interpreter training, and the institutional goals and constraints of the dementia evaluation. The methodology Conversation Analysis has been used to conduct a highly detailed analysis of participants' practices and actions during the administration of the test.

Pathways Within Dementia Diagnosis

“…A specific challenge for memory clinics, however, is that many instruments, for example tests of cognitive functioning, are not adapted to people of all ethnicities, nor translated or validated in all languages needed, and rarely take limited literacy skills into account (e.g. Nielsen, 2011;Plejert et al, 2015). In addition, if a patient speaks a foreign language, it is routine in most memory clinics to appoint an interpreter to mediate the interaction between clinician and patient during the assessment.…”

“…Van De Mieroop et al, 2012), and even fewer on the specific environment of memory clinic encounters. However, in two case-studies of interpretermediated dementia evaluations, Plejert et al (2015), and Majlesi and Plejert (2016) investigated the interplay between interlocutors in this particular setting. Whereas the first study (Plejert et al, 2015) highlighted particular challenges associated with the lack of cultural and linguistic adaptation of a test of cognitive functioning to the patient, and how this lack of adaptation played out in interaction, the second one (Majlesi & Plejert, 2016) investigated how the clinician and interpreter used various embodied resources (e.g.…”

“…in collaborative ways that in various manners potentially affected the patient's understanding and performance of the task at hand. This section primarily discusses some key findings from the initial case-study (Plejert et al, 2015), but also highlights some further aspects of the data that formed the basis for that study. The data comprised video-recordings and ethnographic interviews collected in a Swedish memory clinic in 2013.…”

“…The participants in Plejert et al (2015) are an experienced occupational therapist, a professional interpreter, and a patient, who is an 80 year-old Iraqi Kurdish woman. Her mother tongue is a variety of Kurdish called Feyli, but she also appears to know some Arabic and Turkish.…”

“…Heritage & Maynard, 2006;Lecouturier et al, 2008;Maynard & Frankel, 2006). Recent research has also highlighted specific aspects of dementia evaluations for ethnic minority patients, where an interpreter is needed in order to mediate talk between clinical staff and patients and their companions (Plejert et al, 2015;Majlesi & Plejert, 2016). It is through a social scientific lens that we approach the pathways within dementia diagnosis that are the focus of this chapter.…”