Family voices: Analyses of talk in families with Alzheimer's disease or a related disorder.

摘要

It is widely recognized that communication difficulties pose significant problems for family members of people with disorders of progressive cognitive decline, such as Alzheimer's disease (AD). To date, however, relatively few studies have explored these problems in the context of everyday conversation in family life. The goal of this qualitative study was to explore changes in family conversation associated with a diagnosis of progressive cognitive decline, the meanings associated with those changes for family members, and the implications of those meanings for the family as a unit. The project comprises case studies of two families, one including a woman with AD, her husband, and their three adult children, the other including a woman with nonfluent progressive aphasia, her husband, and their four adult children. Methodology was based on symbolic interactionism and conversation analysis, exploring meanings both as conscious reflection and also as constructions of everyday talk. Constant comparative analysis of interviews conducted with each family member identified meanings that he or she gave to the diagnosis and changes associated with it, highlighting how consistencies and contradictions in those meanings were interwoven within each family unit. Analysis of audiorecorded conversations between the diagnosed person and other family members highlighted how those meanings were constructed in their talk together. For the family with AD, a key finding, discussed in terms of positioning theory, was how the family negotiated changing roles through everyday talk; for the family with progressive aphasia, a key finding, discussed in terms of theoretical considerations of silence, was how family interpreted and accommodated to their affected kin's diminishing talk. Communication accommodation theory provided a framework for discussing the findings for both families, exploring the ways in which members sought to maintain conversational coherence while respecting relational demands for politeness. Finally, because each family was considered as a unit, the findings offer new insights into the nature of family care and support in the context of disease. Together, these case studies inform our understanding of dilemmas, challenges, and strategies for families coming to terms with progressive cognitive decline; the relevance of these findings for clinical practitioners is also addressed.