The discourse of self in dementia

Abstract

The preservation of self-identity in dementia is dependent upon internal (cognitive) and external (social) conditions. This study investigates the integrity of self (internal) and personae (external) in dementia as indexed by the verbal and nonverbal behaviours of dementia residents and their caregivers in a special care unit. Videotaped observations of spontaneous nursing staff-resident interactions were collected over a three-day period. The recordings were transcribed and subjected to detailed discourse analysis. Our analyses focused on several indexicals of self and personae including personal pronouns, proper nouns, interpersonal conflicts, and discursive positioning. The findings revealed that both self and personae are susceptible to decline in dementia. However, the results also provide evidence that even in severe dementia self and personae can be indexed in a variety of ways. We discuss the important role that caregivers can have in reinforcing self and personae in dementia.

Nursing home care: changes after supervision

“…(1998) hold the view that the internal identity (the self) remains intact within patients with dementia despite cognitive impairments, but that the loss of their external identity (personae) – which is mutually constructed when each person relates to the other – could be preserved. Our findings are in line with those of Small et al. (1998), who argue that carers can help patients preserve their personae (external identity) by taking interest in their backgrounds, lived experiences and acknowledging their expressions of needs, wishes and resources.…”

“…Thus, our findings could be interpreted as indicating that carers, in their interactions with patients, improved in preserving patients’ identity and sense of dignity. Sabat and Harré (1992), Mills and Coleman (1994), and Small et al. (1998) hold the view that the internal identity (the self) remains intact within patients with dementia despite cognitive impairments, but that the loss of their external identity (personae) – which is mutually constructed when each person relates to the other – could be preserved.…”

The impact of past and present preferences on stimulus engagement in nursing home residents with dementia

“…In particular, activities relating to self-identity (e.g., occupation or family role) can successfully promote involvement, decrease agitation, increase positive emotional responses, and reduce disorientation (Cohen-Mansfield, Parpura-Gill, & Golander, 2006a). Small, Geldart, Gutman, and Scott (1998) found that personalized interactions between staff members and residents elicited more involvement and cooperative responses by residents than did nonpersonalized interactions. In a study on the effects of personalized, nonpharmacological interventions on agitation, Cohen-Mansfield et al (2007) found that such interventions resulted in statistically significant decreases in overall agitation in the intervention group relative to the control group.…”

The underlying meaning of stimuli: Impact on engagement of persons with dementia

“…Indeed, Cohen-Mansfield, Parpura-Gill, and Golander (2006) found that when participants with dementia were presented with interventions tailored to their self-identity they were more involved than were control group participants with regular activities. Other studies have also found evidence for the persistence of self-identity in persons with dementia, although it may depend on interactions with others that allow this identity to be expressed (Golander & Raz, 1996; Li & Orleans, 2002; Small, Geldart, Gutman, & Clarke-Scott, 1998; Sabat & Harre, 1992; Tappen, Williams, Fishman, & Touhy, 1999). …”