Electronic Thesis and Dissertation Repository

Thesis Format



Master of Science


Health and Rehabilitation Sciences


Savundranayagam, Marie Y.


Background. Several studies recommend language-based strategies for communication with persons living with dementia. Language-based strategies improve coherence, clarity, reciprocity, and continuity of interactions. Person-centered communication (PCC) strategies are the gold standard, including facilitation, recognition, validation, and negotiation. Only one study has examined the overlap between language-based strategies and PCC in long-term care. Little is known about which language-based strategies support PCC in home care. Accordingly, this study investigated the overlap between language-based strategies and PCC in home care interactions. Method. Conversation analysis of 30 audio-recorded routine care interactions between home care workers and persons living with dementia was conducted. The overlap between communication-units coded for PCC and 33 language-based strategies was analyzed. Results. Of 11,347 communication-units, 2,578 overlapped with PCC. For facilitation, 21% were yes/no questions and 15% were announcements of action/intent. For recognition, 25% were yes/no questions and 22% were affirmations. For validation, the majority (81%) of communication-units were affirmations and positive feedback. Finally, for negotiation, 60% of communication-units were yes/no questions. Conclusion. This is the first study examining naturalistic interactions between home care workers and persons living with dementia. The findings highlight the person-centeredness of language-based strategies. Yet only six of 33 language-based strategies occurred in the top 50% of overlapping communication-units. Home care workers in this study use a uniform set of person-centered language-based strategies, illustrated by the frequent use of yes/no questions overlapping with most PCC indicators. Our findings emphasize the need for training among home care workers in the use of diverse language-based strategies that are potentially person-centered.

Summary for Lay Audience

Dementia is a disorder that impairs memory, behaviours, and thinking. Persons living with dementia often experience declines in short term memory, planning, judgement, along with communication and language difficulties. Persons living with dementia experience a deterioration of speech, language, and comprehension difficulties over time. PSWs working in home care, a prominent care setting in the future due to increasing demand, should be trained to communicate effectively with persons living with dementia. Language-based strategies can be used to address communication challenges faced by persons living with dementia. They also improve various elements of conversation with persons living with dementia. Person-centered communication (PCC) helps to acknowledge persons living with dementia as a distinct individual and respond to their unique needs. However, it is unknown whether there is some overlap between language-based strategies and PCC. The cooccurrence of language-based strategies and PCC during home care interactions between PSWs and persons living with dementia was analyzed. Instances in which language-based strategies may contribute to PSWs missing opportunities to be person-centered were also investigated. We found that language-based strategies support PCC during home care interactions with persons living with dementia. PSWs should specifically use the following language-based strategies to support PCC: yes/no questions, acknowledging the feelings of the person living with dementia, using their name, announcing care activities, and giving instructions. However, PSWs should simultaneously be careful when using yes/no questions, announcing care activities, and giving instructions to avoid missing opportunities for PCC. PSWs should also use a wider array of language-based strategies that support PCC during care as many displayed little overlap. The home care setting was unique because PSWs could spend more time having meaningful conversations with their clients with dementia. This contributed to language-based strategies like open ended questions, which allow the person living dementia to make meaningful contributions to conversation, to overlap more frequently with PCC in home care than in long-term care. Our findings can improve care for persons living with dementia by showing specific ways that PSWs can enhance their communication skills using PCC and language-based strategies.