5.5.1 Visit 2: November 21, 2006: Describing a Problem to Recruit Assistance during a Routine Activity

Extract 1 occurs early in the year and shows how Robert handles a problem he encounters when making breakfast (a routine activity) and how he recruits assistance to solve it. Here, he solicits assistance by describing the problem he is facing to his collaborator (ET) when he cannot find the colander for the blueberries. Before Extract 1, Juliet tasks Robert with making breakfast with ET’s help so she can finish some work. Juliet tells him to “try to follow what she (ET) says,” displaying her understanding that Robert is likely to need guidance (not shown). Robert begins preparing fruit and quickly runs into a problem when he cannot find the colander. After searching for it, he eventually solicits help from ET by describing the problem he is facing (line 1) – “I don’ see the thing for the blueberries.”

Although Robert’s problem description contains an imprecise referent – he refers to the colander as “the thing” – his FPP makes evident that he has identified a specific obstacle to completing the activity. After observing Robert search the cupboards (line 2), ET works to clarify the problem (lines 3–10). ET’s “no blueberries?” may be hearable as repair on his problem description. Robert responds by retrieving the blueberries from the refrigerator (line 4), thereby demonstrating to ET that this is not the problem he is facing. He also rejects the implication in ET’s turn that there might not be blueberries (with turn-initial “no”) and verbally confirms that he has them. He then repeats the description of the problem (line 7), retaining the vague referent – “thing” – for the colander that he cannot locate. ET works to clarify what “thing” means (line 8), which Robert describes a bit more precisely as “the red thing.” As a newcomer to the home without shared knowledge, ET is unable to offer adequate assistance and Robert eventually seeks assistance from Juliet, which he does in much the same way, by describing to Juliet the problem he is facing (“I can’t find the thing for the blueberries”).

During these early visits, when Robert is tasked with a routine activity, he independently identifies the appropriate steps. That is, he does not seek assistance or need to be told what items are required or what order the steps should follow (compare Extract 3). When he does run into trouble, Robert troubleshoots first on his own, working to resolve the problem. For instance, in Extract 1 he searches the cupboards, and when his efforts are unsuccessful, he solicits help by identifying the nature of the trouble he has run into, in this case by describing the problem to his collaborator. Although he demonstrates difficulty clarifying what the “thing” is that he cannot find, he shows resourcefulness in problem solving, recruiting assistance, and working to repair misunderstanding.

5.5.2 Visit 7: January 17, 2007: Using “Now What” to Seek Clarification about a Nonroutine Task

The following extract takes place about two months later and constitutes the first observed use of “now what” to solicit assistance. Here, “now what” seems to be employed to help orient to the purpose of a vaguely defined and nonroutinized task that Juliet has instructed him to do – “stand there” – while they are in the pharmacy picking up prescriptions.

As Robert and Juliet approach the line to pay, Juliet asks Robert to stand in line so she can sit in a nearby chair (line 1). After standing in line for nearly a second (line 3), Robert turns to Juliet and asks “now what” (line 4), an FPP that provides the sequential context for Juliet to articulate the (next) action he is to attend to. Juliet responds by directing him to “just wait our tu:rn.” (line 6) and then draws on the present progressive tense to orient him to the immediate task at hand, suggesting that this is what he should be attending to for now: “we’re waiting our turn” (line 8). This first observed use of “now what” thus allows Robert to point to a possible problem orienting to the current activity and also works to solicit a response from Juliet that provides clarification about the nature of the task he is engaged in.

Notably waiting in line is not an activity that Robert is often asked to perform and it is in a context outside of the home, which may be less familiar or routinized. Juliet asks him to stand, perhaps the simplest task Robert is charged with in the eight hours of data examined. It is also a task without a clearly defined next step or endpoint. Robert’s “now what” may thus orient, not to the complexity or multi-step nature of the task, but to its vagueness or indefiniteness. While in Extract 1 Robert’s description of the trouble demonstrates his ability to independently identify the next steps required of a larger activity and solicit help in accomplishing this next step, here his use of “now what” seems to orient to a less precise understanding of the activity he is to be completing and serves as a resource to solicit specific instructions to resolve his uncertainty. Once Juliet orients him to the task he is attending to – “waiting our turn” (line 8) – he demonstrates both understanding of the larger project that standing/waiting in line is in service to and his ability to identify a likely next step to accomplish that larger project when he asks Juliet if she wants him to use the credit card (line 10) (see Mikesell, Reference Mikesell2016).

5.5.3 Visit 10: February 15, 2007: Using “Now What” to Solicit Direct Instructions during a Routine Activity

Robert’s use of “now what” becomes more commonplace over the next couple of months. In ET’s fieldnotes, she first mentions Robert’s use of “now what” after her eighth visit (January 24, 2007), three weeks before Extract 3 (Visit 10; February 15, 2007), when she writes: “Robert was always asking this question. He kept wanting to know what was next.” During Visit 10, Robert employs “now what” six times in one hour. Both the increasing frequency of use and the sequential contexts in which “now what” is used suggest that he may be facing more difficulty independently accomplishing even routine activities. Additionally, while the first observed use of “now what” (shown in Extract 2) seemed to function as a generic request for clarification when the task was vague or unclear, in Extract 3 “now what” works to elicit specific instructions from interlocutors that precisely explicate the next steps of a multi-step activity that he seems unable to identify on his own. In other words, his use of “now what” similarly recruits others to provide assistance, but that assistance now takes the form of precisely articulating his required next actions so that he can perform them. Here, he is tasked with making sandwiches for lunch, and, after yelling to Juliet who is on the phone in another room, ET offers her help and directs him to complete the first step to make the sandwich. Following this sequence, Robert produces “now what,” which prompts ET to produce a series of directives, one following the other, to guide Robert through the activity.

Just before Extract 3, Juliet asks Robert to make sandwiches for lunch and asks ET if she “can help him do that.” She explains how she wants her sandwich (not shown) to ET (via eye gaze and bodily orientation), but RO is gazing at Juliet during her explanation and is thus an observable overhearer. At the start of making lunch, Robert calls out to Juliet (line 6). ET attempts to intervene by asking what kind of help he needs (line 7), to which Robert describes somewhat vaguely that he “need[s] her help” (line 9). In response, ET offers help (line 10) and immediately begins to assess the sandwich verbally (lines 10, 11) while visually inspecting it (line 12). After her assessment, she provides instructions to add one more slice of lunchmeat (line 13). Robert follows ET’s first instruction (line 14) and, after ET’s positive assessment (line 15), Robert produces “now what” (line 16), which then prompts additional step-by-step instructions from ET. She first formulates her instructions as a suggestion to add lettuce and tomato (line 17), possible next steps of sandwich construction, and later produces known-answer questions (lines 26–27, 39–40) to prompt Robert to recall Juliet’s preferences as she had earlier described.

Although during ET’s early visits Robert independently initiates the steps for making meals, over time he elicits instructions from interlocutors with his use of “now what.” Additionally, interlocutors begin to pre-empt next steps by providing instructions even when unsolicited. For instance, in Extract 3 Robert indicates that he needs help and ET offers her own. As soon as that initial help is offered, Robert then recruits ET’s assistance again with “now what.” From then on, ET prompts Robert at nearly every next step, one after the other, even before Robert has an opportunity to recruit her assistance (see Majlesi & Ekström, Reference Majlesi and Ekström2016): She tells him where to put the plate on the counter to ensure there is enough counter space (line 21), monitors his cutting and plating (lines 23–24), and instructs him about what items to put on Juliet’s sandwich (e.g., lines 29–30). As compared to Extract 1, Robert initiates less of the meal assembly independently, in part because his adoption of “now what” as a recruitment device is particularly effective in prompting collaborators to guide him in a step-by-step fashion.

5.5.4 Visit 10: February 15, 2007: Using “Now What” to Exit Interactionally Delicate Moments

Although Robert’s uses of “now what” most frequently recruit assistance (and most often in the form of specific instructions), it is around the time of Visit 10 that its use seems to broaden in scope: In addition to task- or activity-based interactions where “now what” solicits specific instructions, he now also employs “now what” in interactions that are interactionally sensitive and emotionally charged. In Extract 4.1, Juliet animatedly reprimands Robert for several minutes, which ET describes in fieldnotes as “totally flip[ing] out,” because he turned off her television recordings. Although Robert aligns with Juliet’s directives to not touch the television and apologizes on several occasions, his contributions generally go unacknowledged by Juliet who continues reprimanding him. Perhaps because his acknowledgements and apologies are ineffective in closing this delicate sequence, Robert produces “now what,” presumably in an attempt to shift away from the current interactional sequence by recruiting Juliet to launch a next action.

Juliet launched her reprimand about 13 seconds before line 1 in which she articulates her frustration with Robert. She then explicates the source of her frustration (lines 2–5), reminding him that he was told not to touch the television (because Juliet was recording). Although Robert acknowledges her reprimand with “okay” (line 6), Juliet continues, producing a directive to not touch the television (line 7). Robert apologizes once in overlap with her directive (line 8) and then says “I’m sorry” three more times in the clear, with each production getting louder and more forceful (line 9). Juliet does not acknowledge his apologies but continues explaining the difficulty that his actions have caused her (lines 10–11), which continues for about 29 seconds (not shown). Juliet then produces a series of emphatic directives banning Robert from touching the television (lines 13–15), which Robert accepts with “okay.” He then produces “now what” (line 16). Juliet does not respond to his “now what” but remains focused on the television with remote in hand (line 17). She then continues with her reprimand by remarking on what she should be doing instead, highlighting the negative consequences of Robert’s actions (lines 20–21).

The sequential context of “now what” in line 16 is notably different than the contexts previously examined: It is not produced when Robert is engaged in accomplishing a task-based activity and needs assistance. Rather, it is used in an interactionally sensitive moment when Juliet is demonstrably upset with him. The prior task-based uses of “now what” tend to prompt his interlocutor to articulate the next step of an activity, and thus work to progress the activity-in-progress. Its use here may be an attempt to achieve the opposite, that is to not progress the current engagement underway, but to shift focus away from it. Whereas FPP “now what” in well-defined activity contexts works to elicit instructions that move the activity forward, here it can set up a sequential context that provides Juliet the opportunity to move away from the current interactionally sensitive sequence. Importantly, Robert does not produce “now what” immediately following Juliet’s first reprimand to “not touch it.” Rather, he draws on other resources to engage in this interactional moment by acknowledging/aligning with her reprimands and apologizing. Only upon not receiving any uptake does he work to shift the conversation to what might be a next, perhaps less emotionally charged direction with “now what.”

Moments later, Juliet continues with her admonishment with explicit directives (Extract 4.2, lines 25–26, 29, 31–32, 35) and Robert continues to acknowledge them (lines 27–28, 31, 33–34, 37). Again, Juliet provides no recognition of his acknowledgements but continues with her reprimand, giving him further instructions to not touch the television. Following Juliet’s exasperated “Gahwhd” (line 39), Robert produces “now what” (line 40), which he repeats two more times after gaps of silence (line 41 ff.) in which Juliet continues to attend to fixing Robert’s error.

These “extensions” in use outside of well-defined tasks may show how this practice is now not only being employed to solicit assistance to complete a multi-step activity but also works to close a current interactional sequence by attempting to shift the interactional focus away from sensitive moments that are challenging to exit. Notably, in this emotionally charged moment Juliet does not respond to Robert’s “now whats” or allow them to derail her from her reprimand, just as she does not respond to his apologies. That Juliet maintains focus on her reprimand may put demands on Robert, during an already taxing situation, to figure a way out of this sequence when his brief acknowledgements and apologies fail to do so. However, he may not have a readily available repertoire of interactional resources to draw on for effectively navigating this interaction and relies on “now what” to encourage a topic shift. In this way, Juliet’s lack of response contributes to his repeated uses of “now what” as a (failed) exit strategy.

5.5.5 Visit 17: September 6, 2007: “Now What” as Self-Talk

By September (seven months later) Robert is still employing “now what” to solicit assistance to navigate multi-step activities, although he is now asked to complete very few tasks and mostly routine ones. As a consequence, his use of “now what” in activity contexts is less frequent, but his use of “now what” in non-activity contexts (Extract 5), particularly when he appears distressed, anxious, or bored is more prevalent. During Visit 17, four of the five uses occurred in the context of watching television and did not appear to be directed toward an interlocutor, and as such they come off as self-talk.

While watching television, Juliet gets up to get Robert dessert (lines 1–6). Following a brief exchange between Robert and ET (lines 7–8), they resume watching television. He appears visibly restless (a commonly reported bvFTD symptom), shaking his foot (line 10), and fidgeting with his fingers without any observable purpose before he produces two “now whats” (line 11), which ET does not immediately respond to. He quickly stands up and starts to head towards the kitchen (line 14), which prompts ET to ask what he wants (line 15). When he says he wants chips (line 16), ET reminds him that Juliet is bringing him dessert and directs him to sit down (lines 17). They resume watching television and he continues to fidget. Shortly after, he produces “now what” again (line 20) while redirecting his gaze from the television toward the kitchen (Juliet is off camera so it is possible that she has come into Robert’s line of sight). Shortly after, Robert produces “now what” again (line 24), as he shifts his gaze from the kitchen back to the television. ET does not respond but maintains her attention toward the television and they both continue watching until Juliet returns with dessert.

Although Robert’s employment of “now what” retains its function of eliciting assistance, it now is also employed during very different sorts of challenges such as when Robert displays difficulty sitting still and when there is no apparent well-defined task to attend to. Notably, ET here does not as readily respond to his “now what” FPPs. Such extended uses may provide less clear constraints on what constitutes a conditionally relevant SPP for collaborators. For instance, when watching television there is not a clearly identifiable and precise next step to direct Robert to attend to. It should also be noted that as early as February 2007, ET observed Robert’s use of “now what” when he appeared restless and perseverates on a particular repetitive behavior. Following the incident when Juliet bans Robert from touching the television, ET writes:

According to ET, following Robert’s television ban, he entered into a repetitive “loop” of turning the television on and off but recruited ET’s assistance to achieve these ends. Perhaps when feeling agitated or restless, “now what” similarly worked to shift focus in the absence of an immediate task to attend to.

Although Robert’s use of “now what” in Extract 5 and during Juliet’s reprimand are notably different (e.g., here it is not directed toward an interlocutor), for both kinds of trouble these extensions in use of “now what” may work to establish a (new) focus, demonstrating the versatility and resourcefulness of employing such a practice to recruit others when facing a variety of difficulties. Notably, in these non-task focused contexts, where precise directives may not be immediately relevant, interlocutors verbally respond less frequently to “now what” and even experience it with frustration (as evidenced in fieldnotes), perhaps because there is no obvious relevant response when the interactional outcome is unclear. Thus, these uses of “now what” seem less well-suited to achieving the topical shifts that might redirect either Robert’s interlocutor’s (as in the case of Juliet’s reprimand) or his own attention.

By the end of the year Juliet has made plans to relocate to be near family. As she explains it to ET, she needs help because Robert is causing her extra work, which makes her feel both upset and guilty. She tells ET that Robert is no longer helping with routine activities such as meal preparation and can no longer follow simple instructions. For example, when she asks him to hand her an item, he may hand her something “not anywhere near it.” During the last visit, Robert engages very little outside of responding to questions and is not asked to complete any tasks. He also never produces “now what” or seeks assistance.

5.6.1 Thinking Longitudinally

Given that bvFTD is neurodegenerative, this longitudinal perspective contributes to our understanding of manifestations of the disease. As “now what” was predominantly used over the year to solicit assistance in task-based activities, the narrow focus on this one phrase provides insights into how Robert’s engagement in activities evolved over time, changes which are likely due to both Robert’s individually experienced difficulties participating in multi-step activities as well as his collaborators’ perceptions of his difficulties. Notably, Robert’s involvement in activities and responsibilities at home diminished over the year. Early on, Robert recruits assistance, but he independently initiates steps to accomplish tasks, identifies specific sources of trouble, and troubleshoots without being prompted to do so. For instance, during Visit 2 (November 21, 2006), Robert contributes to making breakfast, completing each step independently, and when he occasionally runs into trouble, he troubleshoots first on his own and eventually seeks help by describing the problem to ET.

In comparison, during Visit 17 (September 6, 2007), Juliet asks ET to help him make lunch and ET articulates each step for Robert to follow; he is not required to initiate the steps or identify points of trouble since the guidance is quite extensive and often pre-emptive. Pre-empting his needs and producing successive directives may have been an evolved strategy for Robert’s familiar interlocutors. For instance, it was observed that when his interlocutors refrained from providing explicit instructions, Robert often asked “now what” to solicit instructions, sometimes even in more routinized activities.

Later in the year, many of his uses of “now what” are produced in moments of interactional difficulty (e.g., Juliet’s reprimand in Extract 4) or demonstrable distress or restlessness (e.g., while watching television in Extract 5). Thus, while Robert’s uses of “now what” retain some of their original functionality, they also reveal new kinds of challenges Robert seems to be facing. The analyses presented show how this resource is somewhat ill-fitted to these tasks because it is not precisely designed to address these sorts of challenges, and when Robert employs “now what” in non-task-based contexts, his interlocutors do not verbally respond to them. By the end of the year, Robert engages very little in organized activities (and did not seek others’ assistance) and is given few instructions, which Juliet indicates is because he now has difficulty following even simple directives.

5.6.2 Deficit and/or Skill?

Cross-sectional studies examining coordinated work involving people with dementia typically either highlight the importance of interlocutors as resources, particularly their value in offering directives as guidance, or emphasize the skillfulness of those with dementia as they strategically draw on environmental, including human, resources. The current analysis blurs these two perspectives. The situated analysis that CA provides allows one to view Robert’s use of “now what” both through the lens of deficit and skill, because it illuminates both the troubles Robert faces while simultaneously demonstrating his resourcefulness to navigate such troubles. Robert’s use of “now what” is undoubtedly resourceful and demonstrates his ability to draw on an available resource to participate in and accomplish real-world tasks. At the same time, his reliance on this resource highlights difficulties he is facing, notably challenges with independently and incrementally progressing an activity from start to finish and handling (or exiting) delicate interactional sequences. That such compensatory practices point to both resourcefulness and difficulty suggests that a dichotomous framework – identifying a practice or behavior as either a deficit or skill – may not be the most sensitive for accurately capturing the practices of social engagement of those diagnosed with neurological disorders (see Mikesell, Reference Mikesell, Wilkinson, Rae and Rasmussen2020; Mikesell & Bromley, Reference Mikesell, Bromley, O’Reilly and Lester2016). Deficit implies a shortcoming or deficiency; skill is a developed talent or ability that brings an advantage. The previous analysis reveals how such a practice is skillful – helping an individual participate when they might have difficulties doing so – and at the same time can point to decline or incapacity, since by definition a practice that is compensatory functions to overcome some challenge.

The problem with identifying an atypical practice as strictly a deficit is that it overlooks what the practice provides or makes possible for the individual, and also what the practice may reveal about the resources an individual is capable of drawing on. In many cases, Robert is able to draw on rather simple language and apply it in moments of activity-centered interactions to be able to solicit assistance in a range of everyday tasks. Consequently, it allows him to participate and take part in organized activities. It also allows him to display to others his willingness to engage in these tasks. On the other hand, the problem with understanding a practice like “now what” as strictly a skill – as only what it allows an individual to accomplish – is that it de-emphasizes the significant and sometimes devastating consequences of disease or disorder and may conceal or misrepresent participants’ experiences or the ensuing difficulty of a compensatory practice. In this way, third-party observations/experiences and direct, real-time observations provide unique but complementary perspectives on the sociobehavioral changes resulting from bvFTD.

Examining compensatory practices importantly helps illuminate the types of challenges individuals face. Examining “now what” highlighted Robert’s challenges in navigating the sequential nature of activities that require a number of successive steps to complete. Early on, Robert demonstrated difficulties identifying a nonroutine activity (e.g., waiting in line), but once this was identified, he could identify the next step of the activity (e.g., using a credit card to pay). Later on, he demonstrated difficulty in identifying the individual steps of even routine activities, though his collaborators may have minimized his abilities to do so when pre-empting his need for step-by-step assistance. Overall, however, there seemed to be difficulties navigating the relationship between the “whole” activity and its required parts, which may reflect the executive nature of frontal lobe functioning (Mikesell, Reference Mikesell, Schrauf and Müller2014, 2016). While manifesting cognitive work in observable everyday tasks is not often an explicit undertaking of conversation analytic studies, using CA to consider this delicate balance between deficit and skill contributes to the ways in which we understand the role of cognition in context (see Hutchins Reference Hutchins1995, Reference Hutchins, Enfield and Levinson2006) and provides insights into the relationship between structured clinical tasks that are designed to elicit ‘cognition’ and its real-world manifestations (see Mikesell, Reference Mikesell, Schrauf and Müller2014).

5.6.3 Implications

Longitudinal case studies, such as the one presented here, are limited in scope and generalizability; however, they provide a window into the course of bvFTD from a naturalistic perspective. Such work may provide insights about how social engagement and interactional practices progress over time and how families navigate them. Employing CA, with its utilization of video recordings of real-world interactions, also provides insights into how such “atypical” practices might be categorized and coded, to avoid only capturing abstractions or gross impressions of observable behaviors that are often analyzed through the lens of deficit (see Barsuglia et al., Reference Barsuglia, Nedjat-Haiem, Shapira, Valasco, Jimenez, Mather and Mendez2014). Using CA to examine the sequentially situated, moment-by-moment production of social behaviors and interactional practices provides a nuanced lens into the functionality of a practice, and thus allows us to more easily observe how a practice can both constitute a dementia-related challenge or impairment and simultaneously demonstrate an individual’s skill and resourcefulness. While Perkins et al. (Reference Perkins, Whitworth and Lesser1998: 37) rightly declare that “deviation from what is normal does not necessarily equate with failure or communicative ineffectiveness”, such deviation may point to impairment by highlighting real-world challenges that call for workarounds.

Practices that are idiosyncratic to an individual with dementia may on the surface seem difficult to make sense of, particularly since many dementia behaviors – even those that appear common across individuals – have been framed as nonsensical and randomly produced. However, what a conversation analytic approach to examining Robert’s use of “now what” reveals is that this practice, although atypical, is not nonsensical but largely systematically employed to recruit others’ assistance. Notably, over time Robert’s use of “now what” extends to new contexts and challenges, and in turn seems to lose some of its interactional or functional meaning for interlocutors. Thus, it may be perceived by others in those moments as randomly produced simply because these new contexts are not task-focused ones where “now what” can maintain its sequentially positioned meaning. This may account for why interlocutors responded less frequently to these uses and reported feeling frustrated by them.

As Cohen-Mansfield (Reference Cohen-Mansfield2008) has argued, “disruptive” behaviors may reflect an internal state of the individual. Robert’s extended uses of “now what,” as his disease progressed and as his challenges extended beyond the management of discrete tasks, appeared to become more centered on his internal state of being. He increasingly displayed frustration in his tone and agitation and restlessness in his movements (often getting up and sitting down repeatedly). As such, this one practice may have the potential of serving not just as a resource for Robert, but as a resource for those who regularly interact with him and for those who are often responsible for organizing or monitoring his daily tasks. As it seems to be a “go-to” practice for navigating various challenges and uncertainties, it may, in simplistic terms, provide a marker to highlight these moments for interlocutors, giving them an opportunity to try to take Robert’s perspective and identify what kind of challenge he may be currently facing when “now what” is produced.

6.5.1 Singing in the Turn-Taking Structure of Talk

Dan sings in a wide range of discursive locations. In terms of sections of conversation in the most general sense, Dan sings in middle and closing (or adjourning) sections. It remains inconclusive whether he sings during openings, such as greeting sequences, as those were not recorded. Sections of conversation are a relatively coarse division of interaction. In terms of fine-grained sequential structure, Dan sometimes sings modified songs to open sequences but more often as second pair parts or post-expansions. His singing is thus relatively unconstrained by position.

The length of Dan’s songs spans from single, short turns to multiple turns with intervening talk. On the sparser side, 10 of Dan’s 39 singing occurrences are “one liners.” In Extract 2, for example, Dan produces a short singing turn, and Morgan speaks afterwards.

In an earlier sequence, Morgan informed Dan that they were going to a store she calls Jake Jabs. Dan uses the store name in a single line of singing, and Morgan laughs in appreciation. One could argue that she is curtailing his song by starting a new sequence about taking cameras. However, Morgan does not latch her turn onto Dan’s singing turn, nor does she speak in overlap, and Dan does not continue singing during the pauses in line 3.

Dan also treats a similar single line of lyrics as complete in many other excerpts such as in Extract 3.

Here, Dan himself pauses then switches to talking after the first line of the same song seen in Extract 2. This means that a potential end to a singing turn, and thus a possible transition relevance place to next speaker, is located at the end of a relatively short turn of singing. What constitutes a “line” or turn constructional unit (TCU) is song-specific, and the data suggest that both participants treat the formulaic sequence [oh xxx oh xxx] performed with prosody from “The Fireman’s Band” as a TCU (Foster, Reference Foster2015).

Singing beyond the first TCU is an accomplishment that is contingent upon the actions of co-participants. Co-participants have a role in song extension through use of silences that invite more, continuers, minimal assessments, and laughter (Foster, Reference Foster2015). Additionally, Dan extends songs following explicit invitation for continuation and to account for the song’s relevance, as exemplified in Extract 4. Dan and Morgan have been talking about slip trailing, a technique for applying raised patterns to ceramics. Dan enjoyed making pottery as a hobby after retirement. Earlier he was complaining about his difficulty learning how to do slip trailing, and they had some disagreement over what makes it challenging. The interaction continues below with talk about his trouble. He eventually sings to the tune and general structure of “Old McDonald,” a children’s song in which the singer names an animal and the sound it makes on Old McDonald’s farm, before ending the verse with “e–i–e–i–o.”

In line 23, Dan recontextualizes Morgan’s earlier dabble (line 16) in his version of “Old MacDonald.” Morgan volunteers laughter (line 27), and Dan comes to a possible ending of the song with I won’t say the rest of it (line 28), which hints at the potential for more but a decision to stop. Morgan does not accept the ending and invites continuation with oh go on plus more laughter (line 30). Dan extends the song with the usual final verse Old MacDonald had a farm e–i–e–i–o (lines 31 and 33). This is another possible ending point, but Morgan again does not treat it as an acceptable one. She instead pursues an account for the song’s relevance (line 35). By asking what the song had to do with pottery, Morgan’s go-ahead for more singing emerges as more than a general request for additional lyrics. Singing the rest of it does not just mean any lyrics in this case but ones that relate to prior talk. Dan responds by singing with reference to pottery (line 43). The song again comes to a possible completion point with e–i–e–i–o, with Morgan laughing in overlap (lines 45–46) and Dan producing an affiliative smile. This time, the song ends. The fact that Morgan pursues more singing and Dan expands the song to account for its relevance shows that the song’s ending is contingent and arrived at jointly. Dan makes decisions about appropriate stopping points, but the ending of the song is negotiable. Dan can be held accountable for how the singing relates to the ongoing action, and a lot of interactional work is done to establish progressivity by singing turns and the talk that follows.

Beyond the analytical account of how Dan’s singing fits into the structure of talk, Dan’s innovative songs reveal his exceptional cognitive and creative competencies. His skill at manipulating lyrics into new songs reveals strengths in at least attention, working memory, semantic memory, pattern recognition, and musical memory. These are aspects of cognition that are required to retain words and themes from previous turns and fit them into the syllabic patterns, rhyme, grammatical structures, and concepts of the original lyrics. In an exploration of the poetics of ordinary conversation, Jefferson (Reference Jefferson1996) presents a collection of talk that is produced in part by reference to previous sounds and word categories (e.g., puns, sounds repeated across turns). Dan’s singing puts this type of poetics at the forefront in the way that he playfully integrates words from Morgan’s turns into the formulaic structure of the song. Dan’s singing positions him as someone who can astutely monitor conversation for sources of musical wordplay and as an active participant who creatively furthers interaction. In the next section I analyze how Morgan and Dan orient to his poetics as humorous and well-constructed.

6.5.2 Accomplishing Humor through Singing

Dan at times uses singing to close sequences that are characterized by dispreference and redirects the interaction toward affiliation with humor. Literature on singing in conversation by neurotypical participants is lacking with a few exceptions. In a study by Frick (Reference Frick2013), Finnish speakers in Estonia use singing to end extended interactional sequences that include signs of nonalignment and dispreference, such as being silent after a story and not granting requests. Frick describes how participants in one example follow singing with smiles, laughter, and other sound-making. She argues that this affiliative joint activity builds rapport and distances them from the dispreferred actions without calling for continuation of the sequence. Extract 4 illustrates a similar use of singing by Dan in English. The extended interaction has elements of dispreference and disagreement: dispreference in the blocking of progression of talk about troubles, overt disagreement about slip trailing, and conflicting characterizations of his degree of involvement in pottery. Dan’s singing ends the interaction on a humorous key. Morgan laughs repeatedly during the song, and Dan’s final smile solidifies affiliation as they close the sequence about his involvement with slip trailing and pottery.

Dan’s singing is often treated as funny by co-participants. In many of the extracts, Morgan laughs during and after Dan’s singing, sometimes even when Dan has not laughed. Jefferson (Reference Jefferson and Psathas1979) compares structurally and sequentially distinct types of recipient laughter. Volunteered laughter is produced after a recognition point, which is a moment when a recipient recognizes that laughter is warranted. A recipient produces speaker-invited laughter after a speaker’s end-of-turn or within-turn laughter. There are many examples of Dan and Morgan treating Dan’s singing as humorous by using both types of laughter. The laughter may be volunteered laughter as in Extract 5.

After Dan sings about the vulture, which is a persistent theme throughout the interaction, Morgan produces a stretch of laughter (line 6). In Extract 5, Morgan laughs after a short gap, but she does not always wait until the end of the song to laugh. Lerner (Reference Lerner, Ochs, Schegloff and Thompson1996: 259) writes that “a recipient need not delay affiliation until next turn” with laughter. Indeed, in other examples Morgan laughs throughout and even in overlap with Dan’s singing. Her laughter in overlap demonstrates her understanding of his singing as funny, even near the onset of singing.

In addition to volunteered laughter, Morgan sometimes replies to Dan’s singing with a joke of her own. Extract 6 provides an example.

In this example and on other occasions Morgan makes a humorous remark related to Dan’s song immediately after he finishes singing. Morgan briefly laughs before her turn don’t go out if you’re not feeling well that teases about the possible danger of a weakened person falling prey to vultures. Dan meets her joke with astonishment – as he often does to jokes that are rude, morbid, or at his expense – by looking at Morgan with a wide-open-mouth posture and asking a question with laughter (Wilkinson & Kitzinger, Reference Wilkinson and Kitzinger2006). In this case, Dan produces wh(h)at (line 10) followed by agreement (lines 12–13) and a great deal of laughter. Morgan does not treat his question as a problem with hearing or understanding but instead laughs as well. Jokes can come in tit-for-tat succession, and Morgan’s laughter plus in-kind humorous responses are further evidence that some of Dan’s songs are designed to be funny and are taken as such.

There is evidence that Dan and Morgan orient to wordplay within the song’s original lyrical structure as constituting humor. The participants’ retrospective characterization of singing in Extract 7 provides evidence of this. Morgan and Dan are finishing a meal, and Morgan invites Dan to think about a trip they have planned for the following day.

After Dan finishes singing, Morgan volunteers laughter and evaluates his song with oh goody goody (line 16). Dan joins in her laughter and says fool you didn’t I (line 23). Morgan agrees, and Dan expands with you weren’t sure what I was gonna say (line 25). Morgan again agrees and adds that was a new variant on the theme (lines 29–30). Both Morgan and Dan have treated the song as laughable. A laughable song can fool you because you won’t be sure what he is gonna say, and part of the fun of Dan’s singing is anticipating how he is going to make a new variant on the theme by modifying recognizable lyrics. His performances have value, in part, from the novelty and creativity in which he recontextualizes the text by changing elements based on surrounding talk. In other words, humor hinges on unpredictability within a formulaic sequence and on Dan’s competent performance of clever modifications.

Morgan does not always agree with Dan’s stance towards humor. This type of disaffiliation can be accomplished by withholding laughter. Morgan’s absence of laughter is especially salient after Dan invites her to laugh. Jefferson (Reference Jefferson and Psathas1979: 93) writes, “One technique for inviting laughter is the placement, by speaker, of a laugh just at completion of utterance, and one technique for accepting that invitation is the placement, by recipient, of a laugh just after onset of speaker’s laughter.” A co-participant, however, does not have to accept speaker-invited laughter. For example, in Extract 8 Morgan volunteers laughter at the start of the song but does not join Dan in laughing afterwards.

Morgan is helping Dan get dressed, and after she offers him socks, Dan uses the sockie wokies from her turn for another version of “The Fireman’s Band.” Morgan volunteers laughter in the midst of Dan’s singing (line 11) and takes the position that his singing is humorous in that moment. However, after Dan finishes his song, Morgan declines to laugh and even does a hard exhale (line 14) – perhaps indicating disapproval. Dan’s loud laughter (line 16) makes her laughter relevant again. Morgan does not immediately laugh, and Dan continues with an assessment that song didn’t wanna come out but it came out (lines 16–17) that puts a somewhat positive spin on his difficulty with the song. Jefferson (Reference Jefferson and Psathas1979: 93) explains that one technique to decline an invitation to laugh is with recipient talk that does “serious pursuit of topic as a counter to the pursuit of laughter.” Dan’s it came out provides an alternative route for Morgan, and she declines to laugh by instead responding to Dan’s assessment of the song’s construction. Morgan disagrees with his stance that his rendition came out. She accomplishes this disaffiliation by countering with a second assessment that repeats part of his turn with the added negative qualification that it sort of came out (line 18).

While not made explicit, it could be that their assessments speak to how well his song’s final line to have sockie wokies to wear upon my feet maintained the rhythmic and grammatical structure of the song’s original lyrics “that we should have another drink.” In any case, Morgan’s stance in Extract 8 illustrates that the humor of Dan’s performance is not predetermined. Whether Dan accomplishes humor or not is contingent on the unfolding structure of his lyrics, and participants may shift their stance as the song emerges. The humor of his performance is an accomplishment at every turn.

In summary, doing humor is one of the primary things that Dan accomplishes with singing. A song’s ability to provoke laughter may depend on how well Dan maintains a balance between providing unique modifications while preserving the form of the original text (e.g., syllabic structure, syntactic structure, and final rhyme). Humor may also depend on how well the song reflects semantic themes of the prior discourse. Evidence that Dan and Morgan orient to these elements as constituting humor or a “good” song are found in their responses to his singing. Evaluation of the song may include reference to the song’s relevance to ongoing talk (e.g., what did that got to do with pottery in Extract 4), the construction of the song (e.g., that song didn’t wanna come out in Extract 8), and unpredictability of the wordplay (e.g., fool you didn’t I in Extract 7). Although Dan and Morgan both often treat Dan’s singing as laughable, Morgan does not always affiliate with Dan’s stance toward his singing. The humor of Dan’s singing is an interactional accomplishment that is not guaranteed by the original text, and its achievement contributes to Dan’s situational construction of self as clever and funny.

6.5.3 Doing Complimenting, Complaining, and Requesting through Singing

In addition to using singing to do humor, Dan sings to accomplish a range of other actions including complimenting, complaining, and requesting. I address each of these in turn. There are multiple examples of Dan singing compliments and appreciation in the data. In the most transparent examples, Dan explicitly identifies the person or the action that he appreciates. For instance, in Extract 1 Dan is eating when he announces that he is slowing down with his meal and getting full. Morgan’s well you’ve attacked that with gusto could account for why he is slowing down and getting full. Dan could simply agree with her, or he could provide an alternate account for why he ate that way (e.g., with an assessment about the meal). Dan goes down the latter path with the second part of his song I’m half crazy over eating with you. Morgan treats his singing as a compliment with well that’s very kind of you. In other examples, Dan similarly does gratitude for offers of assistance (Foster, Reference Foster2015).

There are also two examples in which Dan’s singing turns express appreciation for his food, Extracts 9 and 10.

In Extract 9, Dan starts by singing about his meal of blueberries and cereal (lines 2, 4, and 7). This portion of the song ends with I’m half crazy for the cereal on you. There is silence for over 11 seconds while Dan eats. He then continues singing it won’t be a stylish meal I can’t afford a Coors (beer) (lines 9 and 11) before describing an imagined meal in which the blueberries will taste sweet on some ice cream and cookies (lines 13 and 15). After he finishes singing, Dan laughs and looks briefly at Morgan who is preoccupied with writing an email. In the second example, Extract 10, Morgan is out of visual range but can hear Dan from the next room. In line 5, Dan does appreciation of the black beans and their protein content. In both of these extracts Morgan is within hearing distance but occupied with other activities. It could be that the main project of these singing turns is to do gratitude for the meal and/or to re-establish joint interaction with Morgan. Unfortunately, Morgan’s lack of uptake means that we cannot be certain how she might treat his singing his appreciation of food. In many other examples of talk, however, Dan notices ingredients and their attributes in the food that he is eating and then thanks Morgan for taking care of him. This collocation suggests that his doing appreciation of food is part of a practice of expressing gratitude for caregiving.

Dan’s singing often expresses affection by doing appreciation for companionship, gratitude for assistance, and positive evaluations of food. The songs he modifies to accomplish this is the love song “Bicycle built for two,” and Dan can easily change the text to express affection that is specific to each encounter. Dan is acutely aware of the daily help that he needs, and he is quick to express thanks for assistance. He often says things such as thank you for this meal or thank you for taking care of me multiple times during a meal. Modifying songs, especially the sweet love song “Bicycle built for two,” is a resource Dan uses to creatively build closeness and intimacy with Morgan.

Of course, as with talk, there is not a one-to-one correlation between singing and action. Dan at times does a complaint through singing, much in contrast to the humor and appreciation discussed earlier. In Extract 11, for example, Morgan starts a new sequence about a visual word puzzle, or “wuzzle,” that was posted at her gym. Dan sometimes sings in response to Morgan’s announcements of upcoming activities (see Foster (Reference Foster2015) for an analysis of Dan’s singing in response to “mere informings” of new activities in terms of deontic congruence). In this case, Dan’s singing resists the activity.

Extract 11 starts with Morgan’s announcement oh there was another wuzzle today one of these word puzzles (lines 1–2). Her announcement projects the possibility of more than simply news of a new wuzzle. Indeed, Morgan starts writing down the wuzzle, which strengthens the possibility that her announcement is part of a larger “doing the wuzzle” project. Dan then sings a modified version of “Old MacDonald” that contrasts Old MacDonald’s liking of wuzzles to his own dislike of them. The singing concludes with I don’t like wuzzles very much (line 12) that anticipates this larger project. Morgan responds with an assessment you’re good you’re pretty good at them (line 14), and her complimenting turn could also be heard as an account for why he could do the wuzzle despite disliking them. Dan does not align with her assessment, possibly because of the problem of how to respond to compliments (see Pomerantz (Reference Pomerantz and Schenkein1978) on the multiple constrains on compliment sequences), but an agreement might also weaken his resistance to the activity. Morgan presents him with the wuzzle in any case.

Morgan’s another wuzzle (line 1) is relevant here as it points to a repeated activity in which Morgan brings home word puzzles for Dan. Dan struggles with comprehending and completing them. In this instance, Dan takes almost a minute to do the basic word puzzle, and Morgan provides so many clues to assist him that he complains several times you told me the answer. In light of this, Dan’s singing can be heard as a complaint that resists the upcoming wuzzle, an activity that exposes his impaired cognition.

In addition to modifying lyrics to do an appreciation or a complaint, there are two examples in the data of either Dan or Morgan treating his singing as doing a request. Although Dan does not modify the lyrics of “The Fireman’s Band” in these instances, his singing is interpreted within the framework of everyday talk and not treated as a performance of the song to be evaluated. In the first example, Extract 12, Dan sings as Morgan places a cup of coffee in front of him.

At the start of Extract 12 Morgan is walking into the room holding Dan’s cup of coffee as Dan sings a drinking song. This example could be viewed as Dan matching his singing to the events occurring in the world. Retrospectively, however, Dan’s turn it worked (line 12) positions his singing – even if jokingly – as a successful request that Morgan has fulfilled.

In the second example, Extract 13, Morgan herself responds to Dan’s singing as a request that requires an account.

Dan has sung “The Fireman’s Band” just before this extract, and Morgan treats Dan’s singing as an actual request for a drink. She first seeks an account for it with and why do you think that we should have another drink (lines 1–2) and later offers him a root beer (lines 10 and 13). Dan is aware of the fact that he has medical and pharmaceutical restrictions on how much alcohol he can drink (see better be water (line 12) and his lament here we are right next to Coors at least close to it and I don’t even get any beer (lines 17–18, 20)), so it is unlikely that he meant for his singing to be taken as a sincere request for an alcoholic beverage. Indeed, Dan counters by providing an alternative version of what he was attempting to accomplish with I was just trying to be sociable (line 3).

In this section I have primarily focused on how Dan and Morgan give meaning to Dan’s singing by how their responses – such as laughter, assessment, and pursuit of an account – treat it. Extract 13 is a rare case in which Dan uses metalanguage to describe the meaning of it. Even more, it is an example in which Morgan’s treatment of Dan’s singing is not in alignment with how he describes it. Enfield (Reference Enfield2013: 101) uses the term treating‑as to describe the response process participants usually use to characterize a speaker’s actions, in contrast to a describing‑as categorization process. For example, responding to “You look nice” with “Thank you” treats the previous turn as a compliment whereas “He gave me a compliment” explicitly describes it as one. Dan provides us with a described‑as account for his singing that suggests a broad emic action category of being sociable. In this general sense, we may treat all of Dan’s singing events that I have discussed as doing being sociable. He could simply speak instead of sing, but singing allows him to be sociable by performing entertaining songs. The texts that he sings are not neutral vehicles. They are clever and humorous variations of drinking songs, love songs, and children’s songs. Dan’s performances are a resource for him to position himself as funny, affectionate, and as a guy who used to enjoy a drink and who would still like to have one now.

7.1.1 Tag Questions and the Epistemic Order, Deontic Order and Emotional Order

In outlining relevant conversation analytic research on the use of tag questions in interaction, it will be useful to discuss different types of social action (Levinson, Reference Levinson, Sidnell and Stivers2013) that have been analysed in relation to their tag question turn format. It is also important to note that tag question turn formats have been shown to be one practice through which a speaker can display a particular stance concerning issues of epistemics (knowledge), deontics (power, control and agency) or emotion (or affect) in interaction (for a discussion of these three orders within interaction, see Stevanovic & Peräkylä, Reference Stevanovic and Peräkylä2014).

In relation to epistemic issues, for example, a tag question displays an orientation to the knowledge status of the recipient (Ekberg et al., Reference Ekberg, Ekberg, Weinglass, Rendl-Short, Bluebond-Langner, Yates, Bradford and Danby2022). Designing a turn in the form of a tag question can be a means by which the speaker displays their epistemic stance (Heritage, Reference Heritage, Sidnell and Stivers2013) in relation to the recipient as regards the speaker’s proposition. For example, while a yes/no question such as ‘are you married?’ expresses that the speaker has no definite knowledge of whether the recipient is married or not, a tag question format (‘you’re married, aren’t you?’) ‘conveys a strong hunch as to the likelihood of a particular response’ (Heritage, Reference Heritage, Freed and Ehrlich2010: 48) and indexes a smaller information gap between the speaker and the recipient compared to a yes/no interrogative (Heritage, Reference Heritage2012). When a speaker produces a tag question, the epistemic status (Heritage, Reference Heritage2012) of the speaker relative to the recipient of the utterance will influence how that tag question will be heard and treated. When the speaker evidently has a lower epistemic status than the recipient, the tag question is hearable as requesting information from the recipient in the form of a confirmation of the tag-formatted statement proffered by the speaker (Heritage, Reference Heritage2012). In other cases, however, such as when a speaker and recipient have relatively equal access to the information being discussed, the tag question is hearable as a statement by the speaker that seeks agreement from the recipient (Heritage, Reference Heritage2012).

Tag questions have also been analysed in terms of how they are used as a turn format for a different type of action/activity, that is advice-giving (Hepburn & Potter, Reference Hepburn and Potter2011). In their data involving child protection officers (CPOs) talking to callers on a national child protection helpline, Hepburn & Potter (Reference Hepburn and Potter2011) explore how the CPOs regularly use tags when providing advice to callers (for example, ‘you need to sort it out don’t you really’: Hepburn & Potter, Reference Hepburn and Potter2011: 228). Advice-giving, like directives, proposals or requests, is an activity concerned with getting others to do things, such as commit to future actions. As such, it can invoke the relative deontic rights of the participants (Stevanovic & Peräkylä, Reference Stevanovic and Peräkylä2014). Hepburn and Potter (Reference Hepburn and Potter2011) explore instances where advice that has previously been resisted by the caller is presented again by the CPO, including on this latter occasion with a tag. They note that in this context when the advice-giving is produced in a tag question format, it can be seen to be ‘coercive’ (Hepburn & Potter, Reference Hepburn and Potter2011: 236) in that this form of turn design prefers an affirmative response, here in the form of an agreement from the caller, even though the caller has previously resisted the advice.

A third type of action where tag questions have been discussed in relation to their tag question turn design is challenges (Keisanen, Reference Keisanen and Englebretson2007). Like other actions, such as accusations, challenges can be disaffiliative (Sorjonen & Peräkylä, Reference Sorjonen, Peräkylä, Peräkylä and Sorjonen2012) and, as such, can display one way in which the participants negotiate the emotional facets of their relationship (Stevanovic & Peräkylä, Reference Stevanovic and Peräkylä2014). In Keisanen’s data, the challenges can be produced in response to an initiating action, where the tag question turn challenges the appropriateness or relevance of that prior action. Keisanen (Reference Keisanen and Englebretson2007) notes that the tag question turn indexes a discrepancy in information between the participants, and this discrepancy is used as a basis for the challenge.

7.1.2 Tag Questions in Talk-in-Interaction Involving Participants with Dementia

Research into conversations involving people with dementia has not focused systematically on co-participants’ use of tag questions, although their deployment has been noted in passing (Rasmussen et al., Reference Rasmussen, Dalby and Muth2019; Svennevig & Landmark, Reference Svennevig and Landmark2019). However, one area of the literature where they regularly have been discussed is work on what has been labelled ‘elderspeak’. This term is used to refer to a speech register which may be displayed by those (in the literature, particularly health and care staff) talking with older adults and people with dementia. Elderspeak is described as consisting of features including tag questions, a slower rate of speech, elevated and exaggerated pitch and volume, relatively simple grammar and vocabulary, and the use of diminutives (Williams et al., Reference Williams, Kemper and Hummert2004). It is suggested (Williams et al., Reference Williams, Kemper and Hummert2004) that elderspeak may be perceived by hearers as patronizing and as implying a lack of competence on the part of the recipient. The use of a tag question such as ‘you want to get up now, don’t you?’ by a staff member to a resident with dementia has been described as ‘prompt[ing] resident responses, thus suggesting the resident’s inability to independently choose’ (Williams et al., Reference Williams, Herman, Gajewski and Wilson2009: 12), and it has been suggested that the use of tag questions as part of elderspeak is likely to be harmful in that they ‘politely push older adults’ answers and behaviours in a desired direction’ and ‘undermine meaningful conversations and self-determined behaviours of older adults’ (Schnabel et al., Reference Schnabel, Wahl, Streib and Schmidt2021:417).

7.2.1 Semantic Dementia

Semantic dementia is a type of frontotemporal dementia (Snowden et al., Reference Snowden, Goulding and Neary1989). It is also described as the semantic variant of primary progressive aphasia (Gorno-Tempini et al., Reference Gorno-Tempini, Hillis, Weintraub, Kertesz, Mendez, Cappa, Ogar, Rohrer, Black, Boeve, Manes, Dronkers, Vandenberghe, Rascovsky, Patterson, Miller, Knopman, Hodges, Mesulam and Grossman2011). While the presence of a progressive language disorder is required for diagnosis (Gorno-Tempini et al., Reference Gorno-Tempini, Hillis, Weintraub, Kertesz, Mendez, Cappa, Ogar, Rohrer, Black, Boeve, Manes, Dronkers, Vandenberghe, Rascovsky, Patterson, Miller, Knopman, Hodges, Mesulam and Grossman2011), it is known that with disease progression also come changes in other cognitive abilities, behaviour and personality, with symptoms often overlapping with those of behavioural variant frontotemporal dementia (Kertesz et al., Reference Kertesz, Jesso, Harciarek, Blair and McMonagle2010). Semantic dementia leads to significant challenges in communication for the person affected and their family members (Snowden et al., Reference Snowden, Kindell, Neary, Bryan and Maxim2006), including difficulties for the person with dementia in understanding and in finding words when talking.

Research in semantic dementia has largely concentrated on assessing and treating underlying language (and other) impairments (e.g., Jokel et al., Reference Jokel, Rochon and Leonard2006). Less well understood is the impact of such language impairments, as well as changes in memory, behaviour and personality, on everyday conversation. To our knowledge, only two studies have specifically explored conversation in this condition. Kindell et al. (Reference Kindell, Sage, Keady and Wilkinson2013) used conversation analysis to analyse how Doug, a man with semantic dementia, adapted the use of his remaining linguistic and other communicative resources within conversation through regularly deploying enactment (Goodwin, Reference Goodwin1990), that is depicting (rather than describing) an action or event using resources such as direct reported speech (Holt, Reference Holt1996) and bodily behaviour such as eye gaze and gesture. Taylor-Rubin et al. (Reference Taylor-Rubin, Croot, Power, Savage, Hodges and Togher2017) used a discourse-oriented approach to explore what they termed ‘trouble-indicating behaviours’ (TIBs) in seven individuals with semantic dementia recorded while talking to their spouse in a clinical situation. The authors compared the number of TIBs to control subjects and found a higher presence in the turns of the people with semantic dementia. It can be seen, therefore, that both studies, while using different approaches, primarily examined the person with dementia and their communicative strengths or limitations. In this chapter, we aim to add to our knowledge of recurrent features of conversations involving people with semantic dementia by examining primarily the talk of the person with dementia’s co-participants – specifically, their use of tag-formatted utterances – and in addition what the interactional implications of these tag-formatted utterances have for the participation of the person with dementia.

7.2.2 Participants and Data

In each of the three couples in this study, the person with dementia lives at home with their spouse. The couples are:

In each case, therefore, the person with semantic dementia was experiencing significant difficulties with expression, comprehension and cognitive abilities, such as retaining information. This is evident in their neuropsychological test scores using the Addenbrooke’s Cognitive Examination (ACE: revised version and version III) (Hodges, Reference Hodges2005), where Peter scored 27/100, Sarah 36/100 and Doug 18/100. Since a score below 82 on the ACE indicates likely dementia, it can be seen that each of these three people with dementia was at the more severe end of the spectrum.

Conversation was explored through analysis of video recordings of everyday conversations recorded by the couples at home. A total of 7:14 hours of conversation was recorded (couple one, 3:30 hours; couple two, 3:00 hours; couple three, 44 minutes).

An ethics committee registered with the National Health System (NHS) in the United Kingdom approved the study. The data were transcribed using the Jeffersonian transcription system (Jefferson, Reference Jefferson and Lerner2004). In the extracts in this arrows in the margins are used to direct the reader’s attention to the tag questions which are the primary focus of the analysis.

7.3.1 Tag-Formatted Assertions and Assessments

There are three features of tag-formatted assertions and assessments that we wish to highlight as regards their use by co-participants of people with dementia. The first is that they encode a certain level of access (at least to the extent of a strong hunch) on the part of the speaker to the information being discussed (Heritage, Reference Heritage, Freed and Ehrlich2010). The second is that at the same time they acknowledge the recipient as having some epistemic access and authority as regards the information being talked about (Ekberg et al., Reference Ekberg, Ekberg, Weinglass, Rendl-Short, Bluebond-Langner, Yates, Bradford and Danby2022). The third is that they put some interactional pressure on the recipient to respond, and to do so in a way which displays alignment with the statement in the tag question.

In particular we will be showing here how co-participants can use a tag question format when they produce actions which involve providing the recipient with information that the recipient has already been told or might normally be expected to know (Stivers et al., Reference Stivers, Mondada and Steensig2011). Extract 1, involving Sarah and Reg, provides instances of this type of assertion produced by Reg both with a tag (lines 20–21) and without (e.g., lines 13, and 26–27).

In line 08 Reg proffers a new topic (in the form of a tag question; we will return to this instance in due course). Sarah, however, does not buy into, and take forward, the proffered topic (Schegloff, Reference Schegloff2007); it appears (from the long 3.6 second silence, and then her querying ‘Wednesday?’ in lines 10 and 11) that she has a problem in making sense of what Reg has just said, particularly in relation to the day that Reg has mentioned. Reg treats this as a problem relating to Sarah’s dementia, that is a problem in orienting to time, including remembering which day it is that day, and proceeds to produce a series of assertions that violate the norm of not telling a recipient information they (should) already know (Stivers et al., Reference Stivers, Mondada and Steensig2011). These include what day of the week it is today (line 13), what Sarah will be doing tomorrow and the day after (lines 15 and 17), the fact that Sarah did not go to Jean’s last week because she (Sarah) had a migraine (lines 20–21), and that Sarah had had migraines on a few days last week (lines 26–27 and 29–30).

One of these assertions (lines 20–21) is in the form of a tag question. As such, and unlike the other assertions here, Reg simultaneously provides information for Sarah (which, it is clear from the context, Sarah is likely to have had trouble producing herself), while treating the information being conveyed as being within Sarah’s epistemic domain, and, implicitly, as something that she can remember (or at least will be able to remember after being prompted by Reg’s utterance). By making expectable a response from Sarah, with a preference for an agreement, the tag question expects an affirmation by Sarah of this assertion, which in this context will be hearable as evidence that she remembers the fact being conveyed. As such, Reg’s assertion is produced in a manner (i.e., tag-formatted) that treats Sarah as being able to remember the information conveyed in the assertion and affirm it. In this way, Reg bestows competence on Sarah, treating her as having these cognitive competences at this point in the interaction, whether or not she actually does remember her aborted visit to Jean the previous week.Footnote ⁴ With the use of this tag-formatted assertion, therefore, Reg acts to discursively construct Sarah’s psychology (see Hepburn and Potter, (Reference Hepburn and Potter2011: 220) on the psychologically ‘invasive’ use of tag questions) as someone who will be able to remember the happening (or non-happening) that Reg is discussing.

In their talk with their spouses with dementia both Reg and Karina recurrently produce tag-formatted assertions and assessments similar to those seen in Extract 1. One use of this type of utterance for these co-participants appears to be that it allows them to produce assertions and assessments concerning issues which would be expected to be in their spouse’s epistemic domain if that spouse did not have dementia, and to elicit agreement or confirmation from the person with dementia regarding what is being discussed. Of course, in these cases it may be unclear to the co-participants whether their spouse with dementia does indeed remember and have knowledge about the matters encoded in the assertion or assessment. Importantly, however, the tag-formatted utterance treats the person with dementia as if they do, bestowing competence on them and working to elicit their agreement with the matters being discussed. In addition, they engage the person with dementia in co-constructing topical talk about these issues (for example their experiences and feelings, or talk about friends, family members and acquaintances) that are within that person’s lifeworld.

The three participants with dementia in our dataset initiate relatively little within these conversations and often display difficulty in contributing to the conversation due to their cognitive and linguistic impairments. As such, an ongoing issue for the co-participants is how to engage the person with dementia in topic talk and to bring into the conversation issues relating to the person’s lifeworld that the person with dementia is not able to regularly bring in through their own talk.

These issues can be seen in Extract 2 involving Doug and Karina. The couple are talking about Jill (referred to in the extract as ‘she’ and ‘her’), who is a volunteer at a social group for people with dementia which Doug attends and who gives Doug a lift home after the meetings. It is clear from the context that while Jill’s main role is in relation to Doug, she also has a relationship with Karina, and the facts about Jill being discussed in this episode are treated as knowledge shared by Karina and Doug (what Labov & Fanshel (Reference Labov and Fanshel1977) refer to as ‘AB event’ information). A notable feature of the extract is Karina’s recurrent use of tag-formatted assertions (lines 01, 09–10 and 21–25) and assessments (lines 04, 12–15, and 18–21), with six produced within this 40-second episode.

Karina’s tag-formatted utterances here can be seen to repeatedly make expectable responses from Doug, with a preference for Doug to produce aligning responses, agreeing with or confirming what Karina has said. In this way, Karina is able to elicit participation from Doug and to co-construct the topic talk in a particular way; while she provides the vast majority of the content, Doug’s contribution can be limited to responding to – usually in the form of aligning with – that content. Here, therefore, Karina can bring into the conversation, and develop topical talk about, someone who is within Doug’s lifeworld, but whom Doug himself may not have been able to topicalize within the conversation due to his impairments. At the same time, her tag-formatted utterances are hearable as an acknowledgement that this content is (or should be) within Doug’s epistemic domain, and they function to elicit Doug’s alignment with, and co-construction of, this content.

In Extracts 3 and 4 it is possible to see how a co-participant uses tag-formatted utterances to talk about what for the speaker is a ‘B event’ information (Labov & Fanshel, Reference Labov and Fanshel1977), that is information that primarily is, or should be, within the recipient’s epistemic domain. In each of these examples (from conversations on different days) Reg states that Sarah did not sleep well during the previous night (lines 11–12 in Extract 3; lines 11–12 in Extract 4).

Whether one has slept well or not is clearly something about which the person concerned would be expected to have primary epistemic rights. Such information concerning something experienced first-hand by the person themselves is an example of a Type 1 knowable and, as such, something that a participant has rights and obligations to know (Pomerantz, Reference Pomerantz1980). Asserting information about such issues relating to the recipient risks being heard as epistemic trespassing (Bristol & Rossano, Reference Bristol and Rossano2020). Here this risk is mitigated to some extent by being asserted in the form of a tag question, acknowledging these issues as something which should be within the recipient’s epistemic domain and eliciting a response from Sarah in regard to what is being asserted.

There is, therefore, a sense across these conversations involving a person with dementia that the co-participants are controlling the topical content of the talk through most commonly bringing into the conversation matters that they (the co-participants) already know something about, and less frequently asking the person with dementia questions to which they as questioners do not know the answer. A reason for this can be seen to be that the participants with dementia in our dataset are at a level of severity in their illness where they might not be able to provide an answer which provides the information the question is asking for. For these co-participants, tag questions are thus one alternative to producing information-seeking questions such as yes/no questions; while, like yes/no questions, they elicit a response from the person with dementia (here, typically aligning responses) and, as such, scaffold their participation in the conversation, tag questions also permit the co-participant to talk about matters about which they already have knowledge, or at least a good hunch, as to what the response might be.Footnote ⁵

One area of conversation to which these issues can be seen as pertinent is topic proffers (Schegloff, Reference Schegloff2007) by the co-participant of the person with dementia. Reg, for instance, appears to quite regularly proffer topics to Sarah in the form of tag questions. This was seen in Extract 3 (lines 11–12) and Extract 4 (lines 11–12 as well as in Extract 1 (lines 08–09). Schegloff (Reference Schegloff2007) notes that topic proffers (in conversations involving typical adult participants) are most commonly implemented by yes/no questions, and that one type of topic which is often initiated in this way is what he terms ‘recipient-oriented topics’ (170) where it is the recipient who is treated as the more authoritative speaker regarding the matters raised, and who is being set up to be the primary speaker in the topic. In the case of Extracts 1, 3 and 4 it is notable that Reg produces the topic proffer in the form of a tag question rather than a yes/no question. This format for doing the topic proffer means that while Reg launches a topic where he is treating Sarah as the authoritative person (regarding whether she is looking forward to visiting Jean on Wednesday, or how she slept the previous night), he does so in a way where he also has some knowledge of the matters he is proposing Sarah talks about, and thus has some control regarding how the topic might develop (compare, for example, ‘did you sleep well last night?’).

The benefits for the co-participant of having some epistemic access to the issues being discussed can be seen in Extracts 1, 3 and 4, where in each case Sarah does not take the proffered topic forward due to reasons of inability (displayed either as a statement of inability such as ‘I don’t know’ in Extracts 3 and 4, or through her apparent disorientation in Extract 1 regarding the place in time of the issues being discussed). In such cases, Reg is then able to use his knowledge of the matters under discussion (for example, in Extracts 3 and 4 his knowledge of how well Sarah slept based on his observations of her behaviour during the night) to pick up and develop the topic.

7.3.2 Tag-Formatted Challenges

In the previous section we described the use of tag-formatted assertions and assessments by Reg and Karina, two spouses of people with semantic dementia in our dataset. In this section we describe a different type of tag-formatted utterance. This type of utterance – challenges, here in a tag-formatted form (Keisanen, Reference Keisanen and Englebretson2007) – are produced by only one of the spouses, Joanna.

We discuss two episodes here. In both cases, Peter has asked Joanna a question, and following that question (either in the next turn at talk, or in a later turn) Joanna challenges it. In both Extract 5 and 6a this is done in a similar way; with ‘we’ve just been talking about it, haven’t we?’ in Extract 5, and with ‘we’ve been talking about it … haven’t we?’ in Extract 6a. As such, Joanna treats the production of Peter’s question at this point as inappropriate or inapposite in some manner (Heritage, Reference Heritage1998). That is, in requesting information, each of Peter’s questions implicitly claims that he does not have access to this information, while simultaneously presupposing that Joanna does, or is likely to (Heritage, Reference Heritage1984). As such, Peter claims a right to ask the question, and puts some form of obligation on Joanna to answer it (Heritage & Raymond, Reference Heritage, Raymond and De Ruiter2012). In each case, however, Joanna produces a response which is disaligning and disaffiliative (Stivers et al., Reference Stivers, Mondada and Steensig2011); that is, rather than answering the question, she produces a challenge to Peter (see Keisanen, Reference Keisanen and Englebretson2007) which disputes his implicit claim not to have had access to the information that he is requesting.

Extract 5 provides the first example.

The couple are chatting at breakfast. Following a lapse in the conversation Peter asks Joanna a question about what he should do that day if (due to the current cold weather) the golf course is closed (lines 01–02). In his conversations, Peter regularly asks what he or they are doing next or doing later that day, and indeed earlier in this conversation (not shown here) he has already asked a similar question (‘what are we doing today?’), to which Joanna has answered that he was supposed to be playing golf with a friend but that she now has to check whether the golf course will be open or not that day. She reminds Peter they had discussed this issue earlier in the conversation and then prompts him with ‘and what did I suggest?’, to which Peter answers ‘driving range’. So, prior to Extract 5 the couple have already discussed this issue twice in the conversation, with Joanna each time highlighting that Peter may have to go to the driving range (to practise his golf shots) rather than playing a round of golf. Peter has been able to remember this, but only after prompting.

In lines 01–02, therefore, the design of Peter’s question displays that while he has remembered from earlier in the conversation that the golf course may be closed, it appears that due to his memory problems associated with dementia he has again not remembered the alternative suggested twice previously by Joanna, that is that he might go to the driving range instead. As such, Peter in lines 01–02 violates the social norm of a speaker not asking a recipient for information if the speaker has already been given that information (Stivers et al., Reference Stivers, Mondada and Steensig2011).

While an answer to the question, such as ‘you could go to the driving range’, would be the aligning response, Joanna does not produce this type of action. Note that such a response would ignore the inappropriateness of the question and avoid an allusion to the possible cause of that inappropriateness, that is the dementia. Instead, the delay (line 03) and laughter (‘ghhhh’ at the start of line 04) foreshadow a disaligning response, and when Joanna does respond (line 04), it is in the form of tag-formatted challenge to Peter’s prior initiating action, with that response used to ‘challenge the appropriateness or relevance of doing the action completed in the prior turn’ (Keisanen, Reference Keisanen and Englebretson2007: 269). Joanna’s challenge in line 06 indexes Peter’s question as, in effect, not justified at this juncture and, as such, can be heard as a complaint (Heinemann & Traverso, Reference Heinemann and Traverso2009). Her turn also acts as a ‘counter’ to Peter’s question, replacing her possible answer with a question of her own (Schegloff, Reference Schegloff2007).

The tag-formatted version of this counter-question makes two actions relevant from Peter in his response, both of which he subsequently produces (line 06): an agreement (‘mm’) and an answer to his own question (‘driving range’). The tag format is notable since, in making relevant a response from Peter, it pushes him towards producing an aligning response, which in this case will involve him acknowledging the couple’s earlier discussion of this issue. As such, Joanna’s tag-formatted challenge both highlights the inappropriateness of Peter’s question (and, by inference, the dementia which purportedly was the cause of the inappropriate question) and pushes Peter towards acknowledging that his question was inappropriate.

Extract 6a shows a similar phenomenon. Just prior to where this extract starts, the couple have been discussing an appointment that Peter has at the hospital the following day with his cardiologist, Colin Mee. Professor Jones, a consultant who Peter sees at the same hospital concerning his dementia, has also been discussed in this conversation. As the extract starts (line 01), Joanna once again mentions Professor Jones, producing a tag-formatted assertion (which we will not further discuss here) about the hospital being the place where Peter goes to see him, with the tag eliciting an aligning response from Peter (line 02). At line 05, Peter then picks up on this mention of Professor Jones, asking ‘and am I seeing … him there?’, where the ‘him’ refers to Professor Jones and the question clearly concerns the hospital appointment the following day. Peter has evidently forgotten, or got confused about, the earlier part of the conversation where the couple had talked about the fact that the appointment the following day was with the cardiologist, Colin Mee. As in Extract 5, Joanna treats Peter’s question as an inappropriate action to have been produced at this juncture.

In response to Peter’s question, Joanna produces a disaffirmation (line 06). Since Joanna clearly knows who Peter is seeing at the hospital the next day, her turn consisting of a head shake and ‘no’ is hearable as purposefully withholding the other information that would fully answer Peter’s question, that is the identity of the relevant doctor. With this turn and the several turns that follow (i.e., lines 06, 08, 10, 12, 15 and 17–19) Joanna is clearly acting in a pedagogic manner, attempting (unsuccessfully) to elicit from Peter the identity of the doctor. The last of these turns (lines 17–19) is a tag-formatted challenge which, like that in Extract 5, pushes Peter towards acknowledging (line 20) that the couple had indeed been talking earlier in the conversation about which doctor they will be seeing the following day (who is not Professor Jones), and that his question was therefore inappropriate.

In Extracts 5 and 6a the tag-formatted nature of Joanna’s turns can be seen to add an element of coercion (see Hepburn & Potter, Reference Hepburn and Potter2011) to the challenges by putting interactional pressure on Peter to acknowledge that the matters he has asked about had been discussed earlier in that conversation.Footnote ⁶ This element of coercion is evident when these two tag-formatted challenges (Extract 5, line 06; Extract 6a, lines 17–19) are compared with another challenge in Extract 6a by Joanna in response to Peter’s question: ‘no we’ve just discussed wh‑ why you’re going’ in line 08. While this utterance is still hearable as challenging Peter’s question and implying criticism of it, the lack of an interrogative tag means that Peter is not under interactional pressure to confirm this previous discussion and thus to acknowledge any ‘fault’ or ‘blame’ on his part. Indeed, he does not produce an agreement (nor any other talk) in the next available slot (line 09), and it is Joanna who speaks next (line 10).

This coercive feature of tag-formatted challenges is seen particularly clearly in a final instance, Extract 6b, which is a continuation of Extract 6a. After his confirmation in line 20, Peter still displays an inability to identify the doctor (line 21), and at this point Joanna produces part of the answer to her own test (or ‘known-answer’ (Schegloff, Reference Schegloff2007)) question in line 12, in effect reminding Peter that he is going to see the cardiologist (line 22). Joanna’s production of this action is produced with a tag (line 25).

Like the tag-formatted challenges in Extracts 5 and 6a, this tag functions to elicit agreement from Peter that he had previously had access to the information requested, and indeed he then produces an agreement in line 26. A notable feature of the tag in this case, however, is that it is delayed. Not only is it separated in time from the action (line 22) that is attached to, it is also produced after a response cry (Goffman, Reference Goffman1978) of ‘oh god’ from Peter, which is hearable as claiming some form of realization that the cardiologist had indeed been discussed earlier in the conversation. In this context, therefore, Joanna’s subsequent addition of the tag in line 25 acts to elicit a further agreement from Peter, acknowledging that he had been provided with this information earlier.

Cameron et al. (Reference Cameron, McAlinden, O’Leary, Coates and Cameron1988) discuss a somewhat similar coercive function of tag-formatted actions where the action is also indexing some action or activity of the recipient as blame-worthy. In their study, the tag-formatted utterance discussed is produced by a magistrate to a defendant and takes the form of ‘you’re not making much effort to pay off these arrears, are you?’ Cameron et al. observe that designing this accusation with an interrogative tag is hearable ‘as a way of increasing the addressee’s humiliation. Not only is the defendant … being accused of bad faith and idleness, he is also being invited (in an extremely conducive manner) to agree with the magistrate’s assessment of his behaviour’ (p. 88). As with Cameron et al.’s example, Joanna’s tag-formatted utterances in Extracts 5, 6a and 6b work not only to critically challenge Peter and put him on the spot regarding not remembering something that (as Joanna treats it) he should have remembered, they also put interactional pressure on him to respond in a manner which will publicly acknowledge this ‘blameworthy’ forgetting.

As noted above, Joanna is the only spouse of the three who engages in such challenges which act to highlight some aspect of the person with dementia’s conduct as inappropriate. Evidence from persons with other types of communicative impairments suggests that one motivation for the conversation partner to highlight the incompetence of the person with the impairment within conversation may be to improve that person’s talk/conduct in the future (Wilkinson, Reference Wilkinson2014). Whatever Joanna’s motivation, it is clear that at these points in the conversation she is choosing to display a critical stance towards the consequences of Peter’s memory impairments that have resulted from his dementia and to highlight his incompetence in this regard. One consequence of this critical stance that is evident in Extracts 6a and 6b is that Peter subsequently apologizes for forgetting who the couple have been talking about (line 35). In effect, Peter has been brought to a position of apologizing for the consequences of his dementia, and Joanna’s tag-formatted utterances have been a feature of her talk that have pushed him towards acknowledging, and then later apologizing for, this forgetting.

8.1.1 Epistemics and Dementia

In conversation, social actors regularly present and argue for specific versions of events or states in the world. As described in the field of social epistemics, knowledge is socially organized and implies normative rights and obligations concerning who is expected to know and be able to report what (Stivers et al., Reference Stivers, Mondada and Steensig2011). In typical interaction, social actors are expected to have privileged access to certain domains of knowledge, especially personal experiences (Pomerantz, Reference Pomerantz1980). Furthermore, they have epistemic authority and primary rights to report and evaluate events and states-of-affairs within these domains (Heritage & Raymond, Reference Heritage and Raymond2005).

A central problem in atypical interaction involving persons with dementia (and other cognitive impairments) is that these fundamental expectations and rights may not always be taken for granted. Several studies have investigated how problems with episodic memory may lead to communicative problems, such as being unable to answer questions about personal history (Nilsson, Reference Nilsson2017; Hamilton, Reference Hamilton2019; Svennevig & Landmark, Reference Svennevig and Landmark2019; Schrauf, Reference Schrauf2020) or making factual statements that are (more or less obviously) incorrect (Lindholm, Reference Lindholm2015; Hydén & Samuelsson, Reference Hydén and Samuelsson2019; Landmark et al., Reference Landmark, Nilsson, Ekström and Svennevig2021). Consequently, persons living with dementia have an epistemic status that makes their knowledge claims vulnerable to doubts concerning their epistemic value (Lindholm & Stevanovic, Reference Lindholm and Stevanovic2022).

Such reduced expectations of epistemic access are manifested in several characteristic patterns of interaction involving persons with dementia. For instance, interlocutors may format their questions in a way that displays lowered expectations of epistemic access, such as ‘do you remember…’ (e.g., Williams et al., Reference Williams, Webb, Dowling and Gall2019) or by suggesting candidate answers in the question itself (Svennevig & Landmark, Reference Svennevig and Landmark2019). They may also perform blunt other-corrections of statements rather than inviting the persons with dementia to self-correct, thus displaying lowered expectations that they are able to access the correct information themselves (Landmark et al., Reference Landmark, Nilsson, Ekström and Svennevig2021). When talking to third parties, spouses and other accompanying persons may answer on their behalf instead of letting the person with dementia speak for themselves (Österholm & Samuelsson, Reference Österholm and Samuelsson2015; Nilsson, Ekström & Majlesi, Reference Nilsson, Ekström and Majlesi2018; Hamilton, Reference Hamilton2019).

8.1.2 Deontics, Elderly Care and Agency

In conversation, social actors also negotiate rights to determine future actions (Stevanovic & Peräkylä, Reference Stevanovic and Peräkylä2014; Rossi & Zinken, Reference Rossi, Zinken, Enfield and Kockelman2017). The field of social deontics studies how participants seek to define and get acceptance for what is necessary and desirable, and what should, or should not, be done in the immediate or remote future. It also investigates how they negotiate who has the right to tell others what to do and the obligation to do what others tell them to (Stevanovic & Peräkylä, Reference Stevanovic and Peräkylä2012). The manifestations of deontic rights in conversation may vary in explicitness and degree of imposition. As shown by Kendrick and Drew (Reference Kendrick and Drew2016), ways of recruiting assistance vary along a continuum involving at least three forms. At one end we find explicit requests, in the middle we find reports or embodied displays of trouble, giving the interlocutor an opportunity to offer assistance, and at the other end of the continuum we find projectable trouble, in which the interlocutor offers assistance pre-emptively in the face of a projectable (or anticipated) trouble.

Studies from elderly care have shown that care recipients’ opportunities to exert agency and influence their everyday life may sometimes be at risk. The notion of agency can be described as ‘the fundamental conditions and constraints under which we pursue our goals, from the simplest everyday actions to the greatest uses and abuses of power in society’ (Enfield & Kockelman, Reference Enfield, Kockelman, Enfield and Kockelman2017: xv). In this study, agency is understood as the interactional realization of interlocutors’ communicative projects, and their opportunity to exert influence over how the world is (epistemic rights) and how the world ought to be (deontic rights) (Stevanovic & Peräkylä, Reference Stevanovic and Peräkylä2014; Antaki & Crompton, Reference Antaki and Crompton2015). Providing help and assistance with everyday needs and tasks (e.g., health-related, social, and practical) are often given much weight in formal care settings. In later life, and especially for those living with dementia, the need for assistance, and thus reliance on others, may be pressing (Lindström, Reference Lindström, Hakulinen and Selting2005; Persson & Wästerfors, Reference Persson and Wästerfors2009; Ryvicker, Reference Ryvicker2009; Brooker & Kitwood, Reference Brooker and Kitwood2019). In such cases, agency may be distributed, that is ‘divided up and shared out among multiple people in relation to a single course of action’ (Enfield, Reference Enfield, Enfield and Kockelman2017: 9).

Elderly people in need of formal care have been shown to gradually lose autonomy and agency through the communicative practices that evolve in interaction with their caregivers. Heinemann (Reference Heinemann and Backhaus2011) shows how various routine activities in homecare develop over time with the effect that the roles become increasingly institutional and asymmetric, and the care recipients are gradually ascribed less autonomy. For instance, in the case of giving advice, she notes that ‘advice is delivered in a way that clearly positions the caregiver as the expert with the appropriate competence to say what is, or is not, good for the care recipient, while the care recipient is treated almost like a child who is unable to determine for herself what is necessary’ (Heinemann, Reference Heinemann and Backhaus2011: 105).

A few studies have investigated how care recipients manage to accomplish practical tasks or resolve trouble in close collaboration with their care providers. Lindström (Reference Lindström, Hakulinen and Selting2005) describes a variety of syntactic structures care recipients deploy for requesting assistance in the Swedish home help service. Jansson et al. (Reference Jansson, Plejert and Lindholm2019) show the range of multimodal resources elderly multilinguals draw on when seeking assistance in Swedish residential care. The study describes ‘the fine interplay among talk, prosody, gesture and the manipulation of an object’ (p. 23) utilized for recruiting assistance from the care provider, in concert with the extensive efforts made by care providers in figuring out what kind of assistance is being sought. As pointed out by the authors, these sequences of seeking and achieving assistance ‘involve great interactional efforts on the parts of both caregiver and resident’ (p. 3).

Related to the question of deciding on remote actions in the future is the issue of deciding on actions in the present situation, more specifically, the development of the talk and the course of the interaction. People engage in conversation in order to accomplish communicative projects (Linell, Reference Linell2009) and engage in social activities (Levinson, Reference Levinson1979; Mazeland, Reference Mazeland, Reber and Gerhardt2019). Participants may establish a joint project by agreeing on a task (such as making an appointment to go to the movies) to be carried out in collaboration through their conversational contributions. Deontic authority is manifested in the ways the participants launch such projects and influence their development. One way this may be done is by producing ‘first actions’ in adjacency pairs (Schegloff, Reference Schegloff1968). First actions, such as questions and requests, set topical agendas and action agendas that enable and constrain second actions by creating expectations of alignment with the proposed topical content and the projected responsive action type (e.g., an acceptance of a request) (Heritage & Clayman, Reference Heritage and Clayman2011). Another way deontic authority may be manifested is by pursuing an action agenda in the face of resistance or other forms of misalignment from the interlocutor (Pomerantz, Reference Pomerantz, Atkinson and Heritage1984).

In a study of resident–staff interaction in a Japanese eldercare facility, Backhaus (Reference Backhaus2018) found a general pattern that care providers shaped the interactional flow and course of action by producing first pair parts (FPP) of adjacency pairs. Consequently, ‘the residents’ common lack of access to FPP turns severely curtails their agency, assigning them a largely passive role that calls for reaction rather than action’ (p. 215). Of particular interest for the present study, a few deviant cases showed examples of residents going first. Backhaus noted that this ‘reversed turn structure thus allows the resident to more substantially influence the course of the actions’ (p. 214). The present study contributes to this line of inquiry by investigating how a person with a dementia diagnosis and limited verbal resources may successfully influence the course of action by taking topical initiatives and persistently pursuing them in the face of resistance across a series of sequences.

8.3.1 The Disagreement Emerges

The first extract shows how Koki initiates a topic and thereby sets both the topic and the action agenda of the ensuing talk. Furthermore, it shows how he contradicts the nurse, thereby initiating a disagreement.

Prior to Extract 1, Amina has asked about whether he is using the dental prosthesis today. She finds out that the (pink) tube of dental adhesive he normally uses for fastening the prosthesis is empty and promises to buy a new one the next day (data not shown). Around five minutes later, while Koki and Amina are sitting by the kitchen table waiting for the soup to be ready, Koki picks up a different tube of dental adhesive standing on the table in front of him and starts inspecting it. Amina notices the embodied action, and provides a topic proffer that develops into (more) talk about the adhesive:

Amina topicalizes Koki’s inspection of the tube by asking him whether it is adhesive that he is holding (line 02). Koki, in response does not answer the question, but directs and narrows down the topic by launching a new FPP, asking whether he has got it ‘recently’ (line 04). Koki’s prolonged inspection of the tube and his subsequent inquiry about its origin indicate puzzlement about some state of affairs. As will become clear later in the extract, the source of this puzzlement seems to be that the tube has a different colour than the one he usually uses, as it is a weaker type of adhesive. Amina disconfirms that he got it ‘recently’ with an unmitigated negation, thus taking a strong epistemic stance on the matter (line 06). As Koki does not produce any receipt of information, she increments her answer twice. First, she merely explicates the import of her negation (‘it isn’t new’, line 08, ‘it is old’, line 10), but subsequently she provides some additional information addressing a potential underlying concern of Koki’s question (line 10). By comparing the tube to ‘the other’ (type), she treats his question as being concerned with the unusual appearance of the tube.

At this point, Koki initiates disagreement by producing an explicit rejection (‘no’) and an opposing claim (‘it is new’) in line 11. His epistemic position is thus upgraded from a question expressing an assumption to a declarative taking a knowing stance on the matter. The disagreeing turn is produced without delay but is somewhat mitigated by a turn final epistemic hedge (‘I think’).

Amina’s response in line 12 is somewhat puzzling. She merely confirms his opposing claim, without any account of her change of position (such as for instance a token of ‘realization’; see Emmertsen & Heinemann, Reference Emmertsen and Heinemann2010). The unusual character of such a response seems to be reflected in Koki’s repetition of the claim, this time without any hedging (line 14). Amina again confirms (line 15), this time with an upgraded agreement, an ‘echo answer’ (Ferrara, Reference Ferrara and Johnstone1994; Svennevig, Reference Svennevig2003), but still without providing any account for her shift in position.

There may be several possible explanations for this unusual response. One may be that she interprets Koki’s statement as not being in opposition to her own, for instance in that it invokes a different meaning of the word ‘new’. The tube may not be ‘new’ in the apartment (that is, newly bought) but ‘new’ in the sense of a new type of adhesive. Another may be that she merely ‘goes along’ with Koki, renouncing her position on the question in the service of avoiding further disagreement (Lindholm, Reference Lindholm2015). Both interpretations are in line with her subsequent elaboration (lines 17–18, 21), where she changes the focus from the ‘newness’ of the tube to its practical usefulness for Koki. There, she reorients the discussion from an epistemic problem related to the origin of the tube to a potential deontic problem, instructing him to use the current tube for now, while promising to get a new and different one. Amina thus seems to orient to Koki’s original question about the tube as indicating a potential trouble with it by pre-emptively offering to buy one of the other type (Kendrick & Drew, Reference Kendrick and Drew2016). Given that procuring food and supplies is typically a responsibility of the homecare service, she offers assistance by explicitly committing to buying a new tube.

8.3.2 Pursuing the Disagreement by Upgrading Epistemic Stance

At this point, it may seem that they have solved the epistemic problem (about the origin of the adhesive) and the deontic problem (about the usage and replacement of the adhesive). Nevertheless, in Extract 2 (following immediately after Extract 1), Koki pursues the matter further and maintains his opposing claim about the newness of the tube.

Koki’s information-seeking question in line 22 redirects the topical agenda back to the origin of the adhesive, asking about who procured the tube. He thereby maintains control of the topical agenda. In her answer (line 23), Amina also volunteers information about the ‘newness’ of it, thereby relating it to the previous discussion and reverting to her original claim (in lines 08–10) that the tube came there ‘a long time ago’ (line 23). Koki treats this information as new and surprising by repeating the temporal expression with emphatic stress and rising intonation (line 26) (Selting, Reference Selting, Couper-Kuhlen and Selting1996). As a ‘questioning repeat’ (Jefferson, Reference Jefferson and Sudnow1972) it merely requests confirmation, but the emphatic prosody displays a problem beyond hearing and thus makes an elaboration relevant, addressing a problem of understanding or acceptance. Amina attends to this problem indication by providing an account (lines 29–30), in which she claims that the tube has been standing in the kitchen without him noticing it. Interestingly, although she here makes a strong claim about Koki’s personal experiences (what he has seen) and his personal ‘territory’ (his kitchen, where he spends most of his time when awake), she does not mitigate her claim of epistemic access. A long pause ensues (line 31), during which Koki withholds any expression of acceptance or rejection. Amina then self-selects and seems to move towards closure of the topic (line 32). This is done in a similar way as in Extract 1, repeating the conclusion to the practical problem about the use of the prosthesis (and the adhesive).

Koki does not respond to the closing-implicative move, but instead pursues the negotiation about the adhesive by rejecting Amina’s claim with an explicit negation (‘no’) and an opposing claim (‘it come recently’) in line 33. By using falling intonation, he upgrades his epistemic stance and invites her to agree with him. Amina does not respond verbally for the next 3.5 seconds, but instead looks at the tube with an expression of concentration (wrinkled eyebrows) (line 34). By doing so, she seems to be seeking information and thus to be investigating the possibility that she might have been wrong. In conclusion to this activity, she produces a new statement (‘it was here yesterday’, line 35), which bolsters her position by providing evidence for her claim. Koki, in line 37, concedes to this claim, but projects further opposition by initiating a contrastive clause (‘but’), which is subsequently aborted and left hanging in the air. Amina pursues a stronger expression of agreement by producing a prompt, an acknowledgement token with high pitch and rising intonation, accompanied by a nod (line 39). Koki does not accept her claim and instead repeats his own claim, upgrading his epistemic stance by producing it with falling intonation (line 41). At this point, Amina once again (cf. lines 12, 15 in extract 1) concedes to his claim by stating ‘that might be’ (line 42), thus backing down from her initial position. The disagreement is thereby potentially resolved by Koki gaining at least partial acceptance for his repeated claim that the tube is new. Yet, by not displaying full agreement, Amina takes an agnostic stance that does not concede full epistemic authority to Koki on the matter (Lindholm, Reference Lindholm2015; Lindholm & Stevanovic, Reference Lindholm and Stevanovic2022).

8.3.3 Indicating a Practical Problem

Extract 3 shows how Koki takes a new topical initiative in the conversation, this time seemingly related to his practical concerns with the use of the adhesive.

By pointing to a previous (unmet) need related to the adhesive, Koki redirects the topical agenda over to the deontic domain (line 44). As he runs into trouble formulating his utterance to completion, Amina seeks to help him by producing a collaborative completion (line 45). She treats the (incomplete) report as a problem alert by inquiring about his needs here and now, thereby projecting an offer of assistance (Kendrick & Drew, Reference Kendrick and Drew2016). Koki denies having any problems at present (line 48) but proceeds by reissuing the incomplete disjunctive turn initiation (‘but’ from line 44) in line 49, thus projecting some other potential problem. Once again, Amina curtails his attempt to formulate his concern. Instead of giving him time to continue the turn initiation, she asks a new question about the current state of the prosthesis. In this way, Koki’s two attempts to formulate his problem with the adhesive or prosthesis are both met by pre-emptive questions that orient to his needs but do not seem to contribute to clarifying his underlying concern.

8.3.4 Settling the Disagreement

Extract 4 shows how Amina settles the disagreement by further conceding to Koki’s claim and providing an account for how the tube might have been brought there during the day.

After yet another but-initiation by Koki, which is left incomplete (lines 58–59), Amina returns to the topic of the origin of the adhesive. This time she presents a hypothetical scenario as a potential explanation for how the tube may have been brought there during the day, thus supporting Koki’s position that it has ‘come recently’ (lines 60–62). The downgraded epistemic stance (‘probably maybe’ [sic]) marks it as a tentative account. In response to Koki’s open class repair initiator (Drew, Reference Drew1997) (line 64), possibly orienting to the abrupt topic shift, Amina restates the alternative account, this time with an upgraded epistemic stance (‘probably’ line 67). Although these events are potentially accessible to Koki, having spent the day there, she treats the information as new to him and informs him about her conjectures rather than asking him about what he knows. So, despite claiming superior epistemic rights to events within Koki’s epistemic domain, this seems appropriate in this situation, as Koki responds with a news receipt in the form of a change-of-state token (Heritage, Reference Heritage1984) (line 66), and a subsequent statement claiming lack of access to any memories of the events (line 69).

8.3.5 Resolving the Practical Problem

In Extracts 3 and 4 we saw that Koki repeatedly tried to initiate a topical shift by producing the contrastive conjunction men (‘but’), and that he hinted at a practical problem. Extract 5 shows how Koki finally manages to formulate his practical concern, his wish to get a different tube of adhesive, and gets Amina to commit to providing him with one.

Koki’s initiative is formulated as a request for information about the future (line 74), which Amina treats as indicating a wish to have more adhesive, which she offers to get ‘so that it isn’t so empty’ (lines 75–76). In the face of no uptake from Koki (line 77), she pursues a response by inquiring whether he wants more (line 78). Koki immediately confirms this and initiates an account, which is, however, aborted (lines 79–80). Here Koki contributes to changing the topical agenda from the epistemic puzzle about the origin of the tube to the deontic question about what to do about the state of affairs. This also has consequences for the action agenda. By offering to procure another tube of adhesive, Amina treats Koki’s question as indicating a problem with the current situation and invokes a potential solution to it. In terms of Kendrick and Drew’s (Reference Kendrick and Drew2016) recruitment continuum, there is a report of a need which occasions an offer of assistance. This creates a rather equal distribution of agency in establishing the communicative project of deciding to get a new tube of adhesive.

In line 81 Amina starts making practical arrangements for the accomplishment of the service by offering a candidate guess about which colour Koki prefers. This question simultaneously provides a potential account for why he wants additional tubes of adhesive, namely that he wants a different type. After an extended repair sequence clarifying the right type (‘the pink’) (lines 82–90), Amina affirms her commitment to buying the adhesive (line 91), as is normatively required in granting remote action requests (Lindström, Reference Lindström1999). Koki responds to this by thanking her, a post-expansion that serves to ratify Amina’s interpretation of line 74 as a request, his acceptance of the offer and his proposed closure of the sequence (Lindström, Reference Lindström, Hakulinen and Selting2005). In addition, the fourfold reduplication of it adds an expressive and affective dimension to it, displaying (and co-constructing) the importance of the concern to him and his satisfaction with the solution (line 92). Amina reciprocates the thanking and further expands the sequence by reaffirming that she knows his preferences, thus expressing affiliation with him (lines 93–94). These affiliative contributions seem oriented towards redressing and reaffirming the social relationship between them after this prolonged negotiation.

As an epilogue, it may be noted that Koki brings up the topic of the tube twice more, approximately 10 and 22 minutes later in the visit. Both times, Koki requests confirmation of the fact that the tube is new and who brought it. In response, Amina sticks to the story that her colleague has bought the tube earlier that day. Without any epistemic hedges, she responds with ‘it is new. we shop‑ we shopped (*you) today,’. And in response to whether he got it from her, stating ‘no from my colleague who been before me here today’ (data not shown). In that way, even though Koki may have forgotten their previous agreement on the state of affairs, or at least seeks confirmation of it, Amina goes along with and confirms that the tube ‘came there recently’.