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A different story: exploring patterns of communication in residential dementia care

Published online by Cambridge University Press:  03 November 2008

RICHARD WARD ,
ANTONY A. VASS ,
NEERU AGGARWAL ,
CYDONIE GARFIELD  and
BEAU CYBYK
RICHARD WARD
Affiliation:
Centre for the Older Person's Agenda, Queen Margaret University, Edinburgh, UK.
ANTONY A. VASS
Affiliation:
Centre for the Older Person's Agenda, Queen Margaret University, Edinburgh, UK.
NEERU AGGARWAL
Affiliation:
Centre for the Older Person's Agenda, Queen Margaret University, Edinburgh, UK.
CYDONIE GARFIELD
Affiliation:
Centre for the Older Person's Agenda, Queen Margaret University, Edinburgh, UK.
BEAU CYBYK
Affiliation:
Centre for the Older Person's Agenda, Queen Margaret University, Edinburgh, UK.
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Abstract

This article reports findings from a three-year project on ‘Communication patterns and their consequences for effective care’ that explored communication in dementia-care settings. As the proportion of people with dementia living in British care-homes continues to grow, there is a need to understand better their care. Using a range of qualitative methods, the project set out to identify the constituent elements of dementia-care practice and the patterns that characterise day-to-day relations in care homes. The tightly prescribed and standardised nature of the interactions between staff and residents is described: it raises questions about the capacity for dementia care to be truly person-centred. The project found that people with dementia are both capable of communication, and invest much effort in seeking to engage those around them, but are excluded from the monitoring, planning and provision of care in ways that we argue are discriminatory. The case is made for promoting and supporting communication as key skills and competencies for care workers. The value of measuring the level and quality of communication as a means to evaluate care is demonstrated. The authors question the priorities that currently guide care practice and argue that we need to listen to people with dementia and rethink what lies at the heart of dementia care.

Keywords

dementiaAlzheimer's diseasecare homescommunicationcare workdisablismperson-centred care
Type
Research Article
Information
Ageing & Society , Volume 28 , Issue 5 , July 2008 , pp. 629 - 651
Copyright
Copyright © 2008 Cambridge University Press

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References

Aggarwal, N., Vass, A. A., Minardi, H., Ward, R., Garfield, C. and Cybyk, B. 2003. People with dementia and their relatives: personal experiences of Alzheimer's and of the provision of care. Journal of Psychiatric and Mental Health, 10, 2, 187–97.Google ScholarPubMed
Bender, M. and Cheston, R. 1997. Inhabitants of a lost kingdom: a model of the subjective experiences of dementia. Ageing & Society, 17, 5, 513–29.CrossRefGoogle Scholar
Berg, A., Hallberg, I. R. and Norberg, A. 1998. Nurses' reflections about dementia care, the patients, the care and themselves in their daily caregiving. International Journal of Nursing Studies, 35, 5, 271–82.CrossRefGoogle Scholar
Bowie, P. and Mountain, G. 1993. Using direct observation to record the behaviour of long-stay patients with dementia. International Journal of Geriatric Psychiatry, 8, 10, 857–64.CrossRefGoogle Scholar
Brooker, D. 1995. Looking at them looking at me: a review of observational studies in the quality of institutional care for elderly people with dementia. Journal of Mental Health, 4, 2, 145–56.CrossRefGoogle Scholar
Butler, J. 1993. Bodies that Matter: On the Discursive Limits of Sex. Routledge, London.Google Scholar
Coupland, N., Coupland, J., Giles, H. and Kenwood, K. 1988. Accommodating the elderly: invoking and extending a theory. Language in Society, 17, 1, 1–41.CrossRefGoogle Scholar
Dean, R., Proudfoot, R. and Lindesay, J. 1993. The quality of interactions schedule (QUIS): development, reliability and uses in the evaluation of two domus units. International Journal of Geriatric Psychiatry, 8, 819–26.CrossRefGoogle Scholar
Drew, P. and Heritage, J. 1992. Analyzing talk at work: an introduction. In Drew, P. and Heritage, J. (eds), Talk at Work: Interaction in Institutional Settings. Cambridge University Press, Cambridge, 3–65.Google Scholar
Edberg, A. K., Sandgren, A. N. and Hallberg, I. R. 1995. Initiating and terminating verbal interaction between nurses and severely demented patients regarded as vocally disruptive. Journal of Psychiatric and Mental Health Nursing, 2, 3, 159–67.CrossRefGoogle ScholarPubMed
Gilliard, J., Means, R., Beattie, A. and Daker-White, G. 2005. Dementia care in England and the social model of disability: lessons and issues. Dementia, 4, 4, 571–86.CrossRefGoogle Scholar
Gilloran, A. J., McGlew, T., McKee, K., Roberston, A. and Wight, D. 1993. Measuring the quality of care in psychogeriatric wards. Journal of Advanced Nursing, 18, 2, 269–75.CrossRefGoogle ScholarPubMed
Godlove, C., Richard, L. and Rodwell, G. 1982. Time for Action: An Observational Study of Elderly People in Four Different Care Environments. Joint Unit for Social Services Research, University of Sheffield, Sheffield.Google Scholar
Goldsmith, M. 1996. Hearing the Voice of People with Dementia: Opportunities and Obstacles. Jessica Kingsley, London.Google Scholar
Graham, R. 2004. Cognitive citizenship: access to hip surgery for people with dementia. Health, 8, 3, 295–310.CrossRefGoogle ScholarPubMed
Grainger, K., Atkinson, K. and Coupland, N. 1990. Responding to the elderly: troubles-talk in the caring context. In Giles, H., Coupland, N. and Wiemann, J. M. (eds), Communication, Health and the Elderly. University of Manchester Press, Manchester, UK.Google Scholar
Hallberg, I. R., Norberg, A. and Eriksson, S. 1990. A comparison between the care of vocally disruptive patients and that of other residents at psychogeriatric wards. Journal of Advanced Nursing, 15, 4, 410–6.CrossRefGoogle ScholarPubMed
Hallberg, I. R., Edberg, A-K., Nordmark, A., Johnsson, K. and Norberg, A. 1993. Daytime vocal activity in institutionalised severely demented patients identified as vocally disruptive by nurses. International Journal of Geriatric Psychiatry, 8, 2, 155–64.CrossRefGoogle Scholar
Hamilton, H. E. 1994. Conversations with an Alzheimer's Patient: An Interactional Sociolinguistic Study. Cambridge University Press, Cambridge.CrossRefGoogle Scholar
Heritage, J. 1997. Conversation analysis and institutional talk: analysing data. In Silverman, D. (ed.), Qualitative Research: Theory, Method and Practice. Sage, London, 161–82.Google Scholar
Hochschild, A. R. 1983. The Managed Heart: Commercialization of Human Feeling. University of California Press, Berkeley, California.Google Scholar
Hubbard, G., Cook, A., Tester, S. and Downs, M. 2002. Beyond words: older people with dementia using and interpreting nonverbal behaviour. Journal of Aging Studies, 16, 2, 155–67.CrossRefGoogle Scholar
Iwasiw, C. L. and Olson, J. K. 1995. Content analysis of non-professional caregiver-patient interactions in long-term care facilities. Clinical Nursing Research, 4, 4, 411–24.CrossRefGoogle Scholar
Killick, J. and Allan, K. 2001. Communication and the Care of People with Dementia. Open University Press, Buckingham.Google Scholar
Kitwood, T. 1997. Dementia Reconsidered: The Person Comes First. Open University Press, Buckingham.Google Scholar
Kontos, P. 2004. Ethnographic reflections on selfhood, embodiment and Alzheimer's disease. Ageing & Society, 24, 6, 829–49.CrossRefGoogle Scholar
Lanceley, A. 1985. Use of controlling language in the rehabilitation of the elderly. Journal of Advanced Nursing, 10, 2, 125–35.CrossRefGoogle ScholarPubMed
Lee-Treweek, G. 1997. Women, resistance and care: an ethnographic study of nursing auxiliary work. Work, Employment and Society, 11, 1, 47–63.CrossRefGoogle Scholar
MacDonald, A. 2005. Care homes and dementia. Aging and Mental Health, 9, 2, 91–2.CrossRefGoogle ScholarPubMed
MacDonald, A. and Dening, T. 2002. Dementia is being avoided in NHS and social care. British Medical Journal, 324, 548.CrossRefGoogle ScholarPubMed
Marshall, M. 1994. Emerging Trends in Dementia Care: Some Thoughts on the Next Ten Years. Paper presented at Alzheimer's Disease International conference, Edinburgh, Scotland, 23rd September.Google Scholar
McCann, J. J., Gilley, D. W., Herbert, L. E., Beckett, L. A. and Evans, D. A. 1997. Concordance between direct observation and staff rating of behavior in nursing home residents with Alzheimer's disease. Journal of Gerontology: Psychological Sciences, 52, 2, P63–72.CrossRefGoogle ScholarPubMed
Nolan, M., Grant, G. and Nolan, J. 1995. Busy doing nothing: activity and interaction levels amongst differing populations of elderly patients. Journal of Advanced Nursing, 22, 3, 528–38.CrossRefGoogle ScholarPubMed
Reed-Danahay, D. 2001. ‘This is your home now’: conceptualizing location and dislocation in a dementia unit. Qualitative Research, 1, 1, 47–64.CrossRefGoogle Scholar
Reilly, S., Abendstern, M., Hughes, J., Challis, D., Venables, D. and Pedersen, I. 2006. Quality in long-term care homes for people with dementia: an assessment of specialist provision. Ageing & Society, 26, 4, 649–68.CrossRefGoogle Scholar
Schreiner, A. S., Shiotani, H. and Yamamoto, E. 2005. Positive affect among nursing home residents with dementia: the effect of recreation therapy. Journal of Aging and Mental Health, 9, 2, 129–34.CrossRefGoogle Scholar
Small, J. A., Geldart, K., Gutman, G. and Clarke Scott, M. A. 1998. The discourse of self in dementia. Ageing & Society, 18, 3, 291–316.CrossRefGoogle Scholar
Thomas, C. 1993. De-constructing concepts of care. Sociology, 27, 4, 649–69.CrossRefGoogle Scholar
Vass, A. A., Minardi, H., Ward, R., Aggarwal, N., Cybyk, B. and Garfield, C. 2003. Dementia of the Alzheimer's type: communication patterns and their consequences for effective care – ethical considerations. Dementia, 2, 1, 21–48.CrossRefGoogle Scholar
Ward, R., Vass, A. A., Aggarwal, N., Cybyk, B. and Garfield, C. 2002 a. Communication and care. Part 1: Expanding our understanding. Journal of Dementia Care, 10, 5, 33–6.Google Scholar
Ward, R., Vass, A. A., Aggarwal, N., Cybyk, B. and Garfield, C. 2002 b. Communication and care. Part 2: Communication in context. Journal of Dementia Care, 10, 6, 33–7.Google Scholar
Ward, R., Vass, A. A., Aggarwal, N., Garfield, C. and Cybyk, B. 2005. What is dementia care? Dementia is communication. Journal of Dementia Care, 13, 6, 16–9.Google Scholar