Communication in Elderly Care does what it ‘says on the tin’. The issue of communication with older people is one that has been in the spotlight of gerontological practice, education research and media commentary for many years. From a health and social care perspective, communication is seen as a key skill needed for effective care with older people and for minimising undignified and uncompassionate care. However, education and training programmes continue to be dominated by a focus on verbal and non-verbal approaches to communication. Yet it is increasingly acknowledged that these simplistic divisions and behaviourally orientated approaches fail to capture the complexity of communication needs of older people and how these can be effectively met.
This book adopts a different approach to the subject. Drawing on a range of linguistic and conversational research approaches, the book explores the issue of ‘talk’ with older people in a variety of contexts. A focus on talk with older people highlights the importance of ordinary conversation as an essential medium of social engagement and action. The context of interaction cannot be taken for granted nor may it be treated as determined in advance and independent of the context. Instead, context and identity have to be treated as inherently locally produced, incrementally developed and, by extension, as transformable at any moment.
It is this focus that dominates the concerns of authors in this book and is particularly highlighted in Chapter 1 by Kristine Williams. Williams explores the use of ‘elderspeak’ – an approach to communication with older people that has been highlighted for many years as a negative influence in institutional care of older people. The concept of elderspeak highlights what researchers have previously outlined as differences between ‘Institutional Talk’ and ordinary conversation. Institutional interaction involves an orientation by at least one of the participants to some core goal, task or identity (or set of identities) that are associated with the particular institution and that shape the interaction content and style. Secondly, institutional interaction may often involve constraints on what one or both of the participants will treat as allowable contributions to the conversation, and finally, institutional talk may be associated with frameworks and procedures that are particular to specific institutional contexts. The highlighting of the significance of ‘elderspeak’ and the acceptance that institutional talk is different from ordinary talk is important in terms of how practitioners are educated to work with older people and how these ‘conversation rules’ enable or hinder the effectiveness of interactions between care workers, residents and families.
Other chapters focus on different communication issues that impact on the quality of care, quality of life and wellbeing of older people, with a particular focus on residential long-term care. The chapters are written by authors from around the world and so whilst offering a variety of methodological approaches they also bring with them perspectives from different social and cultural contexts. This is a real strength of the book. Each chapter provides insights drawn from research projects undertaken by the authors set within linguistic and conversational analysis methodologies. This is best exemplified in Chapter 6 by Hilke Engfer on dinner conversations between older people and their live-in immigrant care workers. This model of care is still unusual internationally and the research reported in this chapter gets ‘inside’ the interactive dynamics between care workers and family members. Given that the essence of this research was the relationship between individuals in a particular social context, then the focus on an individual's interpretation of talk (immigrant care workers) and the way that interpretation shapes the social world of the individual with dementia and their family is particularly relevant.
The remaining chapters focus on other relevant issues such as creating positive communication environments, supporting the telling of life stories with people with Alzheimer's disease, loss of autonomy, the use of humour, and the connection between art and communication strategies. The authors use linguistic and conversational analysis approaches to describe power relationships that occur in discourse and the way in which these power relationships influence care practices. The structured deconstructive approach to data analysis used in these methodologies enables general inferences and descriptions to be drawn and applied in a variety of gerontological contexts.
This book will be useful for educators who are interested in the intricacies of communication with older people and the ‘action’ of communication strategies, to researchers who are interested in linguistics as well as to students of gerontology who have a particular interest in communication studies. If I have any criticism of the book it is its title – it is ironic that the editors use the term ‘elderly care’ when this term is generally considered to inappropriately label older people and negatively influence how older persons are communicated with. It would be good to see this changed if there is another edition of the book.
