Reframing Social Participation In Dementia Care: A Discourse-Analytic Study of Everyday Interaction

Background and Purpose: Who gets to count as “social” in dementia care – and how might rethinking this question challenge dominant assumptions about communication and participation in dementia care? Dominant medical models often frame people living with dementia (PLWD) as socially disengaged due to cognitive decline, reinforcing deficit-based approaches to care. This study addresses this limitation by examining how social participation is interactionally accomplished in everyday care settings. Drawing on sociolinguistic and discourse-analytic perspectives, the study asks: How do caregivers and people living with dementia collaboratively construct meaningful social participation in routine interactions? The objective is to demonstrate how communication practices can actively constitute person-centered dementia care in everyday interaction.

Methods: This study is based on five years of ethnographic fieldwork in adult day centers in Taiwan. Data for this presentation are drawn from a larger dataset comprising 284 hours of video-recorded, naturally occurring interactions between caregivers and PLWD, 350 typed pages of observational fieldnotes, and 107 hours of audio-recorded interviews with caregivers, older adults, and their family members. The present analysis focuses on interactions between a skilled caregiver and PLWD. Drawing on discourse analysis, particularly the concept of frame lamination, the study examines how caregivers and participants layer task-oriented and social interactional frames in real time.

Findings: Findings show that social participation is actively co-constructed through everyday communicative practices. Routine activities such as exercise are transformed into shared, embodied social engagement. Moments of forgetfulness are reframed as opportunities for humor and affiliation, rather than treated as deficits. Additionally, overhearing is oriented to as a legitimate form of participation, expanding conventional notions of engagement. These practices demonstrate how individuals with dementia remain socially involved when communication is recognized beyond normative linguistic standards.

Conclusions and Implications: This study challenges deficit-oriented models by showing how communication in dementia care can be understood as socially meaningful, even when it departs from standard expectations. For social work research and practice in dementia care, the findings underscore the value of discourse and sociolinguistic approaches in identifying interactional resources that support inclusion and social engagement. The study highlights the importance of attending to everyday communication as a core component of care and emphasizes how social participation is interactionally constructed, with implications for professional development among social workers and caregivers.