Journal of Language Aggression and Conflict - Volume 4, Issue 1, 2016

Sociolinguistic research in the general population has established the existence of gender differences in the social use of language. In particular, it has been noted that women use more markers of politeness, small talk and structural devices (e.g. minimal responses, tag questions) to help maintain their conversations. Analysis of interactions involving people with dementia (PWD) suggests that these gender based differences were still present in the face of dementia. Furthermore, the use of these forms of language helped the women with dementia to avoid conflict and extend the length of their interactions. This study investigated whether the use of such language helped or hindered women with dementia in maintaining conversational satisfaction.

Differences in power are frequent in institutional care settings and provide contexts in which conflict can occur. In order to examine the power imbalance between residents and caregivers and the consequent potential for verbal conflict we first discuss the situations in which persons with dementia (PWD) find themselves within long-term residential care institutions and the interactions they commonly experience with those who care for them. We then examine strategies commonly used by conversational partners that either support or hinder the attempts by PWD to interact competently. The strategies may lead to cooperative conversations or verbal conflicts. They include caregiver marginalization as well as joking and teasing, both of which may serve to positively support PWD or can minimize conflict (Offord et al. 2006; Schnurr and Chan 201l) and can be initiated by both residents and caregivers. The final section contains case studies of interactions with two PWD, “Madge” and “Maureen”, to illustrate the minimization and the positive and negative use of joking and teasing in interactions with PWD. We conclude with a brief discussion with “Maureen” on joking and deliberate repression of conflict.

Clinically, frontotemporal dementia (FTD) is described as primarily affecting personality and interpersonal conduct and resulting in social behavioral disruptions, thus often giving rise to interpersonal conflict. Conflict behavior in both typical and dementia populations is frequently identified as explicit physical and verbal acts such as assault, yelling or insulting, and research often situates conflict and collaboration as opposing dimensions. The premise of this article is to examine the unfolding of moments in which individuals diagnosed with FTD and their carers demonstrate opposing orientations towards an activity in real time interaction: A home nurse needing to fulfill an institutional agenda — taking sitting blood pressure — seeks the cooperation from an individual who, in attempting to lie down, interferes with this agenda. These moments constitute sources of interactional conflict that carers attempt to resolve. However, often conflict behavior and cooperative behavior are not neatly teased apart; for instance, individuals often display conflicting orientations towards an overarching or guiding activity while cooperating in more immediate and discrete interactional tasks. These verbal/nonverbal conflicts are not large acts of aggression; rather, they may be viewed as arising within the mundane moments of life that individuals face in everyday contexts and frequently.

A significant number of people with dementia show challenging behaviours; one of the most challenging is vocally disruptive behaviour (VDB). VDB may be difficult to manage in all settings but particularly in rest homes and private dementia care hospitals. In a 2011 study direct observation of VDB was used to analyse the incidence, content of and response to VDB in two private New Zealand residential dementia care hospitals. Examples of VDB from both hospitals are discussed to illustrate the nature of VDB, both purposive and non-purposive. The relationship of the antecedents and consequences to the VDB are highlighted. Possible interventions to reduce VDB are reviewed. This challenging behaviour is highly variable and case specific. Caregivers would benefit from specific training to equip themselves with a range of interventions to allow for the individual needs of residents and the changing nature of the behaviour. More studies that use direct observation and participatory action research would enhance the current understanding of VDB and how to effectively manage it.

It is proposed that conflict is an almost inevitable outcome, when, as in dementia communication, the delicate relationship between linguistic processing and pragmatics is upset. This relationship has been little researched, even though much is known about the two components in isolation. Making particular use of key observations and claims from the papers in this special issue, a macro-conceptualisation of the dynamics of conflict and aggression in the dementia context is developed. It is proposed that the cognitive and linguistic processing problems experienced by a person with dementia (PWD) can undermine her capacity to manage her spoken output in the way necessary to match the situational pragmatics, resulting in failure to achieve her interactional goals. The mismatch will create internal dissonance that may be expressed as aggression. Importantly, caregivers will also experience dissonance when their communicative agenda is not fulfilled. This may happen when their expectations of the situational pragmatics (e.g., old versus new information) are contradicted by the behaviour of the PWD. Here too, the dissonance may result in aggression or conflict. Modelling the mechanisms of ‘Communicative Impact’ (CI) offers a way to capture the relationship between processing and pragmatics and to examine how speakers attempt to resolve the dissonance. The CI model gives insights into how the risk of conflict in interaction between people with dementia and their caregivers might be minimised.