Talking with older people: enhancing your

skills

The Carolinas Conversation Collection

© HLS

There’s a crucial difference

Between biomedical interviewing and the kind of focused interviewing that elicits detail;

Between ‘taking a history’ and ‘conversational interviews’

positioningPeople (re-)position each other as they

interact. Changes in position change the frame of the interaction

What are the frames of an interaction?Kovecses: ‘a frame is a structured

mental representation of a conceptual category’

Other names for frames: script, scenario, scene, cultural model,

cognitive model, domain, schema, gestalt

Characteristics of frames Evoked by particular meanings of

words or by who is sanctioned to speak when

Impose a perspective on the situation Provide a history, a context Assume larger cultural frames Are idealizations – linked to prototypes They can activate or be activated by

our stereotypes

What do you see?

What point of view?

Point of view, again – where are you positioned?

Thumbnail has PoV, too

Changing frames-1

your impressionof what isgoing on?

Changing frames - 2

Your impression?

Changing frames - 3

Your impression?

How do caregivers position recipients of care?

Changes in position change the frame of the interaction

How do we position older people?These movies/TV shows stereotype older

adults:On Golden Pond The Golden Girls The Bucket List

As a warm up – identify some additional movies and TV shows that present both positive and negative stereotypes of older people.

How does Youth talk to Age?

Researchers have studied how older and younger speakers change speech patterns when they talk to each other.

Coupland, Coupland& Giles. 1991. Language, society and the elderly. Blackwell; Kemper, Ferrell, , Harden, et al, 1998. Use of elderspeak by young and older adults to impaired and unimpaired listeners. Aging, Neuropsychology, and Cognition, 5, 43-55 or http://merrill.ku.edu/IntheKnow/sciencearticles/elderspeak.html

Frequently, younger speakers are patronizing, and use infantile speech to address older citizens.

The impression given by elderspeak: stereotypes on both sides Younger people often repeat the same

information several times, assuming the older person will not hear or understand

They often talk louder as if the person were deaf.

They often use infantile speech as they do with small children and infants

Older adults feel treated like children

Do we always recognize these stereotypes of older persons? They tend to be garrulous What they say often seems foolish They use too many words Their stories include irrelevant detailsRuscher, Janet, & Hurley. 2000. Journal of Language and Social

Psychology, 19:141-149.

What happens when we see the stereotype, & not the person?

The Communication Predicament

Overcome stereotypes with reality Enter the word <grandfather> at

http://newsouthvoices.uncc.edu to read or hear stories by Michael Shelton and Sarah Murphy.

Enter <grandmother> and you’ll find stories by Chantal Luhr, Gloria Cotton and Cullen Case.

Coming soon: the Carolinas Collection

Communication for older peopleCommunication for older people

L.Worrall & L. Hickson. 2003. Communication disability in aging. Delmar, p. 12

In this next section We focus on techniques developed from

our longitudinal corpus of conversation with cognitively impaired conversation partners

Many people have commented that these techniques work with any older person

And with most younger ones

Autobiographical memory crucial for social function Different communicative goals from earlier in life:

◦ focus on positive nature of life experience; ◦desire to communicate significance of life

experience rather than imparting information. May wander off topic or appear verbose – yet their

stories are rated as richer, more interesting May preserve semantic representations while

episodic representation declines selectively. ◦ These memories show up as stories

Focus on special skills:These video scenarios from the Culturally Competent

Project (Alzheimer’s Association) show consented caregivers and residents

◦Echoing and using Go-Aheads for active listening

◦Providing sensitive refocusing◦Asking questions in different ways◦Quilting pieces of story together

When the older person is confused As the disease progresses, the speaker

with dementia◦ will have difficulty finding words ◦ will repeat words and questions ◦ may make up words◦ may speak less often to avoid

embarrassment◦ may have difficulty understanding directions

As dementia progresses, the person begins to

◦make do with fewer words ◦have difficulty in interpreting words ◦offer speech that sounds inappropriate or

incoherent ◦have trouble understanding written

messages

Research on comprehension A number of researchers, such as Kempler,are finding that

◦Simpler sentence structures seem to work better ◦Both repetition and paraphrase were effective at improving comprehension in AD

http://alab.psc.sc.edu/joomla/index.php?option=com_content&task=blogcategory&id=27&Itemid=50

Quilting a story in conversation

AD speakers can retrieve some parts of their life story or past experience

With help, they can retrieve more details of the story or experience

Quilting: Step 1

When you hear a phrase that sounds like it could be part of a larger “story,”

1. Repeat the speaker’s full phrase or sentence slowly, as if it were important, and then pause.

Quilting: Step 2

2. Record the detail as a reminder for future conversation

On a post-itOn a cardOn a chart

Quilting: Step 3

3. Return to that detail in the next conversation you have, and phrase it as a statement.

While you are Quilting,

Use go-aheads and echo to help the person stay on topic

Be aware of partner’s desire to end a topic

Allow for response time◦(one hippopotamus, two hippopotamus … five hippopotamus)

Tips from people who tried Quilting

I had to remind myself to go at her pace and not at mine and with her agenda, not mine (Turner 2003)

Tips from people who tried Quilting

I started the conversation with some information that I had obtained from my coworker (Ashford 2003)

Tips from people who tried Quilting

Learn what time of day is best for the older adult; some people with AD don’t like to talk in the morning (Jackson 2003)

Some “go-ahead” signalsUse intonation as a way to encourage your conversation partner

you can also use this as a way to refocus

Learn to use “indirect” questions Instead of asking direct questions starting

with Who-What-Do you What do you think about…Do you remember…

Try rephrasing as a statement or tag-question question

You had two sisters, I believe You had two sisters, didn’t you

Close topics by confirm/reconfirm People often use formulaic phrases or

proverbs or sayings to sum up a topic and then move on – even with dementia

“L. Wilcox”:well, that’s the way it isIntvwr (BD): yeah, guess so“L. Wilcox”:yup

It is now fine for either to start a new topic

Watch for potential topics

Like the tips of icebergs, little bits of story show up. Maybe there’s a name that gets repeated. Or a fragment of a sentence that sounds like it could be part of a story.

“Glory M.” :… (unintelligible) an old farm girl

Intvwr (BD): a farm girl“Glory M.”: yeh, we lived on the farm

Now try indirect questions, Quilting

It’s your turn

Role-play with your partner: try Quilting

with & without the Go-ahead signals with and without the repetition & paraphrase

with & without waiting for them

Overview: A skills checklist

Open-ended questions about health care experiences or experience with medical condition:

a. Sustaining the topic by Echoing & Go-Aheads

b. Learning to recognize and expand Cues

c. Helping to close the conversation topic with Confirm/Reconfirm sequences

Closings are important

Try to include these three components, even if very briefly:

a. Signaling the closeb. Acknowledging feelingsc. Emphasize importance of leave-

taking, verbally or non-verbally

Who uses these techniques? Patients & providers are both ‘socialized’

for minimal no-problem responses in comprehensive history taking.

But sometimes the patient will expand responses with unexpected details.

And any social worker will tell you that sometimes, the patient will present a small narrative filled with ‘lifeworld’ concerns, and expects an assessment or some kind of response

(Stivers & Heritage 2001)