The Ambiguous Space ofthe Bathroom While Extract 1 casts light on the unclear boundary between public and private that signifies the very nature of the care facility, in this section, I focus specifically on bathroom interactions, through which care workers negotiate their presence in this ambiguous space. All right! Indeed, the immediate physical environment has been found to play a large role in the structuring of discourse among persons with dementia; e.g., Hamilton (2008) found that the majority of talk involving an individual with Alzheimers disease centered on physical objects or people in the immediate environment rather than involving memories or abstract thoughts. 24. 04. What, then, does the visitor say to build on Ms. Todds response? In Agathas view, while Markus might have difficulty formulating responses and choosing among options, this is not the case with politics where he really knows his stuff. Indeed, rather than facilitating his communication, Agatha sometimes feels like she has to discourage Markus from discussing the topic. Stina: 25. Adila: 27. Analysis Now, the analysis presented below and the subsequent arguments made from it should be qualified. mmm hmm I hope to celebrate my fiftieth one day. Recommended Readings Backhaus, P. (2017b). 10 Dementia and the Life Course: Examining Cognitive Decline 207 Practical Highlights 1. Furthermore, patients family members might be able to offer insights on symptomology that the patient is not able to self-report. (2009). However, inadvertently, Agathas interview provides numerous insights into the communication difficulties the first author encountered. This approach can help clinicians obtain a more comprehensive picture of an 10 Dementia and the Life Course: Examining Cognitive Decline 195 individuals symptomology than an exclusive focus on objective testing or patients self-reports. ), Dementia: Mind, meaning and the person (pp. Oxford, UK: Oxford University Press. Our findings suggest how art galleriesand perhaps other kinds of museumsmay be used to promote personal agency and feelings of well-being for persons with dementia managing symptoms related to memory and language. Halpin, M. (2018). Markus then tells a long story about being impacted by mysterious symptoms that no physician could explain. Oh [thats neat. Positioning the actions of talk so that participants with dementia can respond accordingly is, perhaps, the best way to ensure they may demonstrate retained competencies within such mundane interactions and prevent disruptions in interpersonal relationships. The function of questions in institutional discourse. 09. Thats a lot of bells= =It is. 11.1). No she [doesnt like it.] 11. Ivan: 21. vom Lehn, D., Heath, C., & Hindmarsh, J. I describe the strategies by which a resident creates a sense of home and privacy in the common living room and demonstrate how this leads to problematic situations that the care staff has to manage. Thinking about dementia: Culture, loss, and the anthropology of senility. 17. Translations of Swedish into English are meant to be comprehensible, albeit not always altogether idiomatic. 13. 73. 11.4 (2.0) ((showering goes on)) 11 Public and Private Spaces in Residential Care 219 12. The psychiatrist then opens an envelope containing Scotts testing results, and discloses that Scott, indeed, has HD. We may easily envision how important assessment activities are, then, in the negotiation of mutual alignment or dis-alignment in interaction. In terms of qualitative methods, Markus interview, as with Scotts, stresses the importance of not extrapolating a participants cognitive symptoms across different domains of conversation. You probably count faster than I do. Amsterdam, NL; Philadelphia, PA: John Benjamins. 10. Yeah, we made those plates here, not too long ag- well, yeah its been a good while [() [That plates beautiful. As FTD is a neuropathological syndrome that disrupts social behavior impacting both intersubjective co-construction in activities and alignment in interpersonal relationships, the employment of assessments within conversations with persons with FTD is examined within this chapter. Text-Interdisciplinary Journal for the Study of Discourse, 5(3), 147168. As noted by Twigg (2000, p. 145) and demonstrated in ethnographic studies (Grainger, 1993; Jansson & Plejert, 2014; Plejert, Jansson, & Yazdanpanah, 2014), bodywork in care may involve embarrassing or painful procedures. 03. ), Structure of social action: Studies in conversation analysis (pp. 138 A. R. Isaac and H. E. Hamilton As Nevile etal. Further, Rhondas question codes the object in her hand near the dog (lines 34) as the object of knowledge (Goodwin, 1994) and highlights it by offering the candidate response is it a letter or? (line 4). var har du kpte dom? Here, Scott again leaves the topic of the grand tour question and returns to discussing his time overseas. Since care workers in my study could only leave residents out of sight momentarily, they only had at their disposal the area of the bathroom itself and, in many cases, the shower cabin to maintain a certain degree of privacy for residents. Adila usually sits in an armchair with a small table beside her where she has her afternoon coffee (see Fig. I told him that I was (pause) relieved. We can see some of the underlying mechanisms of Fredas turn and, from 9 Disagreements in Assessment Sequences with Persons 175 the anomalies to mundane conversation order, some of the reasons why Penny did not receive it. Also, since the patient has already committed to an expected evaluation of the referent, Diane is able to produce a 180 M. S. Smith like-assessment in the first position. 03. After the interviewer poses the question, Markus responds, do I remember what day it was? 02. 30. Right. Adila: (R) stina: medina: Medina: stina: hej Adila. 17. (xx) looks at Adila--------->> smiles; tilts head aside lazemlen trab ahmar jdid, (.) As genetic technologies advance, individuals with other forms of dementia might encounter similar predictive technologies. ), The handbook of psycholinguistic and cognitive processes (pp. dreamfit plunge Assessments may be positive or negative or somewhere in between. [Housen, 1999; Ritchhart, 2007]). The guides who sat with the visitors attempted to assume the visitors visual perspective and often attended to the visitors overlapping talk, both to which the lead guide may not have had access. Im Not Disabled, Im Under-Employed: Emergence ofInitial HD Symptoms The second case we review is based on an interview completed with Scott, a Canadian/English citizen in his late 40s. 06. Extract 2: Moa is rinsing the shampoo from Oves hair with the shower tube 01. Include occasional pauses to invite residents to say whats on their minds, especially in relation to topics about which they might know a great deal. 23. 08. 5. The function of questions in institutional discourse (pp. Important related efforts by analysts to understand the role of knowledge within such settingsin particular the various ways in which participants in interaction design their contributions, and understand the contributions of others, in relation to a distribution of knowledge that is assumed to preexist (Sidnell, 2015, p. 1)fall within what is referred to as the epistemics of social interaction (see also Heritage, 2012; Stivers, Mondada, & Steensig, 2011). Despite these attempts, research indicates that problems associated with the institutionalization of older peoples care, such as loss of privacy, remain (Heinemann, 2011; Jansson, 2016), and residents are limited in maintaining privacy or exerting control (Hauge & Heggen, 2008)all of which are key characteristics of a home according to social anthropologists (e.g., Douglas, 1991). 19. Despite Ivans negotiations, the continuation of the interaction, marked by opposition and complaining, embodies the vulnerability that frames the care encounter. New York, NY: Oxford University Press. (you) may stand on your hands [j:a [y:ea he he [he he he ((laughter)) [hi hi hi hi .h he he he he .h (.) 14. Siri: 07. With the first case, Debbie, dementia is a specter, such that the 206 M. Halpin and N. Richard prospective impact of the disease can be haunting, but its effects are still abstract and ephemeral. 55. So almost normal. 12. ), Learning from the Talk of Persons with Dementia, The Language of Mental Health, https://doi.org/10.1007/978-3-030-43977-4_11 209 210 G. Jansson Introduction Disability can necessitate care that involves transgressing customary social rules concerning privacy. Penny: [I like it (a lot) No because this ones broken (.) Heritage (1984) notes that such tokens are often found in informing and serve to signal the receipt of new information. Extract 1a3 01. First, the presence of Fredas assessment but also her demonstrative reordering of the turn depicts the underlined utterances transformabilityat least this one that we have seen Freda, at various times, use as different actions. Still, the way the resident is portrayed as a sport diver invokes a masculine and vigorous identity, and dispels any potential unpleasant or threatening experience of the hair wash. Having finished the hair wash, Moa leaves the washing of the body to the resident (lines 0506), varsgod Ove (.) Yes I think- I think its a letter, Some people think its a book but I think its a letter. How may I help you?: Questions, control, and customer care in telephone call center talk. Mmm hmm ((laughter)) That- that is cute, I like the bear. Quantitative analyses reveal that art gallery guides asked 129 of the 193 (67%) questions posed during these three tours, while visitors asked 64 of the 193 questions (33%). Draw upon public objects (e.g., those in art museums or public spaces of care facilities) and private objects (e.g., personal photos, keepsakes) as potential topics of talk. [And I like Mary and the baby too. How does Ms. Todd respond initially (in lines 1214) to the visitors comment about the bells in line 11? Corpus Linguistics and Linguistic Theory, 7(1), 143161. 26. Language, dementia and meaning making: Navigating challenges of cognition and face in everyday life. What is also apparent is how ingrained these expectations are for us that the presence of a diagnosis that sufficiently accounts for the action(s) absence is not sufficient for the co-participant to give an immediate or automatic pass for the anomalies in the talk. Based on Scotts self-assessment, his interactions with the interviewer, as well as indications from health care workers, the first author suspected his HD symptoms would not impact their interview. 324). Discourse Studies, 12(4), 465500. 18. Three, four, five, six, seven, eight, nine, ten, eleven, twelve, thirteen, fourteen, fifteen, sixteen, seventeen, eighteen, nineteen, twenty, twenty two, twenty three, twenty four, twenty five, twenty six Thats not bad at all [() [Twenty six bells. In her response to the guides question, Rhonda makes reference to a specific aspect of the painting, seeking to confirm the identity of an object that she perceives to be a letter in the hand of the young woman. Heritage (Eds. During the observations and recordings, researchers were on alert for any signs of the residents unwillingness to be observed or recorded. Group determinations were made based on relative stage of the disease (see also Hamilton, 2011; MacPherson etal., 2009 for a description of these data). In this particular case, the resident knew the care worker and, as will be shown, the two got along rather well. 10. While the art gallery guides bring to the interactions specialized knowledge of paintings and artists, the visitors, who are elderly, often have first-hand knowledge of life during the time period depicted in some paintings. Cambridge, UK: Cambridge University Press. Ivan: 14. As a result, Freda, or others who display similar problems, is seen as being emotionally distant, self-centered, or emotionally disinhibited. In the extract below, a visitor has come to see Ms. Todd, a woman with dementia who lives in the same assisted living facility as Mr. Wayne from Extract 2a above. 48. 70. Extract 2c: Bell collection (part 2) 27. Minna: 20. I do too. See the the uh clouds in the sky You see the trees in the back uh in the background And here in the front uh this is a beautiful meadow. 47. hello Adila. When Ivan suggests removing the socks, despite Minnas 228 G. Jansson expressed desire to have them on, men ja tnkte bara ta av den hra (but I only thought Id take off this one), the resident escalates her opposition with an extreme case formulation (Pomerantz, 1986), : d fryser ja ihjl nnu mera (oh then I will die of cold even more [emphasis added]). And I, I dont know, I just, it seems like somebody gave me some bells or a bell and I believe- yeah somebody brought me one from Hawaii. Uh do you remember this one? Embodied actions are transcribed according to conventions developed by Mondada (2014), see annotations presented in Chapter 1. It is taken from a conversation between a resident (R) Siri and a care worker (CW) Anna during a morning care session at a dementia unit in a Swedish residential care facility. 10. (1995). nu fr du tvtta dej s skter jag vattnet (here you go Ove (.) Heritage 9 Disagreements in Assessment Sequences with Persons 169 and Raymond have shown that in many situations, assessments can also be used for asserting exclusive or singular epistemic or relational rights to specific forms of knowledge. The role of humor (Heinemann, 2009) and body movement has been emphasized as crucial resources (Yazdanpanah & Plejert, 2017). As these individuals do not currently have any symptoms, a disconnect between their genetic 10 Dementia and the Life Course: Examining Cognitive Decline 189 status and current physical health can be quite dramatic. The small talk sequence about Oves feet 11 Public and Private Spaces in Residential Care 225 Fig. n=63 Source Authors (c) Guide: What- what was that used for? I thought he got tested before they got married? Ove makes the same evaluation and agrees, ja verkligen (yes really). 26. Birmingham, AL: University of Alabama Press. 06. Additionally, the case of Jim, along with the repeat interviews with Agatha and Markus, it is important to emphasize the benefits of family engagement as a central part of healthcare for individuals with a variety of cognitive impairments; indeed, the benefits of such an approach suggest that planning for the family to take an active role could be started sooner in the degenerative process. (2014) argue that objects are constitutive of and constituted through interactions (p. 4), differentiating objects as situated resources (how objects are used by participants in interaction) from objects as practical accomplishments (how objects are oriented to and shaped by participants through interaction). Ritchhart, R. (2007). Jim provides an apt answer to the grand tour question, although he also seems skeptical about his diagnostic status. In line 10, she takes a step aside in an outward direction from the cabinet area (Fig. here ((pointing to object)) [Oh [This is broke here ((Then starts to turn around and move away)) Ohh [Its broken ((Mouthing to Penny)) [((Penny starts laughing)) Its Broken ((Walking out of the store)) Mm mh Hih hheh heh heh No [take it back heh ((Penny in play voice)) [(xxxxx) No take it back heh heh ((Diane and Penny follow Freda out of store)) At line 12, Freda then moves to point out that the object that Diane was holding was broken pointing to a part of the object (which appeared to be a practical or ornamental hummingbird feeder). One is a somatic unit hosting residentsthe primary challenges lie in the area of mobility (dementia symptoms for some develop after admission). The extract given below is indicative of this. I teach myself new skills. However, Scott also notes he has been feeling depressed lately, telling the interviewer, I woke up angry this morning. When asked if his depression is related to HD, Scott responds, No, depression has been with me for a while. As the interview begins, Scott discloses, My brain says this cant really be happening to me. When asked to elaborate, Scott says, I was just on the ocean with my amore. The next thing he knows he is back in Canada and under employed. Reflecting on these large life changes, Scott says, When I meet with the psychiatrist, I can rationalize it, and see it for what it is. Why do you ask? Okay. Extract 1 illustrates the ambiguity to which this chapter is devoted. The epistemics of social relationships: Owning grandchildren. And uh this was- these were sunflowers. (2012, p. 1006) advocate for a clearer demarcation between the public and private, which would provide less ambiguous signals to care staff and residents. Exactly. Instead, based on a correction Markus makes later in the interview, what he is aiming to reveal is that his uncle became ill in 1987 and, in retrospect, this was the emergence of HD. 04. I presu:::me) to which Guide2 asks a 148 A. R. Isaac and H. E. Hamilton follow-up question, as seen in line 14 (Did- did it open? Thinking Points Two strategies emerged in the data that may help persons with dementia orient and respond in more typical ways: Prime the person for the first assessment by, for instance, picking up or pointing to an object before commenting on it; Ensure the person shares or is engaged in the same reference (physical or abstract) of the ongoing conversation. However, Jim and individuals with comparable symptom presentations were explicitly interested in participating in the first authors research. Hm. At this stage, it is paramount for interviewers to follow the participants definitions in order to understand how they might see themselves as different but also normal. The second case, Scott, emphasizes the fluidity of dementia symptoms, which might or might not be salient at all phases of the interview, and underscores the need for researchers to plan or adapt to variability in cognitive issues as the interview unfolds. Indeed, the interviewer finally becomes aware of the extent of his initial ignorance of Scotts cognitive symptoms only after Scott tells a joke partway through their interview. Ove: (R) Moa: (CW) 03. First lets focus on public spaces: The next time you visit an assisted living facility, dementia care unit, or nursing home, take a notebook along with you. Understanding behavior in Huntingtons disease: A guide for professionals. Importantly, this topic has been initially introduced by Rhonda in line 2 (The window (over the door)) and immediately embraced topically by fellow visitor Darla in line 4 (Yes that window oh that- thats (taking) my eye ()). You learn theres a lot of things that you dont need to be. All interviews were conducted by the first author and, consequently, the terms interviewer and first author are used in the text synonymously. The temporal attributes of episodic memory. When persons diagnosed with dementia do not produce the next actions we expect, giving pause to contemplate how their next turns maybe, indeed, affected by their condition, maybe enough to ward off our normal troubled reactions. Her gaze is directed downwards. 176 M. S. Smith Thinking Points When co-participants do not produce the next actions we expect, trouble in our social relationships can emerge. 06. Assessments, or the expression of valued statements M. S. Smith(*) Linkping University, Linkping, Sweden e-mail: [emailprotected] The Author(s) 2020 T. Stickle (ed. While Penny essentially drops the interactional track after Fredas assessment, Diane continues by first producing a turn in line 09 that explicates the affective and experiential reasoning behind her first assessment in the simplest terms in line 01. 16. The interviewer drops the formality of the grand tour questions, moving to a more conversational approach that is tailored to oscillations between talk on international travel, HD, death, employment, and symptoms. Discourse, consciousness, and time: The flow and displacement of conscious experience in speaking and writing. 2. 29. gave me a bell and it just hit me in the head that I wanted to- collect them but I cant remember now whoI guess it was one of my grandchildren. Additionally, to adjust to the situation, the interviewer extensively jotted touchstone or anchor statements that he could use to return to the prior topic of the interview. 10 Dementia and the Life Course: Examining Cognitive Decline 199 Part of the difficulty the first author encountered was the contrast between Markus discussion of politics and their formal interview. Assessments activities, in both their explicit production and in their implicit or underlying biases, present an excellent opportunity for participants to coordinate the intersubjective grounds for both communion and separation in interaction and, thereby, foster a better relationship. 21. The analysis focuses on the care workers practices in turning Adilas indignation into amusement. Heritage, J., & Raymond, G. (2005). 11.4), withdrawing herself physically from the resident. isnt it? In this next extract Its Broken Freda, her friend Diane, and Penny, her caretaker, are shopping in another collectible store.

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