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 Continuum International Publishing Group The Tower Building 80 Maiden Lane 11 York Road Suite 704 London SE1 7NX New York, NY 10038 www.continuumbooks.com © Peter Backhaus and contributors 2011 All rights reserved. No part of this publication may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopying, recording, or any information storage or retrieval system, without prior permission in writing from the publishers. Peter Backhaus and Contributors have asserted their right under the Copyright, Designs and Patents Act, 1988, to be identifi ed as Authors of this work. British Library Cataloguing-in-Publication Data A catalogue record for this book is available from the British Library. ISBN: 978-1-4411-1254-5 (hardback) Library of Congress Cataloguing-in-Publication Data A catalog record for this book is available from the Library of Congress. Typeset by Newgen Imaging Systems Pvt Ltd, Chennai, India Printed and bound in Great Britain 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