114年6月18日 

研究生：李家瑜 

指導教授：陳錦慧 博士

老年社會語言學與失智照護：長期居家照護的對話分析與溝通策略

Gerontological Sociolinguistics and Dementia Care: Conversation Analysis and Communication Strategies in Long-Term Home Care 

摘要:

     隨著失智症人口逐年增加，居家照護與溝通的難度亦日益加劇。特別是在失智長者拒絕配合指令時，往往使居家照護服務員在執行照護任務上面臨更大的挑戰。因此，本研究旨在探討台灣長期照護體系中，居家服務員在與失智長者互動時所採用的溝通策略，並聚焦於照護過程中常見或特定具挑戰性的情境，例如:失智長者對指令表現出拒絕行為時的溝通應對方式。

現有文獻指出，放慢語速、簡化語句、理解失智者的背景經驗，以及留意其非語言行為，皆有助於改善溝通品質。然而，目前針對特定個案進行深入對話分析的研究仍較為缺乏，本研究即試圖填補此一研究空白。

本研究採質性研究取向，結合民族誌式田野觀察與對話分析兩種方法。透過實地錄音與觀察，蒐集居家服務員與失智長者的實際互動資料。研究一主要分析居家照護情境中的溝通目標及對應策略之使用頻率；研究二則聚焦於失智長者拒絕指令時的互動機制與對話進程。

第一階段研究的描述性統計結果顯示，「建立社交關係」為最常見的溝通目標，其次為「促進配合與處理拒絕」與「應對訊息重複」。在策略運用上，居服員傾向採用「依當下情境展開閒聊」、「逐步協商」與「耐心重複回答」等方式，協助減緩抗拒並提升互動成效。

第二階段研究進一步透過對話分析，針對失智長者拒絕服從指令的互動過程進行探討。研究歸納出八種典型的對話發展樣態，並指出較為有效的策略包括：「展現同理心」、「給予適當稱讚」、「延後指令的給予時機」、「運用幽默與笑聲」以及「逐步協商」等。相對地，「假裝威脅」與「刻意迴避可能引發拒絕的關鍵詞」則顯示效果有限，甚至可能引發失智者的不安與抗拒。

綜合而言，本研究提供具體的實務建議，可作為居家服務員溝通教育訓練的考量，也幫助居服員在照護現場中進行溝通決策的重要依據。透過辨識有效與無效的溝通策略，服務人員得以降低互動失敗的風險，營造更和諧與舒適的照護氛圍，進一步提升照護效率與服務品質，並促進良好照護關係的建立。 

關鍵詞: 失智照護溝通；民族誌；老年社會語言學；對話分析  

Abstract:

     Dementia presents significant challenges for long-term home care, particularly when older adults with dementia refuse to follow instructions, thereby making it more difficult for care workers to deliver services effectively. As the dementia population continues to grow, this study investigates a case of long-term home care in Taiwan, focusing on the communication between a home care worker and an older female client with dementia. The study aims to identify the communication strategies used by the caregiver and their corresponding communication goals, with particular attention to scenarios in which the care recipient displays resistance or refusal to instructions and services.

Existing literature suggests several effective communication approaches in dementia care, such as slowing speech, simplifying language, understanding the care recipient’s background, and interpreting nonverbal cues—findings largely derived from interviews and surveys. However, in-depth case studies employing alternative, interaction-focused research methods remain scarce. This study seeks to address this research gap.

Data collection was primarily guided by ethnographic methods and included audio recordings, direct observation, contextual field notes, and the transcription of conversational data to document real-time interactions. The analysis was conducted in two phases: the first examined the distribution of communication goals and strategies, while the second involved conversation analysis to explore the sequential mechanisms of how strategies were used to manage refusals.

Findings from Study 1 indicated that the most frequently observed communication goals were “social rapport building”, “facilitating compliance or dealing with refusal”, and “coping with repeated messages and questions”. Commonly employed strategies included engaging in small talk, patiently repeating answers, and using step-by-step negotiation.

Study 2 identified eight types of conversational outcomes in scenarios involving refusal. Effective strategies for managing refusal included “showing empathy for refusal”, “giving compliments for an instruction”, “postponing instruction-giving”, “using humor and laughter”, and “step-by-step negotiation”. In contrast, strategies such as “pretending to threat” and “avoiding refusal-triggering keywords” were found to be less effective.

This study offers practical communication guidelines for long-term home care workers, enabling them to more effectively identify and apply appropriate strategies when interacting with individuals with dementia. The practical implications derived from this research may contribute to enhancing training programs for long-term home care workers, reducing ineffective interactions, promoting a more harmonious and comfortable care environment, and ultimately improving both caregiving efficiency and service quality in dementia care contexts. 

Key words: dementia care communication; ethnography; gerontological sociolinguistics; conversation analysis