Joint storytelling by patients with Alzheimer's disease and their spouses

Keeping the conversation going: How progressivity is prioritised in co-remembering talk between couples impacted by dementia

This article explores how partners keep the conversation going with people living with dementia (PLWD) when speaking about shared memories. Remembering is important for PLWD and their families. Indeed, memory loss is often equated with identity loss. In conversation, references to shared past events (co-rememberings) can occasion interactional trouble if memories cannot be mutually recalled. This article analyses partners' interactional practices that enable progressivity in conversations about shared memories with a PLWD. In previous research, both informal and formal carers have reported that they can find interacting with PLWD difficult. Identifying practices used by partners is one way to begin addressing those difficulties. Analytical findings are based on over 26 hours of video data from domestic settings where partners have recorded their interactions with their spouse/close friend who is living with dementia. The focus is on 14 sequences of conversation about shared memories. We show how particular practices (candidate answers, tag questions and single-party memory of a shared event) structure the interaction to facilitate conversational progression. When partners facilitate conversational progressivity, PLWD are less likely to experience stalls in conversation. Our findings suggest the actual recall of memory is less relevant than the sense of shared connection resulting from the conversational activity of co-remembering, aiding maintenance of individual and shared identities. These findings have relevance for wider care settings.

Ageing Together: Interdependence in the Memory Compensation Strategies of Long-Married Older Couples

People live and age together in social groups. Across a range of outcomes, research has identified interdependence in the cognitive and health trajectories of ageing couples. Various types of memory decline with age and people report using a range of internal and external, social, and material strategies to compensate for these declines. While memory compensation strategies have been widely studied, research so far has focused only on single individuals. We examined interdependence in the memory compensation strategies reported by spouses within 58 older couples. Couples completed the Memory Compensation Questionnaire, as well as an open-ended interview about their memory compensation practices. We found that internal, intra-individual memory compensation strategies were not associated within couples, but external, extra-individual strategies showed interdependence. Individuals’ scores on material/technological compensation strategies were positively correlated with their partners’. Reported reliance on a spouse was higher for men and increased with age. Our open-ended interviews yielded rich insights into the complex and diverse resources that couples use to support memory in day-to-day life. Particularly evident was the extent of interaction and coordination between social and material compensation, such that couples jointly used external compensation resources. Our results suggest that individuals’ reports of their compensation strategies do not tell the whole story. Rather, we propose that older couples show interdependence in their memory compensation strategies, and adopt complex systems of integrated material and social memory compensation in their day-to-day lives.

With a little help from familiar interlocutors: real-world language use in young and older adults

OBJECTIVES

Functional psychologists are concerned with the performance of cognitive activities in the real world in relation to cognitive changes in older age. Conversational contexts may mitigate the influence of cognitive aging on the cognitive activity of language production. This study examined effects of familiarity with interlocutors, as a context, on language production in the real world.

METHOD

We collected speech samples using iPhones, where an audio recording app (i.e. Electronically Activated Recorder [EAR]) was installed. Over 31,300 brief audio files (30-second long) were randomly collected across four days from 61 young and 48 healthy older adults in Switzerland. We transcribed the audio files that included participants' speech and manually coded for familiar interlocutors (i.e. significant other, friends, family members) and strangers. We computed scores of vocabulary richness and grammatical complexity from the transcripts using computational linguistics techniques.

RESULTS

Bayesian multilevel analyses showed that participants used richer vocabulary and more complex grammar when talking with familiar interlocutors than with strangers. Young adults used more diverse vocabulary than older adults and the age effects remained stable across contexts. Furthermore, older adults produced equally complex grammar as young adults did with the significant other, but simpler grammar than young adults with friends and family members.

CONCLUSION

Familiarity with interlocutors is a promising contextual factor for research on aging and language complexity in the real world. Results were discussed in the context of cognitive aging.

Does collaboration with an intimate partner support memory performance? An exploratory case series of people with epilepsy or acquired brain injury

BACKGROUND

Intimate couples can become cognitively interdependent over time. If one member of the couple has a neurological condition with associated cognitive impairments, their partner can support or 'scaffold' their cognitive functioning through collaboration.

OBJECTIVE

We explored the phenomenon of 'collaborative memory' in a case series of 9 couples in which one member had a neurological condition, specifically an acquired brain injury (ABI; n = 7) or epilepsy (n = 2).

METHODS

To investigate collaborative memory, we compared the performance of the patient when remembering alone versus their performance in collaboration with their partner on three memory tasks, assessing anterograde, semantic, and autobiographical memory.

RESULTS

We found that across all tasks and participants, collaboration typically increased overall memory performance (total score), but the patient's contribution to the task was typically lower when they collaborated compared with when they performed the task alone. We identified two distinct styles of collaboration which we termed 'survival scaffolding' (where the healthy partner 'takes over' memory recall) and 'stability scaffolding' (where the healthy partner cues and structures the patient's recall).

CONCLUSION

This exploratory case series contributes to the sparse literature on memory collaboration in people with neurological conditions. Our findings suggest that there are different styles of collaboration that can both help and hinder memory performance.

The Impact of Self-Reported Hearing Difficulties on Memory Collaboration in Older Adults

Cognitive scientists and philosophers recently have highlighted the value of thinking about people at risk of or living with dementia as intertwined parts of broader cognitive systems that involve their spouse, family, friends, or carers. By this view, we rely on people and things around us to "scaffold" mental processes such as memory. In the current study, we identified 39 long-married, older adult couples who are part of the Australian Imaging Biomarkers and Lifestyle (AIBL) Study of Ageing; all were cognitively healthy but half were subjective memory complainers. During two visits to their homes 1 week apart, we assessed husbands' and wives' cognitive performance across a range of everyday memory tasks working alone (Week 1) versus together (Week 2), including a Friends Task where they provided first and last names of their friends and acquaintances. As reported elsewhere, elderly couples recalled many more friends' names working together compared to alone. Couples who remembered successfully together used well-developed, rich, sensitive, and dynamic communication strategies to boost each other's recall. However, if one or both spouses self-reported mild-to-moderate or severe hearing difficulties (56% of husbands, 31% of wives), couples received less benefit from collaboration. Our findings imply that hearing loss may disrupt collaborative support structures that couples (and other intimate communicative partners) hone over decades together. We discuss the possibility that, cut off from the social world that scaffolds them, hearing loss may place older adults at greater risk of cognitive decline and dementia.

Collaborative Facilitation in Older Couples: Successful Joint Remembering Across Memory Tasks

Although we know a great deal about the effects of age on memory, we know less about how couples remember together and how day-to-day joint remembering might support memory performance. The possibility of memory support when couples remember together is in striking contrast with the standard finding from the collaborative recall literature that when younger pairs of strangers remember together they impair each other’s recall. In the current study, we examined the individual and joint remembering of 78 individuals who made up 39 older, long-married couples. We studied their performance on three memory tasks, varying in personal relevance: recalling a word list, listing all the countries in Europe, and remembering the names of their mutual friends. Couples gained clear collaborative benefits when they remembered together compared to when alone, especially European countries and mutual friends. Importantly, collaborative success was extremely stable over time, with good collaborators still successful 2 years later, suggesting that successful collaboration may be a stable couple-level difference. However, not all couples benefitted equally. Collaborative success related in part to particular conversational strategies that some couples, often those with discrepant individual abilities, used when collaborating. These findings highlight the value of analyzing individuals within their broader “memory systems” and the power of extending collaborative recall methods to more established intimate groups recalling a broader range of memory materials over longer time scales.

"Going episodic": collaborative inhibition and facilitation when long-married couples remember together

Two complementary approaches to the study of collaborative remembering have produced contrasting results. In the experimental "collaborative recall" approach within cognitive psychology, collaborative remembering typically results in "collaborative inhibition": laboratory groups recall fewer items than their estimated potential. In the cognitive ageing approach, collaborative remembering with a partner or spouse may provide cueing and support to benefit older adults' performance on everyday memory tasks. To combine the value of experimental and cognitive ageing approaches, we tested the effects of collaborative remembering in older, long-married couples who recalled a non-personal word list and a personal semantic list of shared trips. We scored amount recalled as well as the kinds of details remembered. We found evidence for collaborative inhibition across both tasks when scored strictly as number of list items recalled. However, we found collaborative facilitation of specific episodic details on the personal semantic list, details which were not strictly required for the completion of the task. In fact, there was a trade-off between recall of specific episodic details and number of trips recalled during collaboration. We discuss these results in terms of the functions of shared remembering and what constitutes memory success, particularly for intimate groups and for older adults.

Effects of communication-debilitating illnesses and injuries on close relationships: a relational maintenance perspective

A communication-debilitating illness or injury (CDI) presents significant challenges for patients as well as for friends and family. In a qualitative study of the effects of a CDI on close relationships, 28 individuals with loved ones who had experienced a CDI were interviewed. Participants described adjustments in communication with the patient and explained what it is like to experience a relationship with a CDI patient. Themes that emerged transcended the type of illness and relationship. Recommendations are made for further research that focuses on patients' relationships with a variety of social network members, beyond primary caregivers.