The Impact of Communication Impairments on the Social Relationships of Older Adults

302 Pages·2017·5.35 MB·English

Portland State University
PDXScholar
Dissertations and Theses Dissertations and Theses
Spring 5-18-2015
The Impact of Communication Impairments on the Social
Relationships of Older Adults
Andrew Demetrius Palmer
Portland State University
Let us know how access to this document benefits you.
Follow this and additional works at:http://pdxscholar.library.pdx.edu/open_access_etds
Part of theCommunication Commons
Recommended Citation
Palmer, Andrew Demetrius, "The Impact of Communication Impairments on the Social Relationships of Older Adults" (2015).
Dissertations and Theses.Paper 2344.
10.15760/etd.2341
This Dissertation is brought to you for free and open access. It has been accepted for inclusion in Dissertations and Theses by an authorized
administrator of PDXScholar. For more information, please [email protected].
The Impact of Communication Impairments on the

Social Relationships of Older Adults

by

Andrew Demetrius Palmer

A dissertation submitted in partial fulfillment of the
requirements for the degree of

Doctor of Philosophy
in
Urban Studies

Dissertation Committee:
Jason T. Newsom, Chair
Paula C. Carder
Diana L. White
Gabrielle Saunders
Hyeyoung Woo

Portland State University
2015
Abstract
Communication forms the foundation of social interaction. For older adults,
however, there is known to be an increased risk of developing conditions that interfere
with the ability to communicate. These conditions may occur for a variety of reasons,
including age-related changes in physical or sensory functioning, injury, and disease. It is
estimated that 55% of all Medicare beneficiaries have a communication impairment of
some kind. Social contact is known to be vital for older adults' mental and physical health
but, because communication impairments often co-occur with other types of disability, it
is difficult to generalize about the relative impact of a communication impairment on the
social relationships of older adults. Specific aims of the study were to examine whether
the severity of a communication impairment is associated with social measures, whether
there is an interaction between communication impairments and physical disability, and
to examine the role of relationship-control strategies in maintaining access to a larger or
more supportive social network. A mixed-methods study design was employed.
Community-dwelling older adults were surveyed about the size and diversity of their
social networks, frequency of social interactions, and physical and mental health (n =
240) and qualitative data were collected from a smaller subsample. Findings
demonstrated that communication impairment was a significant independent predictor for
key characteristics of social relationships, including the composition of the social
network, certain types of social support, the frequency of social participation, and social
self-efficacy. Communication impairment was a significant predictor for higher levels of
loneliness and depression. In addition two distinct pathways between communication
i
impairment and psychological well-being were identified, with social self-efficacy and
reassurance of worth as mediators. Additional insights were provided by the qualitative
results. These findings may guide future clinical practice and research by providing a
better understanding of the role of communication in health, disability, and the risk of
social isolation.
ii
Dedication
I would like to dedicate this work to my parents, to my wife Kristine, to the many
patients that I have learned so much from over the years, and also to the memory of Rob
Williams whose untimely loss is still a source of sadness.

iii
Acknowledgments
In looking back, I was pleasantly surprised to realize that the roots of this project
go back a long way. In rereading the abstract of an article based on my Master’s thesis I
came across this quote, which I had forgotten: “The ability to communicate showed an
inverse relationship with feelings of social isolation.” I’d like to thank Minnie Graham
for inviting me to explore the field of Speech Pathology originally and also for mentoring
me in the completion of a thesis, which started me along this path to a PhD.
It is also worth acknowledging that no one accomplishes these things in isolation.
First and foremost, let me thank all of the study participants who contributed their time
and personal experiences to this research. I’d also like to thank many people for their help
and guidance along the way: Judie Rau for telling me about the Urban Studies PhD
originally; Margaret Neal for supporting my application and introducing me to the field
of Gerontology; the members of my PhD support group, Barbara Shields, Rob Williams,
and Zeljka Carol Kekez; Gretchen Luhr, Cynthia Lopez, and Tracy Braden for
suggestions, support, and practical advice; David Kinsella and the students in his PhD
seminar where the original ideas for this project were developed; the faculty of the Urban
Studies department, the Institute on Aging, and other departments at PSU for allowing
me to put together a course of study and utilize resources from a wide variety of fields;
my Comps committee Jason Newsom, Diana White, and Gary Brodowicz for allowing
me to explore ideas that formed the foundation of the dissertation; Jason Newsom, Dara
Sorkin, and Karen Rook for allowing me to use the data from the Later Life Study of
Social Exchanges for preliminary work in this area; Jane, Pete, and Paul who proofed
iv
early versions of the study materials and instruments; staff at the National Association for
the Deaf, National Multiple Sclerosis Society, the National Spasmodic Dysphonia
Association and Pat Wertz Sanders at WebWhispers for publicizing the study; my
Dissertation Committee for their time and effort in reading my many overlong draft
documents and providing ever-insightful suggestions and feedback; and all of the people
that I have asked for advice or help or bored along the way.
I am deeply, deeply indebted to the Department of Otolaryngology at Oregon
Health and Science University for their support during my completion of this work and
my colleagues at the Northwest Clinic for Voice & Swallowing for covering patient care,
teaching, research, supervision, and so many other things while I was working on the
PhD. Thanks most especially to Donna Graville for her tireless support, advice, and
encouragement, without which I would not have made it through. I would also like to
thank my parents and in particular my Mum whose experiences with hearing loss first
motivated me to consider a career in this area, as well as the many patients and clients
that I have seen and learned from over the years. Thanks above all to my wife, Kristine,
for her ongoing support over the course of this long, long journey.
And following its path, we took no care
To rest, but climbed: he first, then I, so far,
Through a round aperture I saw appear
Some of the beautiful things that Heaven bears,
Where we came forth, and once more saw the stars.
- Dante Alighieri
v
Table of Contents
Abstract .......................................................................................................................... i
Dedication .................................................................................................................... iii
Acknowledgments........................................................................................................ iv
List of Tables ............................................................................................................. viii
List of Figures .............................................................................................................. ix
Introduction ....................................................................................................................1
Background ............................................................................................................. 1
Justification ............................................................................................................. 7
Preliminary Work.................................................................................................... 9
Potential Implications ........................................................................................... 11
Literature Review.........................................................................................................13
Communication and Aging ................................................................................... 13
Theoretical Frameworks for Understanding the Impact of Communication
Impairment ................................................................................................ 25
The Importance of Social Relationships for Mental and Physical Health ............ 42
Defining and Measuring Social Relationships ...................................................... 45
Theories of Social Relationships and Aging ......................................................... 59
The Impact of Communication Impairment on Social Relationships ................... 63
Research Questions ............................................................................................... 77
Method .........................................................................................................................86
Study Design ......................................................................................................... 86
Phase 1 Participants .............................................................................................. 90
Phase 1 Measures .................................................................................................. 99
Phase 1 Analysis ................................................................................................. 107
Phase 2 Qualitative Analysis Plan ...................................................................... 111
Results ........................................................................................................................115
Analysis Overview .............................................................................................. 115
Descriptive Characteristics of Phase 1 Participants ............................................ 115
Reliability Analyses ............................................................................................ 118
Regression Analyses: Predicting Social and Psychological Characteristics ....... 124
Physical Disability, Social Support, and Social Self-Efficacy as
Moderators .............................................................................................. 135
Social Relationship Variables as Mediators of Psychological Well-Being ........ 140
Perceived Changes in Social Self-Efficacy ......................................................... 145
Phase 2 Qualitative Investigation Results ........................................................... 146
Integration of Findings ........................................................................................ 169
Discussion ..................................................................................................................177
vi
Study Contributions ............................................................................................ 177
Interpretation of Findings ................................................................................... 179
Limitations of the Study...................................................................................... 199
Clinical Implications and Suggestions for Future Research ............................... 200
Conclusions ......................................................................................................... 203
References ..................................................................................................................205
Appendix A. Summary of Published Instruments .....................................................237
Appendix B. Published Instruments Related to Disability ........................................240
Appendix C. Published Instruments Related to Mental Health & Well-Being .........244
Appendix D. Published Instruments Related to Social Relationships .......................247
Appendix E. Evidence for Content Validity of the CETI-M .....................................255
Appendix F. Open-Ended Questions for the Individual Interviews ..........................257
Appendix G: Study Approval Documentation from OHSU and PSU .......................259
Appendix H. Approved Study Documents ................................................................262
Appendix I: Identification and Exclusion of Potential Participants ...........................278
Appendix J: Categorization of Open-Ended Responses from Phase 1 ......................281
Appendix K. Additional Descriptive Data from Phase 1 ...........................................286

vii
List of Tables

Table 1. A Summary of Measures Used to Assess Social Relationships in the Health
Literature ................................................................................................................... 44
Table 2. Comparing Component Models of Social Support Across Authors ................... 54
Table 3. A Summary of Recruitment Methods for Phases 1 and 2................................... 89
Table 4. Response Rate by Group for Targeted Participants ............................................ 97
Table 5. Number of Responses Included in the Final Sample by Group for All
Participants ................................................................................................................ 98
Table 6. Calculated Sample Sizes for Various Effect Sizes in the Final Regression Model
................................................................................................................................. 107
Table 7. Age and Health Characteristics of All Participants .......................................... 116
Table 8. Other Health and Demographic Characteristics of Participants ....................... 117
Table 9. Mean, Skewness, Kurtosis, and Internal Reliability for Composite Measures and
Scales ...................................................................................................................... 125
Table 10. Correlation among Study Measures ................................................................ 126
Table 11. Mean Communication Effectiveness Scores by Subgroup ............................. 126
Table 12. Multiple Regressions for Social and Psychological Variables ....................... 127
Table 13. Mediation of the Effect of Communication Effectiveness on Loneliness through
Social Characteristics in a Simultaneous Model ..................................................... 143
Table 14. Mediation of the Effect of Communication Effectiveness on Depression
through Social Characteristics in a Simultaneous Model ....................................... 144
Table 15. Descriptive Characteristics of Qualitative Interview Participants .................. 147
Table 16. Comments by Interview Participants about Changes in Social Characteristics
................................................................................................................................. 148
Table 17. Summary of Themes and Subthemes from the Qualitative Interviews .......... 149

viii