Making sense of sense-making: The challenge of navigating interactional competence in dementia care

Difficulties with communication present a challenge not just for people living with dementia (PLWD) themselves but also for those who care for them. This challenge is amplified in acute care environments with unfamiliar surroundings and staff. Drawing on a wider study using video-recorded data to identify practices to manage or avoid distress for PLWD in the acute hospital, we use conversation analysis to explicate some of the reasons why challenges can arise and consider the implications of this. Previous work has shown that while PLWDs' transactional ability with language may decline, more foundational skills can still persist, notably abilities to produce responsive talk, which follows the rules of turn-taking and displays an orientation to sequence organization. We show that these abilities can also extend to recognizing the lack of orientation to these features in the talk of others. Examples include PLWD drawing attention to missing or inadequate responses to questions from staff, seeking accounts for unaccounted-for actions, and identifying inappropriate referents. Our findings show that even when PLWD are not oriented to time or place and their talk is hard to interpret semantically, staff should not assume that interactional competence is entirely absent.