Multilingual Interaction and Dementia

Charlotta Plejert, Camilla Lindholm and Robert W. Schrauf

Introduction

The purpose of this book is to shed light on multilingual, everyday conversational and clinical interactions among multilingual persons with dementia, their caregivers and families. If Grosjean (1994) was correct in estimating that half of the world's population uses more than one language or dialect in everyday life, then clearly there are many older adults with dementia who both speak more than one language and whose daily interactions are likely to be multilingual. Nevertheless, as we discuss below, there is little literature on the specific issue of multilingualism and actual talk-in-interaction among persons with dementia, their caregivers and family members. The various contributors conduct detailed description and careful analysis of such interactions for the purpose of enriching our understanding of multilingualism and dementia and developing a solid empirical foundation for improving communication and quality of life of multilingual persons with dementia, their relatives, staff in residential care and clinical practitioners. Each chapter highlights practices and actions employed by interlocutors to facilitate mutual understanding, enhance high-quality social relations and assure optimal care and treatment, in spite of language and cognitive challenges. The term multilingual is used in a broad sense here, in order to capture the large range of settings and circumstances in which persons with dementia find themselves, illustrated in the various chapters. Most participants in the studies presented in this volume speak or have actively acquired and used two or more languages over their lifespan, but some of the chapters also highlight social encounters of persons with dementia who have less balanced competence in their various languages. An example of this complex language landscape could be a Kurdish woman from Iraq, with Kurdish as her mother tongue, also speaking some Arabic and Turkish, who has migrated to Sweden in old age to live with her daughter. Her knowledge of the language of the host country might therefore be quite limited. Living with her family is possible until her condition makes medical attention and professional care necessary, so she moves into residential care. In the residential care unit, caregiving staff might either be monolingual speakers of Swedish, or speaking Swedish as a second language, not necessarily being competent in any of the woman's languages. Thus, the different chapters of this book do not only deal with persons with dementia who are multilingual, but with settings permeated by the different languages and cultures of all participants involved. By means of detailed scrutiny of interaction, it is demonstrated how these participants, together, navigate through the maze of mundane as well as clinical activities that make up everyday life.

The Problem: Challenges Facing Multilingual Persons with Dementia

To be able to communicate with other people in meaningful ways is key for the autonomy, sense of self, identity and wellbeing of human beings. When a person is afflicted by the progressive cognitive impairment characteristic of the various dementias, their language and communication skills will be affected in different ways over the course of the illness. The gradual loss of both spoken and embodied resources, including gestures, facial expressions and body movements, can severely hamper a person's opportunities, capabilities, confidence and willingness to partake in social activities. In turn, this suite of losses can lead to social isolation, depression and, in some cases, the acceleration of cognitive decline. Clearly, it is of paramount importance to intervene in this communicative and psychological cascade in whatever way possible. Research in this area in recent years has proactively explored a promising shift from a focus on linguistic deficits and inexorable decline to a focus on the optimization of preserved communicative resources (Davis & Guendouzi, 2013; Hydén et al., 2014; Schrauf & Müller, 2014; see also Leibing & Cohen, 2006). This new direction in research can be traced to seminal works on the language abilities of persons with dementia by Guendouzi and Müller (2006), Hamilton (1994), Ramanathan (1997) and Sabat (2001), which in turn have triggered new and promising research on the facilitative actions and practices of spouses at home, children, and staff in residential care and various healthcare settings (Davis et al., 2011; Jansson, 2014; Jansson & Plejert, 2014; Lindholm, 2008, 2015; Majlesi & Ekström, 2016; Small et al., 2015).

Nevertheless, the majority of research to date on interaction in dementia has dealt with monolingual encounters (for an excellent introduction to methods, see Guendouzi & Müller, 2006), leaving aside the pressing needs and complexities of multilingual and multicultural encounters. This is surprising, since multilingualism in most countries of the world is the rule rather than the exception (de Bot & Makoni, 2005). The twin forces of globalization and political instability in many parts of the world have triggered massive migration across cultural borders. As a result, countries that may have been relatively ethnoculturally homogeneous are becoming increasingly diverse. In these countries, the number of ageing immigrants is rapidly multiplying, and health centres, hospitals and residential care facilities are experiencing a sudden and dramatic rise in numbers of patients and clients from culturally and linguistically diverse backgrounds. Similarly, in many of the world's already ethnoculturally diverse countries there are...