The First Step in Triadic Decision-Making Involving People with Dementia: Determining Who Talks When.

Everyone should have the opportunity to participate in decisions about their health, including people living with dementia. People with dementia typically bring a companion to medical appointments, so most care decisions are made in interactions involving three parties. To make decisions about their care, patients with dementia must have the opportunity to take a turn-at-talk in conversations where decisions are made. However, negotiating who speaks next in triadic talk is a complex task, especially when dementia-associated language and/or memory problems impact communication. Findings show that using second person ("you") pronouns assist people with dementia in responding to queries, yet third person ("she/he") can exclude them from the interaction, although this near-canonical pronoun use can be overridden by sequential placement, gesture, and gaze. We also demonstrate how midturn pronoun switching often only provides for tokenistic inclusion, though this again is dependent on sequential placement and embodied interaction. Data are in English.