Document Type

Article

Publication Date

Spring 2026

Abstract

The following qualitative single-case design study investigates the manner in which autonomy is negotiated and supported in dementia care with particular emphasis on communication. Observational data and semi-structured interviews provided raw data that was coded, themed, and interpreted to better understand how decisions were made among the patient with dementia, the caregiver, and her healthcare team. Results fell into two themes where autonomy was limited or autonomy was active, illustrating the continuous negotiation process. Findings indicate that autonomy is relational, directly affected by the individual, their care team, and their corresponding prejudices. Findings also indicate that the removal of autonomy is often justified in terms of safety, which has roots in realistic dementia care, yet also the preservation of autonomy in several instances, as the caregiver and care team made consistent efforts to support her identity and choice throughout her care. Clinical implications emphasize the need for intentional, communication-centered approaches that emphasize autonomy throughout all stages of dementia. The absence of a speech-language pathologist (SLP) was notable due to the emphasis of communication as a gateway to autonomy; the role of an SLP in dementia care is established as beneficial in bridging communication facilitation and caregiver training, but the SLP may often be amiss from the team. Future research should examine communication support and interdisciplinary care across stages and settings.

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