Reconceptualising Vulnerability Within Dementia Network Interactions A Thematic Literature Review of Communication Involving People With Dementia, Caregivers, and Clinicians

Abstract

Dementia is a progressive neurocognitive disease that necessitates evolving support as the illness progresses. While people with dementia (PwD) are typically characterised as vulnerable, we take a relational approach to vulnerability, suggesting that the interdependence of PwD, caregivers, and clinicians (the dementia network) means that vulnerability resides in the interactional dynamics that take place between them. With this relational approach emphasising the value of communication, we explore 1) the challenges of network members during clinic encounters and 2) the communication practices implemented to co-manage these interactions and their outcomes. Conducting a thematic literature review, we searched five health sciences databases on dementia triadic communication, screened 407 titles/abstracts and 44 full-text articles. Our analysis of the 22 included articles highlights that 1) diagnostic communication is complicated by several challenges impacting information exchange, 2) members navigate difficult relational dynamics and role clarity, and 3) decision making in dementia networks is a complex, multistep process. Findings reflect how vulnerability emerges in interaction for members in dynamic ways. Efforts to understand communication needs faced by all members and how they are co-managed can contribute to the design of health communication strategies and care environments that consider the entire network and promote equitable health outcomes.