Dementia and learning : The use of tablet computers in joint activities

Abstract: 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.