This ethnographic study examines talk between normal and confused speakers. Most data derive from loosely structured research interviews, but use is also made of data from household situations. The analysis draws on theoretical traditions which examine everyday social interaction. From this perspective, confused speakers represent a case of naturally occurring deviance which allows for the investigation of 'normal talk' and how speakers deal with its absence. I focus on minimally active, moderately active, and very active confused speakers. All deviate from what ordinary members would commonsensically describe as normal, appropriate talk for the circumstances, in both what they say and how they talk. None of these groups can handle their own biographies, or routine common-sense knowledge, as effectively as ordinary members. However, minimally active speakers abrogate responsibility for context-sensitivity; moderately active speakers seem aware of context issues but may not act in a context-renewing way; while very active speakers seem not to be influenced by contextual issues but maintain a highly active part in the conversation. Normal speakers may take over the management of context for confused speakers, model context-sensitive talk, or withdraw their full participation. Frequently these strategies promote reasonably normal conversational appearances, but they do not entirely make good the impaired identity of confused speakers. My analysis suggests the definition of normal talk is constrained by how participants jointly construct social occasions. Normal speakers appreciate issues of context, acknowledging how it shapes and renews conversation. Confused speakers tend not to be context-sensitive in these ways, and their difficulties in this respect and in the generation of an identity appropriate to the event, creates problems within the conversation both for them and for others.

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Background¡GThe study found patients of end stage renal disease(ESRD) may have various comorbidities, and recently many studied showed ESRD patients with dementia were gradually diagnosed by clinical physicians, in particular of Alzheimer¡¦s disease. This becomes a very important issue because it often occurs in elderly and may increase the utilization of health care and motality. Objectives¡GThis study explores the prevelance of ESRD with dementia and finds out if there are any significant difference upon demography status, comorbodities, dialysis therapy, utilization of health care between ESRD with dementia and without dementia. As well as we will discuss the risk factors of ESRD patient with dementia. Methods¡GWe conducted secondary data analysis with admnstrative data of National Health Insurance between 2000, 2002, 2004 and 2006. We firstly seleced the patients diagnosed as ESRD and dementia, and merged the data set and other related variables.The data was analyzed by Chi-square test, t-test and logistic regression. Result¡GThe prevelance of ESRD with dementia were 0.35%(2000), 0.46%(2002), 0.89%(2004), 1.08%(2008)¡FESRD patients with and without dementia was significant difference (p < 0.0001) between sex, dialysis therapy, dialysis duration, and the regions of hospital organizations, class of hospital organizations, specialty,except the region of hospital organization in 2002¡F ESRD patients with and without dementia was significant difference (p < 0.0001) between age, comorbidities, outpatient visits and expenditures. Finally we found age, sex, hemodialysis therapy, outpatient visits were the risk factors of ESRD with dementia. Conclusion¡GThe study was benefited by large sample of adminstative data, but there were some limitation of precision of diagnoses and payment issue of health care system, therefore, we strongly suggested further study could be conducted by research questionnaires to make up the weakness of adminstatrative data.

This thesis documents a study which set out to explore the links between culture, dementia and long-term residential care in Scotland. A key aim of the work was to gain insights into manifestations of individual formative culture as part of selfhood in people with dementia in care homes, and how service providers take account of this in constituting „person-centred‟ care processes (which are claimed by virtually every such provider in Scotland). Another aim was to explore the contexts influencing care processes at individual care home/theoretical/government policy levels. Lastly, as a study with a „critical‟ bent, it set out to provide suggestions for future research based on the conclusions reached. In doing this, it involved six care homes, three of which were in large urban centres and three of which were in a remote island group. Sixteen social care workers and nurses took part, as did eleven care home residents with significant dementia. An ethnographic approach to data gathering and analysis, combined with a poststructural discourse analysis in interpreting initial findings, represented the research methods used. It was found that culture as an aspect of selfhood is a much more reducible phenomenon than is represented by traditional metanarratives of diversity, and failure to take account of this can have substantial implications for „person-centred care‟(especially for people who are progressively losing the ability to adapt to new sociocultural environments because of cognitive impairment). Failure to acknowledge these very individual formative sociocultural contexts in people with dementia who are in long-term care, may lead to a failure to acknowledge personhood. Conclusions revolve around the assertion that accepted discourses of cultural diversity, combined with other socially-located discourses linked to the residential care home sector, combine to produce environments in which „knowing the person‟ (and knowing the sociocultural contexts which help define that person), often do not feature highly in so-called „person-centred‟ approaches.

My interest in studying neurodegenerative models of illness lies primarily in the need to define human personhood over the progressive and often irreversible experience of dementia. Here, I analyze, challenge, and ultimately move beyond purely functional theories of personhood, which are necessarily exclusive in their reduction of the human person to a mere demonstration of capacity (for rationality, self-consciousness, suffering, or otherwise) that is inversely proportional to neuropathology. Bringing to the fore important contributions from both secular philosophical thought and the Abrahamic faith traditions, I argue that functional perspectives neglect the psychosocial, spiritual, and biographical dimensions of personhood, which must be described in reference to both historical and concurrent life experiences. Accounting for these features requires the promotion of social environments that are ideal for the maintenance or preservation of this sense of "person" and calls for the treatment of patients with dementia based on personhood and inherent dignity. / My thesis, as an analysis of this debate in the interdisciplinary field of bioethics, brings together philosophy, medicine, law, and the Abrahamic faith traditions to establish guidelines toward a more integrative definition of personhood in the context of the evolving and interactive experiences of degenerative dementia.

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Thesis (MApSc(OccupationalTherapy))--University of South Australia, 2000.

Thesis (Ph.D.) - University of Glasgow, 1993. / Thesis submitted to the Faculty of Medicine, Department of Division of Developmental Medicine, University of Glasgow, 1993. Includes bibliographical references. Print version also available.