Background and Purpose: Dementia communication is commonly understood as a consequence of progressive cognitive decline. However, growing evidence suggests that meaningful interaction can persist despite substantial impairment, raising questions about the factors that facilitate conversational engagement in everyday care settings. Existing research has largely focused on Euro-American contexts and has paid limited attention to how communication is shaped by cultural, emotional, and relational processes within Southeast Asian caregiving environments. This study investigates how conversational continuity, emotional tone, and thematic relevance influence interactions between caregivers and older adults with dementia (OAD) in Malaysia.
Methodology: A qualitative descriptive design informed by a pragmatic epistemological framework was employed. Data were collected from 42 caregivers across institutional and home-based care settings in Malaysia through a two-week focused observation phase followed by semi-structured interviews. The data were analysed using reflexive thematic analysis.
Findings: Eight interrelated themes were identified that illuminate how conversational continuity, emotional engagement, nonverbal communication, reminiscence, communicative disruption, and meaning negotiation shape interactions between caregivers and OAD. These findings challenge deficit-oriented accounts of dementia communication by demonstrating that conversational continuity is not solely determined by cognitive capacity but emerges through the interplay of thematic familiarity, emotional regulation, caregiver responsiveness, and culturally embedded practices. Familiar topics, positive emotional states, reminiscence, and nonverbal sensitivity emerged as key facilitators of meaningful engagement, while repetition, topic shifts, and misunderstanding presented recurring interactional challenges.
Contributions: The study advances interactional understandings of dementia communication by demonstrating how communicative participation emerges through the interplay of cognitive, affective, and sociocultural resources. Empirically, it contributes evidence from an underrepresented Southeast Asian context, while practically informing culturally responsive caregiver training and person-centred dementia care.
Keywords: Dementia communication, conversational continuity, caregiving, mood regulation, reminiscence, person-centred care, Southeast Asia.
Cite as: Ismail, R., Asyraf, N. W., Alias, N. D. F., Mohd Nor, M., & Husain, S. (2026). Conversation dynamics: Continuity, mood, and topics in interactions with older adults with dementia. Journal of Nusantara Studies, 11(2), 148-167. http://dx.doi.org/10.24200/jonus.vol11iss2pp148-167
BACKGROUND
Caregiver education is fundamental to dementia care, yet novice caregivers often receive large amounts of information immediately following diagnosis, when emotional adjustment and learning readiness may influence engagement. Less is known about how caregivers engage with, understand and apply dementia-related information in this period. This study explored caregivers' experiences of receiving and applying information during nurse-led dementia counselling, using Cognitive Load Theory as one interpretive lens alongside broader Meleis' Transition Theory and Lazarus and Folkman's Transactional Model of Stress and Coping.
METHODS
A secondary qualitative descriptive study was conducted using semi-structured interview data from 11 novice dementia caregivers recruited from a tertiary hospital's outpatient geriatric clinic. Data were analysed using reflexive thematic analysis, with multiple theoretical frameworks serving as sensitising lenses to inform interpretation.
RESULTS
Three themes were identified: (1) 'Navigating Informational Demands in Early Dementia Caregiving,' reflecting difficulties engaging with complex information during emotional distress and uncertainty; (2) 'Building Understanding Through Practical Experience and Repetition', describing how caregivers gradually applied and contextualised information through practice and repeated exposure; and (3) 'Preferences for Accessible, Individualised and Integrated Dementia Education', highlighting preferences for staged, personalised, multimodal, and integrated educational support. Emotional readiness, prior experience, practical relevance and accessible support systems were identified as important influences on caregivers' learning experiences.
DISCUSSION
Post-diagnostic learning was shaped by the interaction between emotional adjustment, informational demands and available support. Findings suggest that dementia counselling may be better supported through staged, personalised and multimodal approaches rather than single information-dense encounters. While Cognitive Load Theory offered one useful perspective, the findings more broadly reflected emotional, relational and transitional experiences, better understood through the complementary lenses of Meleis' Transition Theory and Lazarus and Folkman's Transactional Model of Stress and Coping, with practical implications for psychogeriatric nursing and post-diagnostic caregiver support.
Close relational partners play a critical role in shaping each other’s emotions during social interactions, a process known as interpersonal emotion regulation. We examined how different forms of dementia (i.e., Alzheimer’s disease [AD], behavioral variant frontotemporal dementia [bvFTD], primary progressive aphasia [PPA]) affect interpersonal emotion regulation. We assessed how caregivers perceived their partners’ prosocial regulatory efforts and tracked real-time changes in caregivers’ affect during a dyadic interaction. We also investigated how these processes relate to caregivers’ mental health. Informal caregivers (N = 62) reported on their own mental health symptoms (depression, anxiety) and how their care recipients, who had different forms of dementia, use prosocial interpersonal emotion regulation (i.e., efforts to make their partner feel better). Dyads then engaged in a 10-minute unrehearsed discussion about a conflict in their relationship. Following this, caregivers viewed a video recording of the interaction and used a rating dial to provide continuous ratings of their own affective valence (negative-neutral-positive) during the conversation. Results revealed that among care recipients with AD, PPA, and bvFTD, those with bvFTD showed the lowest use of prosocial interpersonal emotion regulation, and their caregivers experienced the greatest increases in negative affect during the interaction. Across diagnoses, greater increases in caregiver negativity during the interaction were associated with greater caregiver depression (but not anxiety). These findings provide new information about interpersonal emotion regulation in dementia and highlight how the emotional changes that occur during dyadic interactions are tied to caregiver depressive symptoms.
Casey K. Brown, Enna Chen, Kuan-Hua Chen et al.· Emotion· 0 citations
This study explores how a tactile and play-based intervention, the Colorful Counting Brickers, fostered emotional and social engagement among older adults with dementia in a Taiwanese long-term care setting informed by relationally grounded care practices. Grounded in person-centered care and theories of embodied selfhood, the research employed a four-phase design process including rapid ethnographic immersion, iterative design development, expert consultation, and in-situ implementation. Thematic analysis of observations, caregiver interviews, and written reflections revealed that engagement was not a fixed behavioral response, but an emergent and relational process shaped by sensory interaction, peer reciprocity, and caregiver facilitation. Three key dimensions emerged. First, embodiment was evident as residents engaged through tactile exploration, affective responses, and gestural interaction. Second, relationality enabled peer reciprocity, including imitation, turn-taking, and spontaneous assistance. Third, immediacy was apparent as caregivers adjusted facilitation strategies in real time through emotional attunement and embodied familiarity. The study introduces the concept of co-design-in-practice to describe these situated and informal design contributions enacted by caregiving staff. This research contributes to the field of dementia care by reframing caregiving as a form of design agency and by emphasizing the relational and culturally embedded nature of engagement. It advocates for a shift from designing isolated products to designing with and through everyday care practices. This perspective informs a more inclusive and practice-sensitive model of participatory dementia innovation that recognizes the experiential expertise of caregivers and the lived realities of those they support.
Yen-Fu Chen, Chaw-Mew Hung, Yen-Ting Yao et al.· Dementia· 0 citations
Abstract Introduction Persons with dementia and their caregivers are more physically inactive than cognitively healthy peers or non-caregivers, yet little is known about their views on dyadic physical activities. This study explored the perceptions, facilitators, barriers and expectations related to dyadic physical activity among persons with dementia and their caregivers. Methods An exploratory dyadic qualitative study was conducted with 24 community-dwelling dyads in Hong Kong SAR, China. Semi-structured dyadic interviews were analysed using inductive thematic analysis. Results Four themes comprising 22 subthemes were identified. Dyads recognised mutual physical, psychological and relational benefits and valued activities that fostered shared enjoyment and relational resonance, though some questioned dyadic activity’s relevance. Engagement was facilitated by clear rewards, established habits, everyday collaborative activities, culturally meaningful incentives and strong social and professional support in a facilitative environment. Participation was hindered by limited shared understanding of physical activity, negative emotions in partner, mismatched fitness levels and activity rhythms, social withdrawal by the person with dementia, time pressures and conflicting family attitudes. Dyads expected interventions to yield tangible health and fitness gains, be tailored to both partners’ capacities and interests, provide appropriate challenge and ensure safety through explicit risk management strategies. Conclusion Dyadic physical activity is not simply ‘doing it together’. Instead, interventions should be tailored, health-oriented and relationally attuned, with explicit consideration of the practical and emotional challenges faced by both dyad members. Psychoeducation regarding the significance of physical activity may need to extend beyond the dyadic members to the wider family to promote ‘doing it together’.
Shanshan Wang, Yang Fei, Yat Wa Justina Liu et al.· Age and Ageing· 0 citations
Dance-based interventions are increasingly recognised as valuable psychosocial approaches to support the wellbeing and social participation of people living with dementia. However, existing research has largely focused on outcomes, with limited attention to how such programmes are facilitated and experienced in practice. This study explored how dance facilitators understand and navigate the multi-level influences shaping the organisation, delivery and perceived impact of dance sessions for people living with dementia and their informal caregivers. An exploratory descriptive qualitative design was adopted, using semi-structured interviews with six facilitators involved in a dance-based programme in Malta. Data were analysed using reflexive thematic analysis, guided by a socio-ecological-relational framework. Findings showed that dance facilitation is a relational and adaptive practice embedded within interacting individual, interpersonal, organisational, community and societal contexts. Facilitators continuously adjusted activities in response to participants' cognitive, physical and emotional needs, using embodied and non-verbal approaches to support engagement. Relational processes, including shared movement and caregiver involvement, were central to fostering connection and inclusion. However, participation and sustainability were shaped by organisational environments, accessibility and persistent stigma, highlighting constraints beyond the control of facilitators. These findings emphasise that the value of dance lies in how it is enacted in practice, underscoring the need for supportive contexts.
Background Residents with neurocognitive disorders in long-term care facilities experience behavioral and psychological symptoms that affect well-being and relationships. Life story books, personalized compilations of memories, may enhance communication and emotional connection through reminiscence. Objectives To examine observed changes in the effects and acceptability of the life story books intervention among residents with neurocognitive disorders and their informal caregivers. Methods A convergent mixed-methods design was conducted in three long-term care facilities with sixteen resident–caregiver dyads. Quantitative data were collected before and after a six-month intervention, complemented by qualitative interviews and observations. Results Fifteen residents and eleven caregivers completed the study. Quantitative findings revealed changes in positive affect and pleasure, as well as reduced agitated behaviors and an increase in irritability. Qualitative findings highlighted enhanced engagement, communication, and emotional connection. Caregivers reported high acceptability and confidence in using the books, despite occasional emotional ambivalence. Conclusion Life Story Book is a feasible and person-centred intervention that shows promise in promoting emotional well-being and meaningful connections in the context of dementia care.
Marie-Soleil Hardy, Camille Savoie, M. Laberge et al.· Sage open aging· 0 citations