‘Oh he was forgettable’: Construction of self identity through use of communicative coping behaviors in the discourse of persons with cognitive impairment

Abstract

Communication involving persons with cognitive impairment (CI) associated memory issues requires particular attention in the clinical setting due to the sensitive and often difficult institutional work that must take place between the patient and his or her physician. An individual with CI is often tested for memory issues during the office visit, generating a potentially face-threatening situation. Said individual may attempt to preserve positive identity or ‘save face’ (Gumperz, 1982) by using communicative coping behaviors (CCBs). This study characterizes the use of CCBs (e.g., accounts and humor) by persons with CI in clinical interviews and provides important insight on how to improve doctor—patient communication involving people with CI. In order to describe and compare CCBs used by persons with cognitive impairment, and those used by cognitively normal individuals, verbatim, in-office transcripts from both groups were analyzed. Results showed that participants with CI used more memory accounts than cognitively normal individuals and similar amounts of humor in order to save face and construct a normal identity. These data help to inform doctors and caregivers regarding the ways in which persons with CI construct and preserve a positive sense of self-identity through communication.

Jacqueline A Guendouzi and Nicole Müller, Approaches to discourse in dementia

“…This is true of much work in this field (Saunders, 1998;Saunders, de Medeiros, & Bartell, 2011; as well as others (de Medeiros, Saunders, Doyle, Mosby, & Van Haitsma, 2012) who approach the person with dementia as conversational contributor. Guendouzi and Mu¨ller acknowledge that they too share this position.…”

Identifying patterns of communication in patients attending memory clinics: a systematic review of observations and signs with potential diagnostic utility

“…23 noted that in patients attending a general outpatient neurology clinic 96.7% with cognitive impairment attended with family or a carer, whereas only 34.4% of cognitively normal persons did. 45 Patient's ability to answer and participate in consultation (n = 3). Two papers studied patients' ability to recall and describe memory concerns.…”

“…35 In outpatient neurology appointments companions contributed a greater number of comments in consultations where patients had cognitive impairment. 45 Karnieli-Miller and colleagues graphically represented the shifts in a triadic memory clinic interaction over the course of an initial assessment. 37 They noted too that the companion tended to interject when the patient gave 'incorrect' information or when the physician directed the conversation towards the companion.…”

Interpreting “I don’t know” use by persons living with dementia in Mini-Mental State Examinations

“…As illustrated, LOK IDKs in the position immediately following physicians' MMSE questions occur without (1) and with dependent complements (2). We classify both of these LOK IDKs as isolated response in our taxonomy, as the IDK- face-saving strategy used by impaired patients to 'explain, justify or excuse memory performance' [6]. IDK signals a knowledge gap, and the following turn elements provide a justification for it: the patient does not, as a habit, consult her calendar which is why she is unable to provide the date.…”

“…dementia) from cognitive decline associated with normal aging, functional memory disorders, and depression [1,2,3]. This lack of confidence may stem from providers' discomfort with explicit cognitive assessment, a potentially embarrassing [2] or outright confrontational [4] process that is face-threatening to patients [5,6] and often exposes stigmatized cognitive deficits [7]. However, few dementia-specific, evidence-based communication curricula exist to assist providers in the negotiation of communicative barriers to productive cognitive assessment [8,9].…”