OXFORD UNIVERSITY PRESS

The Dynamics of Dementia Communication

ISBN : 9780190917807

Price(incl.tax): 
¥15,246
Author: 
Alison Wray
Pages
352 Pages
Format
Hardcover
Size
156 x 235 mm
Pub date
Mar 2020
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It is well recognized that when people are living with a dementia, effective communication can be a challenge for both them and those they interact with. Despite a plethora of good advice, it can be surprisingly hard to sustain constructive communicative behaviours and to integrate them successfully into routine daily care and interaction.

The Dynamics of Dementia Communication asks why that is. What is it about communication, as a human social and cognitive practice, that makes it so difficult to manage the disruptions caused by dementia? Why is it so common to feel awkward, confused or irritated when talking with a person living with a dementia? Why is the experience of living with a dementia so personally and socially devastating? What approaches to communication would work best, and why? To answer these questions, the book integrates information from a wide range of different sources, covering the biological, social, and emotional factors associated with the dementia experience. New concepts and theoretical perspectives offer novel ways of thinking about the challenges of communication generally, and in the context of dementia. Topics explored include whether it is acceptable to deceive people living with a dementia and why society's failure to support people living with a dementia and their carers is so devastating. The final chapter suggests what people living with a dementia need if communication is to promote and protect everyone's well-being.

By providing a deeper understanding of what topples the best-intentioned attempts at interaction, and by explaining why poor communication affects everyone involved, this book sets new agendas for improving the welfare of people living with a dementia, their families, and professional carers.

Index: 

FOREWORD

Should You Read This Book?

Summary of the Main Ideas in the Book

Is This Book for You?

How the Book Came About

PART ONE: CONTEXTS SHAPING COMMUNICATION

CHAPTER ONE: THE CHALLENGES OF COMMUNICATION IN THE DEMENTIA CONTEXT

1.1 Why Is It Difficult to Sustain Effective Communication Practices in Dementia Interaction?

1.2 Overview of the Book

1.3 Key Concepts

1.3.1 Defining 'Dementia'

1.3.2 Defining 'Communication'

1.4 Core Orientations

1.4.1 Personhood

1.4.2 Recognising the Role of Ego

1.5 Concluding Remarks

CHAPTER TWO: THE BIOLOGICAL DETERMINANTS OF DEMENTIA COMMUNICATION

2.1 How Do the Brain Changes Associated with Diseases of Dementia Affect Communication?

2.2 Exploring the Language of People with Alzheimer's Disease

2.2.1 Overview of Alzheimer's Disease

2.2.2 The Impact of Alzheimer's Disease on Language

2.2.3 The Impact of Alzheimer's Disease on Pragmatic Capabilities

2.2.4 Language as a Marker of Future Alzheimer's Disease

2.3 Language and Communication in Fronto-temporal Lobar Degeneration

2.3.1 Overview of Fronto-temporal Lobar Degeneration

2.3.2 The Impact of Semantic Dementia on Communication

2.4 The Impact on Language and Communication of Other Dementias

2.5 Pinning Down 'Dementia Communication'

2.6 Variation in Susceptibility to Diseases of Dementia and Their Symptoms

2.6.1 Why Do the Brain Changes Affect People and Their Communication Differently?

2.6.2 Genetic Disposition to Diseases Causing Dementia

2.6.3 Environmental Factors

2.6.4 'Rementia' and Temporary Lucidity

2.6.5 Brain and Cognitive Reserve

2.7 Concluding Remarks

CHAPTER THREE: THE ROLE OF MEMORY IN COMMUNICATION

3.1 What Constraints on Communication are Imposed by Memory Deficits in Dementia?

3.2 Long-Term Memory

3.2.1 Declarative Memory

3.2.2 Implicit Memory

3.2.3 Emotional Memory

3.3 Short-Term and Working Memory

3.4 How We Bring Information Back to Mind

3.5 Memory Changes in Normal Aging and in Dementia

3.6 The Impact of Memory Impairment on Communication

3.7 A Deeper Look at Episodic Memory and Communication

3.7.1 Episodic Memory and Autonoetic Experience

3.7.2 The Unreliability of Episodic Memory

3.7.3 The Impact of Losing Reliable Episodic Memory

3.8 Concluding Remarks

CHAPTER FOUR: THE SOCIAL CONSTRUCTION OF DEMENTIA

4.1 How Do Social Attitudes and Contexts Shape How We Interact with People Living with a Dementia?

4.2 Social and Emotional Factors Exacerbating Dementia Symptoms

4.3 The Construction of Dementia as a Disease

4.3.1 The Medicalization of Age-related Degenerative Diseases

4.3.2 The Commodification of Dementia Research

4.3.3 Defining People by Test Results

4.3.4 Mild Cognitive Impairment and the Boundary with 'Normal Functioning'

4.3.5 How People Living with a Dementia are Treated

4.4 Dementia as a Social Burden

4.4.1 Western Attitudes to Dementia and Care

4.4.2 Alternative Perceptions of Dementia

4.5 The Protection Afforded by 'Social Reserve'

4.5.1 What is Social Reserve?

4.5.2 Social Reserve and Social Capital

4.6 Concluding Remarks

CHAPTER FIVE: THE EXPERIENCE OF DEMENTIA COMMUNICATION

5.1 How Do Constraints on Communication Shape the Experiences of People Living with a Dementia and Their Carers?

5.2 Communicating When You Have a Dementia

5.2.1 Communicating the Dementia Experience

5.2.2 What People Living with a Dementia Say They Need

5.3 How Family and Professional Carers Communicate with People Living with a Dementia

5.3.1 The Emotional Burdens that Carers Bring to an Interaction

5.3.2 The Expression of Carers' Emotional Burden

5.3.3 Interaction between Professional vs Family Carers

5.4 Conceptualising Emotional Reserve

5.5 Concluding Remarks

CHAPTER SIX: APPROACHES TO EFFECTIVE COMMUNICATION IN CARE

6.1 How Do Approaches to Care Attempt to Address Challenges in Communication?

6.2 Person-centred and Relationship-centred Care

6.3 How to Communicate Well with People Living with a Dementia

6.3.1 Communication Parameters in Care Approaches

6.3.2 Content

6.3.3 Presentation of Information

6.3.4 Pragmatics and Contextual Expectations

6.3.5 Delivery

6.3.6 Environment

6.3.7 Attention to the Person's Needs

6.3.8 Affective Orientation

6.3.9 Nonverbal Communication

6.3.10 Widening the Scope of Communication

6.4 Concluding Remarks

PART TWO: CONCEPTUALISING COMMUNICATION

CHAPTER SEVEN: COMMUNICATION PROCESSES

7.1 How Do We Achieve Impact through Communication?

7.2 Overview of the Communicative Impact Model

7.2.1 The Three Components

7.2.2 The Role of the Hearer

7.3 Exploring the Context Component

7.4 Exploring the Resources Component

7.5 Exploring the Processing Component

7.6 Matters Arising

7.6.1 The Dynamics of Three or More

7.6.2 How Can We Judge Our Communicative Impact?

7.6.3 Why Does CI Work? What's in It for the Hearer?

7.7 Concluding Remarks

CHAPTER EIGHT: CONCEPTUALISING COMMUNICATION

8.1 How is the Communicative Impact Model Theoretically Justified?

8.2 Humans' Drive to Create a Comfortable World

8.2.1 An Evolutionary Impetus

8.2.2 Humans' Priorities in Modifying their World

8.2.3 Altruism: Promoting the Well-being of Others

8.3 Pragmatic Theory and the Context Component

8.4 Getting What We Want

8.5 Knowing What to Say: the Use of Context

8.5.1 Defining 'Context'

8.5.2 Using Context for Communicative Impact

8.5.3 Building and Structuring Context through Schemas

8.6 Formulating Output

8.6.1 Navigating Explicitness

8.6.2 From Selection to Execution

8.7 Concluding Remarks

PART THREE: APPLICATIONS AND IMPLICATIONS

CHAPTER NINE: DRIVERS OF DISRUPTED COMMUNICATION

9.1 Why Is Dementia So Disruptive to Communication?

9.2 The Role of Context in Sustaining Effective Communication

9.2.1 Contextual Gaps as a Catalyst for Low Social and Emotional Reserve

9.2.2 Pronouns as a 'Case Study' of Context in Communication

9.3 Dementia Communication: Problems and Responses

9.4 Unintended Consequences of Meeting Problems with Solutions

9.5 Awkward Pragmatic Gaps

9.6 Insights from Second Language Interaction

9.7 Concluding Remarks

CHAPTER TEN: DIFFERENT IN DEGREE OR KIND? HOW PEOPLE LIVING WITH A DEMENTIA ARE POSITIONED

10.1 How Does the Conceptual Positioning of People Living with a Dementia Impact on Communication?

10.1.1 Exploring Degree and Kind

10.1.2 Manifestations of the Degree and Kind Perspectives

10.2 The Carers' Paradox

10.3 Deception in Dementia Interaction

10.3.1 Defining Deception

10.3.2 Nuances of Deception and Truth-telling

10.3.3 Arguments for and Against Deceiving People Living with a Dementia

10.3.4 Case Study: Specialized Early Care for Alzheimer's (SPECAL)

10.3.5 How Do Deceptive Practices Relate to Degree and Kind?

10.3.6 Unrealistic Expectations?

10.4 Reconceptualising Degree and Kind

10.5 Concluding Remarks

CHAPTER ELEVEN: AN AGENDA FOR IMPROVING COMMUNICATION IN THE DEMENTIA CONTEXT

11.1 What Are the Priorities for Improving Communication by and with People Living with Dementia?

11.1.1 Why We Communicate

11.1.2 How Dementia Disrupts Communication

11.1.3 Emotional and Social Reserve

11.1.4 Difference in Degree and Kind

11.1.5 Carers' Paradox and Awkward Pragmatic Gaps

11.2 What Do People Living with a Dementia Need from Their Interlocutors?

11.2.1 Opportunities for Communication

11.2.2 Real Communication

11.2.3 Communicative Support

11.2.4 Kindness and Compassion

11.2.5 Empowerment: Alternative Routes to Communicative Impact

11.2.6 Insight and Flexibility

11.2.7 Building Social and Emotional Reserve

11.2.8 Respect and Dignity

11.2.9 Navigating Truth and Deception

11.3 Towards Better Communication

11.3.1 Linking New Ideas to Existing Practice

11.3.2 Mapping Effective Practices for the Interlocutor as Hearer and Speaker

11.4 Kindness and the Communicative Agenda in Care

11.5 Concluding Remarks

REFERENCES

ENDNOTES

About the author: 

Alison Wray took her BA and D.Phil in linguistics at the University of York, UK. After completing a postdoctoral research project on singers' pronunciation in the Department of Music at York, she held a lectureship in linguistics at the then College of Ripon and York St John (now York St John University). In 1996 she was appointed Assistant Director of the Wales Applied Language Research Unit at Swansea University, and in 1999 became a Senior Research Fellow at Cardiff University. She became a (full) Professor at Cardiff in 2005 and a Research Professor in 2007. She is internationally known for her research into formulaic language, publishing two seminal books on the topic in 2002 and 2008. Since 2008 she has focussed on understanding the challenges of communication by and with people living with a dementia and has presented on this topic in countries around the world.

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