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Dementia and learning: The use of tablet computers in joint activities
Linköping University, Department of Culture and Society, Division of Ageing and Social Change. Linköping University, Faculty of Arts and Sciences.ORCID iD: 0000-0002-5449-8524
2023 (English)Doctoral thesis, comprehensive summary (Other academic)Alternative title
Demens och lärande : Användandet av surfplattor i gemensamma aktiviteter (Swedish)
Abstract [en]

Living with dementia is generally associated with terms such as loss, confusion, and dependency; not development, agency and collaboration. Contributing to a growing body of research that acknowledges the remaining abilities of people living with dementia, and how they cope with challenges in their everyday lives, this thesis concerns a topic habitually framed by negative presumptions, namely learning. 

The risk of developing dementia increases with advancing age, and with an aging population the number of people living with dementia is expected to rise. Dementia is a complex condition that can have various underlying causes; it includes numerous diagnoses and is commonly characterized by a decline in cognitive and communicative functions. Due to its clinical connotations, people living with dementia often face negative assumptions about how they are, and what they can or cannot do. Alongside prevailing metaphors such as a return to childhood or empty shells, people living with dementia have been depicted as passive and disengaged communicators, incapable of initiating social action and asserting agency, who struggle to maintain attention in interactions. 

The aim of this thesis is to study novel learning in everyday activities for people living with dementia, taking the use of tablet computers as a case in point. Learning is approached from an interactionist perspective, where it is understood as a social and situated process, and conceptualized as changing participation in joint activities. The data used in this thesis comprises a collection of 50 video recordings where a person living with dementia, who has no previous experience of using touchscreen technologies, is using a tablet computer together with either a caregiver or another person living with dementia. The participants were asked to use the tablet computers according to their own interests, and did not receive any information regarding learning as an objective of their activities. Through four empirical studies, all using the methodological framework of multimodal conversation analysis, this thesis challenges the stereotypical belief that people living with dementia are incapable of novel learning. 

Study I shows how a woman living with dementia, over the course of six weeks, learns to perform the basic navigational steps needed to use an augmentative and alternative communication application. The analysis demonstrates how the participant's reliance on detailed information from her interlocutors gradually declined both during and across recordings. Study II highlights how people living with dementia position themselves as learners in unfamiliar joint activities. The results emphasize that the participants living with dementia publicly display their current understanding of the ongoing joint activities, introduce learning as a conversational topic, and are actively engaged in soliciting the information needed to partake. Study III shows how professional and family carers support the participants living with dementia in managing the tablet computers. The analysis reveals that the caregivers orient towards the doing of the participants with dementia, are attentive to their displayed understanding of the unfolding activities, and adapt any instructions with detailed multimodal cues if required. Study IV moves away from the dyadic constellations consisting of a person living with dementia together with a caregiver, and instead focuses on how people living with dementia manage the joint activities together with a peer. The results show that the participants treat the activities as collaborative endeavors, and orient towards the displayed competences of each other by offering or soliciting information when needed. 

Taken together, the findings from this thesis demonstrate that novel learning is possible for people living with dementia even without the use of structured interventions. The learning process is highly collaborative, and the participants actively support each other's conduct throughout the unfolding activities. Apart from possibilities for repeated participation in joint activities, procedural and agentive aspects of learning for people living with dementia are emphasized. 

Abstract [sv]

Att leva med demens förknippas vanligtvis med termer som förlust, förvirring och beroende; inte utveckling, agens och samarbete. En vanlig föreställning är att nytt lärande är ouppnåeligt för personer med demens. Genom att studera lärande, ansluter den här avhandlingen till ett växande forskningsfält som undersöker hur personer med demens nyttjar kvarvarande förmågor för att hantera de utmaningar som uppstår i vardagen. 

Risken att utveckla demens ökar med stigande ålder och med en åldrande befolkning förväntas antalet personer som lever med demens att öka. Demens är ett paraplybegrepp som innefattar en stor mängd sjukdomar som vanligtvis karaktäriseras av förändringar i kognitiva och kommunikativa förmågor. Demenssjukdomars kliniska konnotationer avspeglas inte sällan i allmänna uppfattningar om demens, och personer som lever med demens möter ofta negativa antaganden om hur de är och vad de kan eller inte kan göra. Utöver stereotypa beskrivningar som att gå i barndom eller vara ett tomt skal, finns det föreställningar om att personer med demens är oengagerade samtalspartners, oförmögna att initiera social handling, hävda agens eller upprätthålla fokus i interaktioner. 

Avhandlingens syfte är att undersöka nytt lärande i vardagen för personer som lever med demens, med användandet av surfplattor som huvudexempel. I avhandlingen undersöks lärande från ett interaktionsbaserat och situerat perspektiv, där lärande konceptualiseras som förändrat deltagande i en gemensam aktivitet. Den empiriska grunden består av 50 videoinspelningar där en person med demens, som saknar tidigare erfarenheter av tryckkänslig teknik, använder en surfplatta tillsammans med antingen en vårdgivare eller en annan person med demens. Deltagarna ombads att använda surfplattorna efter egna intressen och fick inga instruktioner gällande lärande som ett mål med sitt deltagande. Avhandlingen baseras på fyra artiklar, metodologiskt grundade i multimodal interaktionsanalys, och resultaten kontrasterar mot den stereotypa bilden av personer med demens som oförmögna till nytt lärande. 

Artikel I visar hur en kvinna med demens, över sex veckors tid, lär sig hur man utför de grundläggande stegen i en kommunikationsstödjande applikation. Analysen demonstrerar hur deltagaren gradvis blir mindre beroende av detaljerade instruktioner från sin samtalspartner. Artikel II framhäver hur personer med demens positionerar sig själva som lärande individer i nya aktiviteter. Resultaten visar att deltagarna med demens explicitgör sin situerade förståelse av de pågående aktiviteterna, introducerar lärande som ett samtalsämne och är aktivt engagerade i inhämtandet av den information som de behöver för att kunna delta. Artikel III visar hur vårdgivarna stöttar deltagarna med demens i handhavandet av surfplattorna. Analysen betonar att vårdgivarna orienterar mot deltagarnas görande i aktiviteterna, är uppmärksamma på deras uppvisade förståelse och anpassar sina instruktioner med detaljerade kroppsliga indikatorer vid behov. Artikel IV undersöker hur personer med demens hanterar aktiviteten tillsammans med andra personer med demens och utan stöd från kognitivt friska deltagare. Resultaten tydliggör hur deltagarna behandlar aktiviteterna som ett gemensamt projekt och uppvisar en medvetenhet kring varandras förmågor genom att såväl erbjuda som efterfråga information när aktiviteten stannar upp. 

Sammantaget visar avhandlingens resultat att nytt lärande är möjligt för personer som lever med demens, även utan strukturerade interventioner. Lärandeprocessen är starkt kollaborativ och deltagarna stöttar aktivt varandras bidrag genom aktiviteterna. Utöver möjligheter till upprepat deltagande i gemensamma aktiviteter, framhävs vikten av kroppsliga och agensbaserade aspekter för lärandet hos personer m

Place, publisher, year, edition, pages
Linköping: Linköping University Electronic Press, 2023. , p. 92
Series
Linköping Studies in Arts and Sciences, ISSN 0282-9800 ; 850
Keywords [en]
Dementia, Situated learning, Conversation analysis, Collaboration, Scaffolding
Keywords [sv]
Demens, Situerat lärande, Samtalsanalys, Samarbete, Stöttande
National Category
Gerontology, specialising in Medical and Health Sciences
Identifiers
URN: urn:nbn:se:liu:diva-193546DOI: 10.3384/9789180750714ISBN: 978-91-8075-070-7 (print)ISBN: 978-91-8075-071-4 (electronic)OAI: oai:DiVA.org:liu-193546DiVA, id: diva2:1754837
Public defence
2023-06-09, K4, Kåkenhus, Campus Norrköping, 09:00 (English)
Opponent
Supervisors
Available from: 2023-05-04 Created: 2023-05-04 Last updated: 2023-05-04Bibliographically approved
List of papers
1. A person living with dementia learning to navigate an iPad: A case study
Open this publication in new window or tab >>A person living with dementia learning to navigate an iPad: A case study
2022 (English)In: Disability and Rehabilitation: Assistive Technology, ISSN 1748-3107, E-ISSN 1748-3115, Vol. 17, no 5, p. 570-579Article in journal (Refereed) Published
Abstract [en]

Purpose: This study challenges the notion that people living with dementia are unable to achieve novel learning without focussed intervention techniques. The purpose of this study is to explore how a woman living with dementia (Alzheimer’s disease) learns to use a tablet computer with support from communicative partners.

Method: The study is based on video recordings and the theoretical framework of learning as changing participation in joint activities. Quantitative and qualitative focus is on changes in the interactional organization

over the course of six weeks in the activity of using an augmentative and alternative communication application.

Results: Over time, the participant living with dementia, relies less on the expertise and explicit instructions of her communicative partners when navigating the application, and more on the immediate feedback provided by the tablet computer.

Conclusions: The findings suggest that novel learning still is possible for people living with dementia, even without the implementation of focussed interventions. This study further emphasizes the procedural nature of learning for people living with dementia as the woman’s embodied actions were carried out in an increasingly more direct fashion.

Place, publisher, year, edition, pages
Taylor & Francis, 2022
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-168965 (URN)10.1080/17483107.2020.1800117 (DOI)000558271500001 ()32757964 (PubMedID)2-s2.0-85089177345 (Scopus ID)
Available from: 2020-09-04 Created: 2020-09-04 Last updated: 2023-05-04Bibliographically approved
2. People with dementia positioning themselves as learners
Open this publication in new window or tab >>People with dementia positioning themselves as learners
2021 (English)In: Educational gerontology, ISSN 0360-1277, E-ISSN 1521-0472, Vol. 47, no 2, p. 47-62Article in journal (Refereed) Published
Abstract [en]

Recent studies have demonstrated that people living with dementia, contrary to common believes, are capable of novel learning without structured interventions. Opportunities for learning throughout an individuals lifespan have been acknowledged as important factors in facilitating social participation and promoting wellbeing. However, little is still known about the situated practices used in the learning process for people living with dementia. This study aims to explore how people living with dementia in Swedish residential care facilities position, perceive, and assert, themselves as learners in a novel activity. The study is based on video recordings of eight people living with dementia, who for the first time use tablet computers as a social activity on a one-to-one basis with their formal caregivers. Through interaction analysis, we show how the participants living with dementia use the engagement displays of requests, accounts, formulations and metacomments to make their active undertaking in the ongoing activity public to their communication partner. Our findings suggest that people living with dementia might still perceive themselves as individuals capable of novel learning and that they are active and engaged agents in this process.

Place, publisher, year, edition, pages
TAYLOR & FRANCIS INC, 2021
National Category
Gerontology, specialising in Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-172867 (URN)10.1080/03601277.2020.1855501 (DOI)000598220700001 ()
Available from: 2021-01-24 Created: 2021-01-24 Last updated: 2023-05-04
3. Supporting people living with dementia in novel joint activities: Managing tablet computers
Open this publication in new window or tab >>Supporting people living with dementia in novel joint activities: Managing tablet computers
2023 (English)In: Journal of Aging Studies, ISSN 0890-4065, E-ISSN 1879-193X, Vol. 65, article id 101116Article in journal (Refereed) Published
Abstract [en]

A bourgeoning number of studies have demonstrated that people living with dementia are capable of participating in a wide range of everyday activities when supported by care professionals or family carers. However, little remains known about the situated practices used by carers to support people living with dementia as active co-participants in novel joint activities. Taking the use of tablet computers as an example, this study focuses on the interactional organization of instructions in joint activities involving people living with dementia, who have no previous experiences of touchscreen technologies, and their carers. The study is based on forty-one video recordings of ten dyads, each comprising a person living with dementia and a carer, as they are using tablet computers with applications suited to individual interests. Drawing on multimodal interaction analysis, we show how the carers continually foster the accomplishment of their interlocutors, and rarely take over responsibility for closing an ongoing joint project themselves. Our findings suggest that the carers' instructions, realized as verbal and embodied directives, function as a form of scaffolding practice that facilitates the coordination of visual perception and embodied conduct for the participants living with dementia.

Place, publisher, year, edition, pages
Elsevier, 2023
Keywords
Dementia; Conversation analysis; Directives; Scaffolding; Technology; Embodiment
National Category
Social Psychology
Identifiers
urn:nbn:se:liu:diva-192102 (URN)10.1016/j.jaging.2023.101116 (DOI)000949478800001 ()
Available from: 2023-03-02 Created: 2023-03-02 Last updated: 2023-05-04
4. People living with dementia collaborating in a joint activity
Open this publication in new window or tab >>People living with dementia collaborating in a joint activity
2022 (English)In: Learning, Culture and Social Interaction, ISSN 2210-6561, E-ISSN 2210-657X, Vol. 34, article id 100629Article in journal (Refereed) Published
Abstract [en]

Recent research has stressed the collaborative competences of people living with dementia, showing how they are capable of participating in a multitude of everyday activities when supported by cognitively healthy individuals. However, little is known about the collaborative work between different people living with dementia. Accordingly, this study aims to explore how people living with dementia, without the support of a cognitively healthy interlocutor, collaborate with other people living with dementia in an unfamiliar activity. The study is based on video recordings of three dyads, each comprising two individuals living with dementia, as they are using tablet computers with reminiscence and communication aiding applications. Drawing on multimodal interaction analysis, we show how the participants living with dementia treat the activities as joint endeavors and, when needed, engage in problem-solving sequences where they make their knowledge about how to progress within the activities publicly visible to their interlocutor. Our findings suggest that people living with dementia do collaborate with each other, and that the interactional labor between different people living with dementia is more symmetrical than what has been described in joint activities involving people living with dementia and cognitively healthy individuals.Previous article in issue

Place, publisher, year, edition, pages
Elsevier, 2022
Keywords
Collaboration, Dementia, Peer learning, Scaffolding, ICT, Aging
National Category
Social Psychology
Identifiers
urn:nbn:se:liu:diva-184602 (URN)10.1016/j.lcsi.2022.100629 (DOI)000798787900004 ()
Available from: 2022-04-27 Created: 2022-04-27 Last updated: 2023-05-04Bibliographically approved

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