認知症コミュニケーション論 The Dynamics of Dementia Communication

著者名：Wray, Alison

Oxford University Press（2020/03/19発売）

• 言語：ENG
• ISBN：9780190917807
• eISBN：9780190917821

Description

It is well recognized that when people are living with a dementia, effective communication can be a challenge for both them and those they interact with. Despite a plethora of good advice, it can be surprisingly hard to sustain constructive communicative behaviours and to integrate them successfully into routine daily care and interaction.The Dynamics of Dementia Communication asks why that is. What is it about communication, as a human social and cognitive practice, that makes it so difficult to manage the disruptions caused by dementia? Why is it so common to feel awkward, confused or irritated when talking with a person living with a dementia? Why is the experience of living with a dementia so personally and socially devastating? What approaches to communication would work best, and why?To answer these questions, the book integrates information from a wide range of different sources, covering the biological, social, and emotional factors associated with the dementia experience. New concepts and theoretical perspectives offer novel ways of thinking about the challenges of communication generally, and in the context of dementia. Topics explored include whether it is acceptable to deceive people living with a dementia and why society's failure to support people living with a dementia and their carers is so devastating. The final chapter suggests what people living with a dementia need if communication is to promote and protect everyone's well-being.By providing a deeper understanding of what topples the best-intentioned attempts at interaction, and by explaining why poor communication affects everyone involved, this book sets new agendas for improving the welfare of people living with a dementia, their families, and professional carers.

Table of Contents

FOREWORDShould You Read This Book?Summary of the Main Ideas in the BookIs This Book for You?How the Book Came AboutPART ONE: CONTEXTS SHAPING COMMUNICATIONCHAPTER ONE: THE CHALLENGES OF COMMUNICATION IN THE DEMENTIA CONTEXT1.1 Why Is It Difficult to Sustain Effective Communication Practices in Dementia Interaction?1.2 Overview of the Book1.3 Key Concepts1.3.1 Defining 'Dementia'1.3.2 Defining 'Communication'1.4 Core Orientations1.4.1 Personhood1.4.2 Recognising the Role of Ego1.5 Concluding RemarksCHAPTER TWO: THE BIOLOGICAL DETERMINANTS OF DEMENTIA COMMUNICATION2.1 How Do the Brain Changes Associated with Diseases of Dementia Affect Communication?2.2 Exploring the Language of People with Alzheimer's Disease2.2.1 Overview of Alzheimer's Disease2.2.2 The Impact of Alzheimer's Disease on Language2.2.3 The Impact of Alzheimer's Disease on Pragmatic Capabilities2.2.4 Language as a Marker of Future Alzheimer's Disease2.3 Language and Communication in Fronto-temporal Lobar Degeneration2.3.1 Overview of Fronto-temporal Lobar Degeneration2.3.2 The Impact of Semantic Dementia on Communication2.4 The Impact on Language and Communication of Other Dementias2.5 Pinning Down 'Dementia Communication'2.6 Variation in Susceptibility to Diseases of Dementia and Their Symptoms2.6.1 Why Do the Brain Changes Affect People and Their Communication Differently?2.6.2 Genetic Disposition to Diseases Causing Dementia2.6.3 Environmental Factors2.6.4 'Rementia' and Temporary Lucidity2.6.5 Brain and Cognitive Reserve2.7 Concluding RemarksCHAPTER THREE: THE ROLE OF MEMORY IN COMMUNICATION3.1 What Constraints on Communication are Imposed by Memory Deficits in Dementia?3.2 Long-Term Memory3.2.1 Declarative Memory3.2.2 Implicit Memory3.2.3 Emotional Memory3.3 Short-Term and Working Memory3.4 How We Bring Information Back to Mind3.5 Memory Changes in Normal Aging and in Dementia3.6 The Impact of Memory Impairment on Communication3.7 A Deeper Look at Episodic Memory and Communication3.7.1 Episodic Memory and Autonoetic Experience3.7.2 The Unreliability of Episodic Memory3.7.3 The Impact of Losing Reliable Episodic Memory3.8 Concluding RemarksCHAPTER FOUR: THE SOCIAL CONSTRUCTION OF DEMENTIA4.1 How Do Social Attitudes and Contexts Shape How We Interact with People Living with a Dementia?4.2 Social and Emotional Factors Exacerbating Dementia Symptoms4.3 The Construction of Dementia as a Disease4.3.1 The Medicalization of Age-related Degenerative Diseases4.3.2 The Commodification of Dementia Research4.3.3 Defining People by Test Results4.3.4 Mild Cognitive Impairment and the Boundary with 'Normal Functioning'4.3.5 How People Living with a Dementia are Treated4.4 Dementia as a Social Burden4.4.1 Western Attitudes to Dementia and Care4.4.2 Alternative Perceptions of Dementia4.5 The Protection Afforded by 'Social Reserve'4.5.1 What is Social Reserve?4.5.2 Social Reserve and Social Capital4.6 Concluding RemarksCHAPTER FIVE: THE EXPERIENCE OF DEMENTIA COMMUNICATION5.1 How Do Constraints on Communication Shape the Experiences of People Living with a Dementia and Their Carers?5.2 Communicating When You Have a Dementia5.2.1 Communicating the Dementia Experience5.2.2 What People Living with a Dementia Say They Need5.3 How Family and Professional Carers Communicate with People Living with a Dementia5.3.1 The Emotional Burdens that Carers Bring to an Interaction5.3.2 The Expression of Carers' Emotional Burden5.3.3 Interaction between Professional vs Family Carers5.4 Conceptualising Emotional Reserve5.5 Concluding RemarksCHAPTER SIX: APPROACHES TO EFFECTIVE COMMUNICATION IN CARE6.1 How Do Approaches to Care Attempt to Address Challenges in Communication?6.2 Person-centred and Relationship-centred Care6.3 How to Communicate Well with People Living with a Dementia6.3.1 Communication Parameters in Care Approaches6.3.2 Content6.3.3 Presentation of Information6.3.4 Pragmatics and Contextual Expectations6.3.5 Delivery6.3.6 Environment6.3.7 Attention to the Person's Needs6.3.8 Affective Orientation6.3.9 Nonverbal Communication6.3.10 Widening the Scope of Communication6.4 Concluding RemarksPART TWO: CONCEPTUALISING COMMUNICATIONCHAPTER SEVEN: COMMUNICATION PROCESSES7.1 How Do We Achieve Impact through Communication?7.2 Overview of the Communicative Impact Model7.2.1 The Three Components7.2.2 The Role of the Hearer7.3 Exploring the Context Component7.4 Exploring the Resources Component7.5 Exploring the Processing Component7.6 Matters Arising7.6.1 The Dynamics of Three or More7.6.2 How Can We Judge Our Communicative Impact?7.6.3 Why Does CI Work? What's in It for the Hearer?7.7 Concluding RemarksCHAPTER EIGHT: CONCEPTUALISING COMMUNICATION8.1 How is the Communicative Impact Model Theoretically Justified?8.2 Humans' Drive to Create a Comfortable World8.2.1 An Evolutionary Impetus8.2.2 Humans' Priorities in Modifying their World8.2.3 Altruism: Promoting the Well-being of Others8.3 Pragmatic Theory and the Context Component8.4 Getting What We Want8.5 Knowing What to Say: the Use of Context8.5.1 Defining 'Context'8.5.2 Using Context for Communicative Impact8.5.3 Building and Structuring Context through Schemas8.6 Formulating Output8.6.1 Navigating Explicitness8.6.2 From Selection to Execution8.7 Concluding RemarksPART THREE: APPLICATIONS AND IMPLICATIONSCHAPTER NINE: DRIVERS OF DISRUPTED COMMUNICATION9.1 Why Is Dementia So Disruptive to Communication?9.2 The Role of Context in Sustaining Effective Communication9.2.1 Contextual Gaps as a Catalyst for Low Social and Emotional Reserve9.2.2 Pronouns as a 'Case Study' of Context in Communication9.3 Dementia Communication: Problems and Responses9.4 Unintended Consequences of Meeting Problems with Solutions9.5 Awkward Pragmatic Gaps9.6 Insights from Second Language Interaction9.7 Concluding RemarksCHAPTER TEN: DIFFERENT IN DEGREE OR KIND? HOW PEOPLE LIVING WITH A DEMENTIA ARE POSITIONED10.1 How Does the Conceptual Positioning of People Living with a Dementia Impact on Communication?10.1.1 Exploring Degree and Kind10.1.2 Manifestations of the Degree and Kind Perspectives10.2 The Carers' Paradox10.3 Deception in Dementia Interaction10.3.1 Defining Deception10.3.2 Nuances of Deception and Truth-telling10.3.3 Arguments for and Against Deceiving People Living with a Dementia10.3.4 Case Study: Specialized Early Care for Alzheimer's (SPECAL)10.3.5 How Do Deceptive Practices Relate to Degree and Kind?10.3.6 Unrealistic Expectations?10.4 Reconceptualising Degree and Kind10.5 Concluding RemarksCHAPTER ELEVEN: AN AGENDA FOR IMPROVING COMMUNICATION IN THE DEMENTIA CONTEXT11.1 What Are the Priorities for Improving Communication by and with People Living with Dementia?11.1.1 Why We Communicate11.1.2 How Dementia Disrupts Communication11.1.3 Emotional and Social Reserve11.1.4 Difference in Degree and Kind11.1.5 Carers' Paradox and Awkward Pragmatic Gaps11.2 What Do People Living with a Dementia Need from Their Interlocutors?11.2.1 Opportunities for Communication11.2.2 Real Communication11.2.3 Communicative Support11.2.4 Kindness and Compassion11.2.5 Empowerment: Alternative Routes to Communicative Impact11.2.6 Insight and Flexibility11.2.7 Building Social and Emotional Reserve11.2.8 Respect and Dignity11.2.9 Navigating Truth and Deception11.3 Towards Better Communication11.3.1 Linking New Ideas to Existing Practice11.3.2 Mapping Effective Practices for the Interlocutor as Hearer and Speaker11.4 Kindness and the Communicative Agenda in Care11.5 Concluding RemarksREFERENCESENDNOTES