Pragmatics and Society - Volume 15, Issue 1, 2024

People living with a dementia and their family carers are at high risk of being excluded from the contact, activities, information and services that help them remain resilient. Using interview data from family dementia carers, this article explores the sources of enablement and inhibition in accessing these aspects of social inclusion. Carers and those living with a dementia are found to inhibit and enable social inclusion for themselves, each other, and other carers. However, carers attribute most agency to the external environment: what is provided and how easy it is to access, along with the attitudes and beliefs of others. Poor communication surfaces as an impediment to social inclusion, with carers often left trying to bridge communicative gaps despite limited knowledge and self-confidence.

The paper contributes to ongoing research on memory work with a focus on “memory work markers” (mwm), affirmative and negative constructions with first person singular verbs such as ‘I remember’ and ‘I know’. We observe them in a longitudinal approach, based on a hexagonal French corpus of biographical interviews, and compare speakers with Alzheimer’s dementia (AD) and cognitive impairment (CI) with matched speakers in normal aging. We observe a general tendency to use negative mwm more frequently in normal aging, while the speaker with AD uses positive as well as negative mwm for memory work performance, and the speaker with CI as tools for topic self-selection. We conclude that framing the process of remembering with mwm can preserve speakers’ autonomy and that an inclusive conversation style could be enhanced by the nuanced awareness of mwm and their relevance in interaction.

This case study explores the dynamics of code choices in interactions involving bilingual people living with dementia of the Alzheimer’s Type (DAT) and their primary care partners, focusing on two narrative interviews held in private settings. Drawing on a combination of Communication Accommodation Theory and Conversation Analysis, it takes account of the patterns, communicative functions and effects of code choices and code switching as practices of interactional adjustment. The qualitative analysis sheds light on inclusive and non-inclusive interactional adjustments expressed through code choices by individual speakers, especially focusing on code accommodation at turn boundaries. Results indicate a high language awareness in the two speakers living with DAT and positive communicational outcomes when code accommodation is performed by the conversational partner.

Language as a primary vehicle for communication and cognition is intimately linked to the construction of identities and social relationships, and to social participation and inclusion. By means of appraisal analysis (a tool grounded in Systemic Functional Linguistics) of interview data, we explored attitudes to language(s), speakers and language use in a nursing home for older people in Ireland, where a large proportion of residents and staff are bilingual in Irish and English. We found that in their interviews, participating residents accord high value to their bilingualism and status of native Irish speakers. Participating staff members emphasize the value of Irish for relationship building and positive interactions among residents and staff. Residents’ strong bilingual identities and language preferences set a standard for deliberately bilingual practices, which affirm the local linguistic and cultural identity, while also actively including non-Irish speaking residents by treating both languages as resources for belonging.

This study traces the initial processes in creating and assessing ‘comics,’ or graphic materials of various sorts, which illustrate situations in dementia caregiving. Dementia care materials intended for paid caregivers need to accommodate three related work situations (home care aides, residential care aides and nursing assistants), and be comprehensible for low-literacy and second-language caregivers. Their creation draws on pragmatic constructs underlying an emphasis on reading oneself into the materials and on interpersonal interaction between caregiver and recipient. While our focus here is on English, we also illustrate our work with Filipino, Latin American Spanish, and Taiwanese Mandarin.

To help older adults living with cognitive impairments to engage in positive social interactions and maintain verbal creativity, intergenerational small-group sessions of haiku creation and appreciation activity were conducted online during the pandemic. Haiku, a short 17-syllable form of poetry originating in Japan, conveys simple yet emotive seasonal images free from the complexity or logical continuity required of prose. Accordingly, it offers anyone the challenge of an unfamiliar activity while minimizing impediment from linguistic and memory difficulties. The participants’ interactions during the activity and post-session interviews reveal that for both young and old, the haiku creation format facilitated self-expression and sharing of personal narratives. The key to meaningful interaction was the equal positioning of persons with and without cognitive impairments and their efforts to understand their interlocutor’s purpose and conversational direction. The study encourages further studies in pragmatics centered on affect-oriented communication.

Humor has been found to be used as a discourse strategy for negotiating power relations and mitigating FTAs in institutional elderly care. Drawing from two years of ethnography in two adult day centers in Taiwan, this article examines verbal play between a person living with dementia and a caregiver over time to illustrate how verbal play is used as meaningful, tailored practices for person-centered dementia care that leads to enhanced cognition and positive emotion. The caregiver’s framing of dementia care as person-centered and her laminating multiple frames of interactions to enrich communicative environments provides a fruitful approach to dementia care in institutional contexts and beyond.

Using recorded interactions between nursing home residents and care staff, this study demonstrates interactional strategies of younger recreation workers during a weekly recreational activity named Tea Time Talk that serves to reduce generational as well as epistemic gaps with the residents. This study focuses on how older residents’ reference to memory loss or forgetfulness is deindividuated and trivialized by humorously framing it as something the participants can forget together. I will claim that such intergenerational interactions on a regular basis help create solidarity between the residents and nursing home staff, as well as maintain dignity of and respect towards the older residents who often experience a sense of exclusion from the ‘here and now’ which affects their life satisfaction at the end-of-life stage.

This EMCA (Ethnomethodology and Conversation Analysis) study concerns carers’ multimodal methods for including residents living with dementia in social activities in remote locations. It illustrates how groups of residents are pre-arranged and how the residents are subsequently singled out one by one through requests to come along. Though the request may be the second one, it may be designed as a first request. Subsequently, carers employ multimodal methods to solicit moving and to escort the singled-out residents.

The paper concludes that carers’ methods are employed with a view to difficulties resulting from dementia and to pre-empt confusion in the residents. However, the methods may lead to exclusion. Except for one instance, this is not problematized by the residents. The paper argues that some residents may understand they will be included next or in a while. For other residents, forthcoming activities are not relevant unless extra efforts are made to reintroduce their relevance to them.

This study suggests that the concept of proto-conversation may be used to describe and understand communication with people with late-stage dementia who have lost their abilities to produce verbal language. In the study, a multimodal conversation analytic method is used to analyze sequences of interactions between professional caregivers in an elderly care home and people with late-stage dementia. The study shows how minimal actions (shift of gaze directions, vocalizations or bodily movements) not instantly recognizable as intentional, communicative conduct, may be recognized and treated as communicative contributions by engaging the person living with dementia in proto-conversations. In such interactional sequences, the caregivers do not only turn the contributions of persons with dementia into actions through their responses, but they also treat the persons as agentive actors and position them as partners in interaction.

This article highlights co-participant strategies during conversations involving participants diagnosed with dementia that encourage continued, productive interaction fostering inclusivity. The conversation excerpts illustrate positive results when non-impaired co-participants respond to impaired syntax as though it makes sense or as if it completes a coherent syntactic–semantic action. Helpful co-participants yield control of conversations, rather than issuing corrections; demonstrate an acuity for when to divert topics; and acknowledge their co-participants’ concerns. In contrast, non-inclusive strategies include overuse of questions, overcorrecting, minimizing dementia symptoms, or dismissing co-participants’ concerns, which frequently result in persons with dementia resisting or withdrawing from conversations, often accompanied by displays of anger. The goal is to raise awareness of strategies which promise an increase in and longer duration of interactions, decrease loneliness, and increase health and emotional outcomes of older persons.