Conversation dynamics: Continuity, mood, and topics in interactions with older adults with dementia

Abstract

Background and Purpose: Dementia communication is commonly understood as a consequence of progressive cognitive decline. However, growing evidence suggests that meaningful interaction can persist despite substantial impairment, raising questions about the factors that facilitate conversational engagement in everyday care settings. Existing research has largely focused on Euro-American contexts and has paid limited attention to how communication is shaped by cultural, emotional, and relational processes within Southeast Asian caregiving environments. This study investigates how conversational continuity, emotional tone, and thematic relevance influence interactions between caregivers and older adults with dementia (OAD) in Malaysia. Methodology: A qualitative descriptive design informed by a pragmatic epistemological framework was employed. Data were collected from 42 caregivers across institutional and home-based care settings in Malaysia through a two-week focused observation phase followed by semi-structured interviews. The data were analysed using reflexive thematic analysis. Findings: Eight interrelated themes were identified that illuminate how conversational continuity, emotional engagement, nonverbal communication, reminiscence, communicative disruption, and meaning negotiation shape interactions between caregivers and OAD. These findings challenge deficit-oriented accounts of dementia communication by demonstrating that conversational continuity is not solely determined by cognitive capacity but emerges through the interplay of thematic familiarity, emotional regulation, caregiver responsiveness, and culturally embedded practices. Familiar topics, positive emotional states, reminiscence, and nonverbal sensitivity emerged as key facilitators of meaningful engagement, while repetition, topic shifts, and misunderstanding presented recurring interactional challenges. Contributions: The study advances interactional understandings of dementia communication by demonstrating how communicative participation emerges through the interplay of cognitive, affective, and sociocultural resources. Empirically, it contributes evidence from an underrepresented Southeast Asian context, while practically informing culturally responsive caregiver training and person-centred dementia care. Keywords: Dementia communication, conversational continuity, caregiving, mood regulation, reminiscence, person-centred care, Southeast Asia. Cite as: Ismail, R., Asyraf, N. W., Alias, N. D. F., Mohd Nor, M., & Husain, S. (2026). Conversation dynamics: Continuity, mood, and topics in interactions with older adults with dementia. Journal of Nusantara Studies, 11(2), 148-167. http://dx.doi.org/10.24200/jonus.vol11iss2pp148-167