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’ positioning People (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 impression of what is going 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 Language, society and the elderly. Blackwell; Kemper, Ferrell,, Harden, et al, Use of elderspeak by young and older adults to impaired and unimpaired listeners. Aging, Neuropsychology, and Cognition, 5, or  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 details Ruscher, Janet, & Hurley Journal of Language and Social Psychology, 19: What happens when we see the stereotype, & not the person?

The Communication Predicament

Overcome stereotypes with reality  Enter the word at to read or hear stories by Michael Shelton and Sarah Murphy.  Enter and you’ll find stories by Chantal Luhr, Gloria Cotton and Cullen Case.  Coming soon: the Carolinas Collection

Communication for older people L.Worrall & L. Hickson 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 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-it On a card On 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” signals Use 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 is Intvwr (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 close b. Acknowledging feelings c. 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)