Communication, Ageing, and Rehabilitation

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Communication, Ageing,and Rehabilitation

• Cindy Gallois
• The University of Queensland

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Disability and Chronic Illness

• More and more important as
• Population ages, people live longer
• Acute illnesses cured, serious injuries treated
• Societal cost, stretching health , salient
• Effective rehabilitation/management crucial
• Mobilising free or cheap resources is key

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Communication and Ageing

• Two main perspectives
• Ageing as communication deficit
• impact of cognitive and physical problems (e.g.,
  dementia, hearing impairment)
• Ageing as victimisation
• Impact of population stereotypes and ageism
• Both perspectives neglect impact of
  disability/ill health as separate categories

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Analogy with Disability

• Research tends to treat disability and motivation
  for rehabilitation as monolithic
• Health professionals perspective
  deficit-rehabilitation models still most common
• Management of emotions and expectations
• Stage models
• denial of disabled status, then bargaining, anger
• integration of new status, developing coping
  strategies
• This perspective is similar for ageing

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Stereotypes, Intergenerational Communication

• Highlights perspective of majority
• Emphasises values about ageing, communication
  strategies toward older people
• Older adults as victims of patronising or hostile
  talk
• Intergenerational comm as intergroup
• Analogy with interability communication

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Stereotypes about Ageing

• Older adults are perceived as
• Angry, bitter, frustrated
• Patronised, ignored
• Less active, competent, happy, sociable
• Deserving of respect and kindness
• Analogous to stereotypes about people with
  disabilities
• Age surrogate for illness/disability in
  stereotypes?

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The Communication Predicament of Ageing (Ryan et
al.)
encounter with older adult
Negative changes in ageing cues
recognition of ageing cues
loss lessened of personal
control and psychological
activity and self esteem social interaction
stereotyped expectations
reinforcement for
age constrained stereotyped opportunities
behaviours
modified speech behaviour toward the older adult
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Communication Enhancement Model
encounter with older adult
maximised communication skills and opportunities
recognition of cues on an individualised basis
modified communication to accommodate individual
need
optimised health well-being and competence of
person
increased effectiveness and satisfaction of
provider
individual assessment for multi-focused
interventions
empowerment of client and provider
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But Wait Is this all?

• Assumes all older adults (not to mention all
  younger people) are similar to each other in
  intergenerational communication
• Assumes older adults (with or without
  disabilities) react to others behaviour
• Assumes inclusive communication is best

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Age, Disability/Chronic Illness Key Dimensions

• Congenital/early acquired disability/chronic
  illness
• People belong to disabled or ill group from start
• Stereotypes, identity, communication reflect this
• Disability/illness acquired later (e.g., with
  ageing)
• Onset often sudden (accident, sudden illness)
• Move from non-disabled majority to disabled
  minority
• Person enters minority with previous qualities,
  resources, and stereotypes taken along from
  majority
• Start of self-stereotypes and identity
• Specific disability/illness matters greatly

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Key Dimensions

• Degree slightsevere, specificgeneral
• Visible to invisible
• Type sensorymotor, cognitiveaffective
• Impact on communication
• Verbal, non-verbal
• Slight to major
• Relation to ageing process
• Perceived
• Actual

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Research on Age Stereotypes

• Relatively few studies take account of
  dimensions, illness, disability
• Results indicate
• Family relationship matters
• Communication accommodation matters
• Culture matters
• But Westerners are not necessarily more negative

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Research on Disability Stereotypes

• Most has either
• Used a generic disability label
• Examined severe visible motor disability
  (wheelchair) may be default stereotype
• Examined one specific disability (deafness)
• Need for comparative approach

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Individual differences in Goals

• Goal of minority (cf. Berry, 1980)
• Assimilation (return to majority group)
• Integration (minority and majority identity)
• Separation (from majority group)
• Marginalisation/individualism (denial of status,
  use of another identity)
• Goal of majority (Fox et al., 2000)
• Assimilation, pluralism, segregation,
  individualism

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Motivation for Rehabilitation

• When disability/illness acquired late, requires
  extensive treatment or rehab
• Level of motivation needed is very high
• But person did not choose to do this
• Time frame is months, years, forever (depending
  on severity and type)
• Motivation predicts rehab outcome

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Back to CPA Model
encounter with older adult
Negative changes in ageing cues
recognition of ageing cues
loss lessened of personal
control and psychological
activity and self esteem social interaction
stereotyped expectations
reinforcement for
age constrained stereotyped opportunities
behaviours
modified speech behaviour toward the older adult
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Intergenerational CommunicationA two-way street

• Subtle stereotypes have a strong impact on
  motivation for rehabilitation
• Age-related stereotypes, from HP or others
  experience
• Involve persons self-stereotypes (attributed to
  others)
• CPA model older adult reacts to OPs behaviour
• But older person has own agendas, drives
  communication may not desire inclusion
• Other person must react to this
• Reaction itself may lead to communication of
  subtle (or unsubtle) stereotypes from both

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Conclusions for Communication

• Models must be genuinely intergroup
• Make no assumptions
• About what ageism is
• About what disability/illness means
• About what changes are necessary
• Involve all stakeholders in theory-building
• Take full account of individual differences