Monolingual and bilingual communication between patients with dementia diseases and their caregivers

Sammanfattning: The purpose of the thesis was to elucidate demented monolingual patients' communicative behaviour as described by their caregivers, and demented bilingual patients' communication, interaction, and relationship with caregivers who could/could not Finnish.The first part of the thesis includes two time-studies and interviews with caregivers in the geriatric care of monolingual patients (I, II). The caregivers spent less time caring for the demented patients than for the non-demented patients with the same degree of dependence. The problems to communicate with the demented patients caused ethical problems and jeopardized the caregivers’ commitment.In the second part of the thesis the preconditions for communication were studied by means of medical, neuropsychological, and linguistic examination of demented Finnish immigrants. Patients' relatives were interviewed and patients' interaction with caregivers was observed in standardised situations (III). The communication, interaction, and relationship between bilingual demented patients and mono/bilingual caregivers were studied during video-recorded morning care sessions by the E.H. and J. Erikson theory of 'eight stages of man'. Phenomenological-hermeneutic (IV), and factor analysis (V) was performed. Also phenomenological (VI) analysis of the morning care sessions was used. The patients functioned on a higher level of ability together with the bilingual caregivers. These caregivers promoted the patients' integrity in a more comprehensive way than monolingual caregivers, and the patients exhibited more trust, autonomy, initiative, industry, identity, intimacy, generativity, and integrity. Their interaction with bilingual caregivers was more multidimensional and the progression of their interaction was more positive than that with monolingual caregivers. The bilingual caregivers' relationship with the demented immigrants was characterised by communion; disclosure of virtues such as patience, honesty, and humility; respect for the person; will; and joy.The findings of the study are discussed within a hermeneutic-humanistic perspective stressing the patient's dependence, vulnerability and need for support. The conclusion is that verbal communication in the patients’ native language makes it easier for caregivers to promote patients' integrity, which in turn enables patients to disclose more of their latent capacity.