Communication in elderly care : cross-cultural perspectives

245 Pages·2011·1.176 MB·English

by  Peter Backhaus

Communication in Elderly Care
Also Available from Continuum:
Professional Discourse, Britt-Louise Gunnarsson
Workplace Discourse, Almut Koester
Communication in
Elderly Care
Cross-Cultural Perspectives
Edited by Peter Backhaus
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© Peter Backhaus and contributors 2011
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Copyright, Designs and Patents Act, 1988, to be identifi ed as Authors of
this work.
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A catalogue record for this book is available from the British Library.
ISBN: 978-1-4411-1254-5 (hardback)
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Contents
Preface by Nikolas Coupland vii
Introduction by Peter Backhaus xiii
1 Elderspeak in Institutional Care for Older Adults 1
Kristine N. Williams
2 Dementia Care Communication in Residential Facilities:
Intersections of Training and Research 20
Boyd H. Davis and Mary K. Smith
3 Creating a Positive Communication Environment in
Long-Term Care 40
Rosemary Lubinski
4 Care of People with Alzheimer’s Disease in New Zealand:
Supporting the Telling of Life Stories 62
Margaret Maclagan and Annabel Grant

5 From Home to Institution: Roles, Relations, and
the Loss of Autonomy in the Care of Old People
in Denmark 90
Trine Heinemann
6 Cake or Meat?—A Case Study on Dinner Conversations
in a Migrant-in-the-Family Household in Germany 112
Hilke Engfer
7 “Me Nurse, You Resident”: Institutional Role-Play in a
Japanese Caring Facility 129
Peter Backhaus
vi Contents
8 Reframing to Regain Identity with Humor:
What Conversations with Friends Suggest for
Communication in Elderly Care 145
Yoshiko Matsumoto
9 At the Intersection of Art, Alzheimer’s Disease, and
Discourse: Talk in the Surround of Paintings 166
Heidi E. Hamilton
10 Using Narrative Arts to Foster Personhood in Dementia 193
Ellen B. Ryan and Lori Schindel Martin
Notes on Contributors 218
Index 223
Preface by Nikolas Coupland
Old age, as a concept, is very much a product of its time. We may
feel that 60 years is long enough for a person to make a category
transition between childhood and old age. It is also long enough, in
terms of social change, to have seen postwar economic recoveries
and expansion, then deindustrialization and a sharp decline in the
prevalence of manual labor, technological advances and transfor-
mations in health care science and provision, improvements in wel-
fare provision, the invention of “retirement,” and so on. Very clearly
these have not been universal or universally progressive shifts; but
they are the historical backdrop to most of the national and cultural
settings dealt with in this book. The concept of “the elderly,” or at
least contemporary understandings of what it means to be old, are
a rather direct legacy of historically transformed social arrange-
ments and opportunities. At the same time, old age inevitably fea-
tures in new patterns of intergenerational politics, both formal and
informal.

The last 60 years have also seen the strongest-yet wave of globaliza-
tion. This implies not only demographic mobility (in which many
older people have not fully taken part) as well as rampant commodi-
fi cation and consumerism, but also some less tangible shifts. There
are good reasons to believe that social being is itself subject to greater
commodifi cation, that social identities (for example, not only those
linked to nation, class, and gender but also age), which were formally
quite consolidated, are nowadays more malleable and uncertain. The
life project itself seems more subject to commodifi ed appraisal and
negotiation—“what have I achieved, and what is my life worth?”
Media refl exively stylize social identities, offering us radically diverse
but perhaps equally ungrounded and largely unattainable images of
viii Preface
(what the media themselves defi ne as) youth, middle age and the dif-
ferent conditions and types of old age.
No wonder, then, that we see interdisciplinary research nowadays
on what it means to be old, and on how societies are coming to terms
with increased human longevity on the one hand and shifting ideolo-
gies of aging on the other. The sharpest edge of these struggles
involves the most vulnerable older people in any given society, and
hence the policies and practices of so-called “elderly care.” This book
makes a welcome contribution to understanding the enactment of
care for old people, in its highly diverse national, institutional and
interactional contexts, and to developing critical perspectives on
it—with an eye to intervention and improvement.
In my own earlier work with colleagues on the sociolinguistics of
aging, we initially strove to keep clear of institutional contexts and
concerns. We wanted to avoid the assumption that old age is inher-
ently or “naturally” of academic interest only when issues of depen-
dency and care are uppermost. What we found, of course, was that,
even in “everyday” contexts of talk, themes of declining health-in-ag-
ing, morale, and expectations were far from absent. We managed to
locate a set of ideological presuppositions—age-circumscribing and
often age-prejudicial discourses—that routinely acted as resources
for talk about old age, but also for older people’s own talk about
themselves. Those discourses continued to be very much at work
when we moved from researching everyday exchanges to researching
geriatric medical consultations. We argued that the institution of

geriatric medicine, at least as it was in evidence in our British data at
that time, was engaged in anti-agist ideological campaigning, at the
level of policy but also at the level of spoken interaction. The “prob-
lems” that patients and practitioners alike were confronting seemed
to be as much ideological as biomedical and welfare related.
There are many points of contact between our own earlier studies
and those reported in the present volume. It remains important to
locate and debate dominant ideologies in the context of elderly care
and of aging more generally. Likewise we need to be critically aware
of where the boundary between the institutional and the non-institu-
tional lies, and how it is defi ned. As some contributors to the present
book explain, the condition of old age is not inherently decremental
Preface ix
and institutionalized care is received by only a minority of older peo-
ple. Those in care are a highly diverse population and indeed not a
single “social group” in any signifi cant sense. Not only do they span
some forty plus years of chronological age, they range from the
healthy to the seriously ill and from “fully-functioning” (which has
always been a worryingly mechanistic attribution) to people with
severe cognitive impairment. “Care homes” are themselves enor-
mously diverse, ranging from elite and opulent hotels to disgraceful
and demeaning hostels. No wonder that local reactions to institution-
alized care for the old can range from abhorrence to deep respect for
professional excellence.
The contributions to this book offer many profound insights and
positive practical suggestions for care of the elderly with respect to
communication and social relations. The two most basic insights for
caregivers, through their (sometimes inadequate) training, might be
the following. First, the old are not a natural social group. Social his-
tories have generated an age cohort which, in most national settings,
is unusually diverse—ranging from the most to the least affl uent, the
widest to the narrowest of social experiences, the most conservative
to the most progressive, and so on. The old include some people for
whom modernist postwar structures persisted, and who tend to hold
on to a sense of “traditional values,” a durable and prescriptive social
order. Some others pioneered rock ‘n’ roll culture, feminism, new
ecological sensitivities, mobility and much of the diversity that late
modernity has (in patches) tended to foster. The old are in many

senses the pioneers of social change and of its legacy in late
modernity.
The second insight relates to my use of pronouns like “they” in the
preceding paragraph. The old are not “them”; they are “us.” It is psy-
choanalytically understandable that those who progressively age (that
is, all of us) should in some ways fear old age and try to sequester it,
investing it either with stereotypes of incompetence, misery, and
“unwatchability,” or alternatively the rosy glow of wisdom and a
golden age lifestyle. In contexts of care it is too easy to fall prey to
either of these stereotypic constellations, or to some mix of them
which is liable to give rise to what is called “elderspeak,” which in
earlier work we tried to model as under- and over-accommodation by