Camilla Lindholm

Proverbs and formulaic sequences in the language of elderly people with dementia

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.

Parallel Realities: The Interactional Management of Confabulation in Dementia Care Encounters

Persons with dementia sometimes confabulate (that is, utter statements unaware of their falsity). This threatens the shared world that is normally presumed as the basis for communication. Coparticipants then have to choose between acquiescing in the confabulation, being noncommittal, or indeed correcting the speaker. In this conversation analytical case study of one individual with vascular dementia, I investigate how health-care personnel and volunteers deal with the problem. The data were extracted from a 30-hour video corpus of interactions between one confabulating person and, in total, eight other elderly individuals, three professional caregivers, and a volunteer at a Swedish-speaking day care center for the elderly in Finland. We see how care providers react to confabulations with a range of response practices along the continuum of acquiescence and noncommitment (but not into the more challenging area of correction). Data are in Finland-Swedish with English translation.

Dementia care for people from ethnic minorities: a Nordic perspective

Most Western countries have a sizeable ethnic minority migrant population. Although traditionally culturally homogenous, this is also true for the Nordic countries. In 2013, the population of foreign-born and first degree descendants constituted 21% of the population in Sweden (http://www.scb.se), 14% in Norway (http://www.ssb.no), 9% in Denmark (http://www.statistikbanken.dk), and 4% in Finland (http://www.stat.fi). Ethnic minority groups differ substantially between countries. Although differences also exist between the Nordic countries, migrants from former Yugoslavia, Turkey, Pakistan, and Poland represent some of the largest ethnic minority groups across the countries. The ethnic minority populations in Nordic countries are younger than the majority populations, but during the next decades, many will reach old age. Thus, the number of people from ethnic minorities with dementia is expected to increase considerably during the next 25 years (Figure 1). On the basis of this fact, Nordic countries now face an increasing demand for assessment, treatment, support, and care for people from ethnic minority groups. Although pioneering studies on dementia care for people from the Finnish minority in Sweden were conducted in the early 1990s (Ekman, 1993), it is not until the last 5 years that research and developments in the field of dementia and ethnic minorities have slowly emerged throughout the Nordic countries. Taken together, the research and clinical experiences indicate that the current practice for care for people from ethnic minority groups is suboptimal. Older members from ethnic minority groups and their families seem to underuse dementia services, and only 11% of the expected number of elderly from ethnic minorities with dementia receives a formal dementia diagnosis (Nielsen et al., 2011). This is concerning as it may lead to poorer dementia outcome and care for people from ethnic minorities. The barriers to accessing dementia services have not been well studied but may include language barriers, different help-seeking patterns, poor knowledge, and misconceptions about dementia, in addition to different cultural views on caregiving. When evaluating memory problems in patients from ethnic minorities, clinicians sometimes rely on unqualified interpreters or family members as interpreters. This may affect the evaluation and be a barrier for efficient communication. Also, most clinics perform assessments with cognitive instruments that are only validated in Western populations. These challenges are not only present in the Nordic countries but seem to be similar across Europe (Nielsen et al., 2011). Although the Rowland Universal Dementia Assessment Scale has been validated (Nielsen et al., 2013) and implemented for multicultural cognitive screening in several dementia clinics across Denmark, Sweden, and Norway, culture sensitive dementia services are generally lacking. In Nordic countries, few older members from ethnic minority groups live in care facilities, and when they do, the communication and interaction between staff and elderly, who do not have any language in common, has proven to be challenging and to affect the quality of care (Plejert et al., 2014). Mainstream care facilities are rarely prepared to provide appropriate services for patients and families from ethnic minorities, as they often will have different needs and expectations to the dementia services. Although efforts to deliver culturally sensitive and appropriate care for elderly from ethnic minorities exist in all Nordic countries, they are scarce. Figure 1 Prognosis for foreign-born and first degree descendants with dementia in Denmark. Prevalence estimates are based on demographic data from Statistics Denmark and West European dementia prevalence rates from the World Alzheimer Report 2009.

Boundaries of participation in care home settings: Use of the Swedish token jaså by a person with dementia

ABSTRACT This article is a conversation analytic study of how one elderly person with dementia and her interlocutors interact in a care home setting. Participation is studied in the form of responsive action of the person with dementia, focusing on the Swedish response token ‘jaså,’ which has not previously been analysed in detail. The central claim is that even though the sequential placement of the response token indicates interactional competence, other factors reveal limited competence and communication impairment. First, the person with dementia’s use of gaze is reduced, and she seems to rely on the auditory but not on the visual channel. Second, the interlocutors do not in all situations treat her as a ratified participant in spite of her attempts to contribute to the interaction. This study contributes both to the study of participation in the context of communication impairment and to the study of response tokens in Swedish.