Ruth Herman

Elderspeak Communication: Impact on Dementia Care

Resistiveness to care is common in older adults with dementia. Resistiveness to care disrupts nursing care, increasing costs of care by 30%. Elderspeak (infantilizing communication used by nursing staff) may trigger resistiveness to care in individuals with dementia. Videotaped care episodes (n = 80) of nursing home residents with dementia (n = 20) were coded for type of staff communication (normal talk and elderspeak) and subsequent resident behavior (cooperative or resistive to care). Bayesian statistical analysis tested relationships between staff communication and subsequent resident resistiveness to care. The probability of resistiveness to care varied significantly with communication (Bayes P = .0082). An increased probability of resistiveness to care occurred with elderspeak (.55, 95% CrI, .44-.66), compared with normal talk (.26, 95% CrI, .12-.44). Communication training has been shown to reduce elderspeak and may reduce resistiveness to care in future research.

Automatic measurement of propositional idea density from part-of-speech tagging

The Computerized Propositional Idea Density Rater (CPIDR, pronounced “spider”) is a computer program that determines the propositional idea density (P-density) of an English text automatically on the basis of partof-speech tags. The key idea is that propositions correspond roughly to verbs, adjectives, adverbs, prepositions, and conjunctions. After tagging the parts of speech using MontyLingua (Liu, 2004), CPIDR applies numerous rules to adjust the count, such as combining auxiliary verbs with the main verb. A “speech mode” is provided in which CPIDR rejects repetitions and a wider range of fillers. CPIDR is a user-friendly Windows .NET application distributed as open-source freeware under GPL. Tested against human raters, it agrees with the consensus of two human raters better than the team of five raters agree with each other [r(80) = .97 vs. r(10) = .82, respectively].

Elderspeak’s Influence on Resistiveness to Care: Focus on Behavioral Events:

Resistiveness to care (RTC) in older adults with dementia commonly disrupts nursing care. Research has found that elderspeak (infantilizing communication) use by nursing home (NH) staff increases the probability of RTC in older adults with dementia. The current analysis used general sequential querier (GSEQ) software to analyze behavior sequences of specific behavioral events. We found that older adults with dementia most frequently reacted to elderspeak communication by negative vocalizations (screaming or yelling, negative verbalizations, crying). Because negative vocalizations disrupt nursing care, reduction in elderspeak use by staff may reduce these behaviors thereby increasing the quality of care to these residents. The results clearly demonstrate that sequential analysis of behavioral events is a useful tool in examining complex communicative interactions and targeting specific problem behaviors.

The influence of global discourse on lexical ambiguity resolution

The influence of global discourse on the resolution of lexical ambiguity was examined in a series of naming experiments. Two-sentence passages were constructed to bias either the dominant or the subordinate meaning of a homonym that was embedded in a locally ambiguous sentence. The results provided evidence for the immediate (0-msec interstimulus interval) resolution of lexical ambiguity and were subsequently replicated in Experiment 2, in which an 80-msec stimulus onset asynchrony exposure duration was employed for the homonyms. Strong dominant and subordinate biased discourse contexts activated only the contextually appropriate sense of a homonym. In Experiment 3, each sentence of the discourse was presented in isolation. The pattern of activation obtained in Experiments 1 and 2 was found to be contingent on the integration of the two sentences to construct an overall global discourse representation of the text. The results support a context-sensitive model of lexical ambiguity resolution.

Linking Resident Behavior to Dementia Care Communication: Effects of Emotional Tone

Care for older adults with dementia is complicated by behaviors such as verbal and physical aggression and withdrawal that disrupt and increase the costs of providing care. These behaviors, referred to as resistiveness to care (RTC), have been linked to staff elderspeak communication, measured by behaviorally coded explicit behaviors. This study examined videotapes of nursing home (NH) residents with dementia interacting with staff during bathing to explore the relationships between implicit messages communicated by nursing staff and resident RTC behavior. Implicit messages in nursing staff communication were rated using the Emotional Tone Rating Scale by naïve coders. Associations between implicit ratings of care, respect, and control were analyzed in relation to RTC scale scores. Highly controlling communication was significantly correlated with increased resident RTC (r=.49, p<.05). Associations between the care and respect dimensions of communication were not significantly correlated with RTC; however, trends in hypothesized directions were identified. The association between emotional tone and RTC found in this study suggests that it is an important factor in care. Understanding affective messages is a first step in modifying these implicit messages conveyed during staff-resident communication. Research is needed to confirm these findings and to identify and test interventions to teach staff to reduce controlling messages that will to reduce RTC and improve care.

The effects of aging and dual task demands on language production.

ABSTRACT A digital pursuit rotor task was used to measure dual task costs of language production by young and older adults. After training on the pursuit rotor, participants were asked to track the moving target while providing a language sample. When simultaneously engaged, young adults experienced greater dual task costs to tracking, fluency, and grammatical complexity than older adults. Older adults were able to preserve their tracking performance by speaking more slowly. Individual differences in working memory, processing speed, and Stroop interference affected vulnerability to dual task costs. These results demonstrate the utility of using a digital pursuit rotor to study the effects of aging and dual task demands on language production and confirm prior findings that young and older adults use different strategies to accommodate to dual task demands.

Revealing Language Deficits Following Stroke: The Cost of Doing Two Things at Once

ABSTRACT The costs of doing two things were assessed for a group of healthy older adults and older adults who were tested at least 6 months after a stroke. A baseline language sample was compared to language samples collected while the participants were performing concurrent motor tasks or selective ignoring tasks. Whereas the healthy older adults showed few costs due to the concurrent task demands, the language samples from the stroke survivors were disrupted by the demands of doing two things at once. The dual task measures reveal long-lasting effects of strokes that were not evident when stroke survivors were assessed using standard clinical tools.

Different effects of dual task demands on the speech of young and older adults

Abstract Young and older adults provided language samples in response to elicitation questions while concurrently performing 3 different tasks. The language samples were scored on three dimensions: fluency, grammatical complexity, and content. Previous research has shown that older adults use a restricted speech register that is grammatically less complex than young adults’ and has suggested that this restricted speech register is buffered from the costs of dual task demands. This hypothesis was tested by comparing language samples collected during a baseline condition with those produced while the participants were performing the concurrent tasks. The results indicate that young and older adults adopt different strategies when confronted with dual task demands. Young adults shift to a restricted speech register when confronted with dual task demands. Older adults, who were already using a restricted speech register, became less fluent although the grammatical complexity and informational content of their speech was preserved. Hence, some but not all aspects of older adults’ speech are buffered from dual task demands.

Older adults with and without stroke reduce cadence to meet the demands of talking.

Purpose:Cognitive tasks performed while walking can be challenging for older adults, especially for those with stroke. Conversational speech requires attention and working memory. The purpose of this study was to examine how older adults with and without stroke meet the demands of walking while talking. Methods:Community-dwelling older adults, 12 without stroke and 24 with, were videotaped walking an irregular elliptical pathway. Audio recordings were made as subjects discussed topics such as describing a memorable vacation. Each participant performed in single and dual task conditions: speaking, walking, and speaking while walking. Primary measures of interest included cadence and speech rate. Components of language including measures of fluency, grammatical complexity, and semantic content were analyzed to examine additional changes in speech. Paired t-tests were used to compare single and dual task performance for each group. Group differences for dual task effects were examined with independent sample t tests. Results:Cadence decreased with the addition of talking for those without stroke, P < .007, and those with stroke, P < .001. Speech rates did not change with walking for either group; those without stroke did not alter the language components. Participants with stroke reduced the grammatical complexity and semantic content of speech when walking, Ps < .013. Those without stroke spent more time doing both tasks at once than those with stroke, P < .023. Conclusion:Clinicians can expect older adults to reduce walking speed to meet the demands of walking and talking. Older adults with stroke may use additional strategies to walk and talk simultaneously.

Tracking Talking: Dual Task Costs of Planning and Producing Speech for Young versus Older Adults

ABSTRACT A digital pursuit rotor was used to monitor speech planning and production costs by time-locking tracking performance to the auditory wave form produced as young and older adults were describing someone they admire. The speech sample and time-locked tracking record were segmented at utterance boundaries and multilevel modeling was used to determine how utterance-level predictors such as utterance duration or sentence grammatical complexity and person-level predictors such as speaker age or working memory capacity predicted tracking performance. Three models evaluated the costs of speech planning, the costs of speech production, and the costs of speech output monitoring. The results suggest that planning and producing propositionally dense utterances is more costly for older adults and that older adults experience increased costs as a result of having produced a long, informative, or rapid utterance.