Interactions between older persons with cognitive impairment and staff in an adult day care setting

Abstract

As society ages, an increasing number of elderly people suffering from dementia of various etiologies, especially Alzheimer's Disease, will require professional care. Understanding the nature of interactions between caregivers and people with dementia can help social workers, and other health professionals, to improve the services they provide to their elderly clients. This qualitative study explored the experience of seven cognitively-impaired participants as they interacted with five staff members in an adult day care setting. The researcher employed participant observation and interviewing as primary methods of data collection. Prolonged engagement over sixteen months, peer debriefing, triangulation, member checking, negative case analysis, and auditing enhanced the validity of the study. Derived from symbolic interactionism, concepts of self and society, along with dramaturgical notions of roles, stage, and script, supplied a framework to organize information. Grounded theory, thick description, and narrative interpretation were used to analyze the data. Based on analysis, interactions, including verbal and nonverbal gestures, routines, and structured activities, were divided into six major analytic categories. Nurturance describes the staff's efforts to care for clients. Management encompasses the staff's maintaining order and ensuring the safety of clients. Dignity concerns staff's balancing the amount of assistance offered to clients with respect for their autonomy. Social Grace corresponds to clients' early socialization patterns. Emotional Connectedness applies to the emotional communication between clients and staff. The Continuing Self refers to the continuity of clients' selves from the past to the present. These categories were further separated into two broader themes: actions taken by staff, and the internal processes of clients. Specifically, Nurturance, Management, and Dignity describe staff-initiated interactions by which staff cares for, stimulates, and respects clients. Social Grace, Emotional Connectedness, and Continuing Self relate to clients' inner dynamics as affected by client-staff interactions. These social interactions are hypothesized to kindle clients' ingrained patterns of socialization and recall early emotional bonds, linking who clients are now with who they were. Consideration was given to the limitations of this small study about people with dementia, and to its implications for more research, for theory development, and for practice issues involving social work and other health care professions.