Is 'elderspeak' always inappropriate? An empirical investigation of the use of elderspeak in dementia care

“长辈之言”总是不合适吗？

• 批准号: 2421040
• 金额: --
• 依托单位: University of Nottingham
• 依托单位国家: 英国
• 项目类别: Studentship
• 财政年份: 2020
• 资助国家: 英国
• 起止时间: 2020 至 无数据
• 项目状态: 已结题
• 来源: https://gtr.ukri.org/projects?ref=studentship-2421040
• 关键词: elderspeak; always; inappropriate; empirical; investigation

According to Alzheimer's Disease International (2019), worldwide there are already over 50 million individuals with a dementia diagnosis, and this is expected to rise to 152 million by 2050. Many of these individuals will at some point require various forms of care, which comes with its own challenges. The importance of communication in healthcare is well known, but this is recognised as challenging in situations involving people living with dementia (PLWD) (Griffiths et al., 2014).Ryan et al. (1995) suggest that individuals adjust their communication style for older adults, based on potentially erroneous assumptions or stereotypes of incompetence and dependence in these individuals. This leads to communication that may be interpreted as patronising, such as simple or childlike speech with exaggerations (loud speech), and restricted topics. This is also known as elderspeak. Ryan et al. suggest that this speech style can lead to decreased self-esteem, depression and withdrawal in its recipients. Other literature also portrays elderspeak in a decidedly negative light, highlighting consequences and providing information on how to recognise and avoid it (e.g. McLaughlin, 2020; Williams et al., 2017; Williams et al., 2009; La Tourette and Meeks, 2000). Lowery (2013) provides further review on this topic. Despite the prevalent view of elderspeak as a negative, a preliminary investigation from Torres-Soto (2019) found that older adults in a care facility showed no behavioural or emotional differences when viewing an interaction using elderspeak, compared to a neutral interaction. Interestingly, other evidence (Lombardi et al., 2014; Hummel, 2012) suggests that context may have an influence on the appropriateness of elderspeak. In addition, Grimme et al. (2015) found that elderspeak was often used with good intentions, as some healthcare professionals viewed it as useful and more appropriate for PLWD. Therefore, it seems that further investigation is needed into exactly how elderspeak is received by PLWD in different contexts. This leads to the following research questions. Research Questions1) In what contexts is elderspeak used in the care of people living with dementia (PLWD), and by whom?2) How is elderspeak received and responded to by PLWD?3) What is the impact of local interactional context on receipt or rejection of elderspeak by PLWD? Does activity type (e.g. medical history taking vs assisting someone with eating) affect receipt?MethodsConversation analysis (CA) will be used to examine in detail a pre-existing data set of video-recorded interactions between healthcare professionals and PLWD, in an acute hospital setting. A small number of additional recordings will also be gathered by the student to supplement the data set. NHS ethical approval will be gained for new data collection, using existing approved protocols. The analysis will go beyond individual psychological dispositions by intensively scrutinising and comparing multiple episodes to allow patterns and their consequences to be identified. Data sessions with the supervisory team and other expert CA analysts will be used to enhance the robustness of the findings.This project will contribute to the empirical literature on best practice communication for PLWD. The findings will also be practically applied, with the aim to develop training resources that can be delivered to healthcare staff. This training will be grounded in the kinds of actual interactions that occur in the hospital setting and will respond to needs that staff themselves identify. Findings will be disseminated via academic journals, conferences and summaries will be sent to key stakeholders (such as dementia charities and healthcare professionals).

根据阿尔茨海默病国际组织 (2019) 的数据，全球已有超过 5000 万人被诊断为痴呆症，预计到 2050 年这一数字将增至 1.52 亿。其中许多人在某个时候将需要各种形式的护理，这也带来了挑战。沟通在医疗保健中的重要性众所周知，但在涉及痴呆症患者 (PLWD) 的情况下，这被认为具有挑战性（Griffiths 等人，2014）。 （1995）建议个人根据老年人的无能和依赖的潜在错误假设或刻板印象来调整他们与老年人的沟通方式。这导致沟通可能被解释为居高临下，例如简单或孩子气的夸张言论（大声讲话）以及受限制的话题。这也称为长老语。瑞安等人。表明这种言语风格会导致接受者的自尊心下降、抑郁和退缩。其他文献也从明显负面的角度描述了长辈之言，强调了后果并提供了如何识别和避免它的信息（例如 McLaughlin，2020；Williams 等人，2017；Williams 等人，2009；La Tourette 和 Meeks，2000）。 Lowery (2013) 对此主题提供了进一步的回顾。尽管人们普遍认为长者语言是负面的，但 Torres-Soto (2019) 的一项初步调查发现，与中性互动相比，护理机构中的老年人在观看使用长者语言的互动时没有表现出行为或情绪差异。有趣的是，其他证据（Lombardi 等人，2014 年；Hummel，2012 年）表明，语境可能对长辈讲话的恰当性产生影响。此外，格里姆等人。 (2015) 发现长者语言的使用往往是出于良好的意图，因为一些医疗保健专业人士认为它有用且更适合 PLWD。因此，似乎需要进一步调查 PLWD 在不同环境下如何接受长者语言。这引出了以下研究问题。研究问题 1) 在什么情况下，在护理痴呆症患者 (PLWD) 时使用长者语言，由谁使用？2) PLWD 如何接受和回应长者语言？3) 当地互动环境对 PLWD 接受或拒绝长者语言有何影响？活动类型（例如记录病史与帮助某人进食）是否会影响收据？方法对话分析 (CA) 将用于详细检查在急症医院环境中医疗保健专业人员和 PLWD 之间的视频记录交互的预先存在的数据集。学生还将收集少量额外录音来补充数据集。使用现有批准的协议收集新数据将获得 NHS 的道德批准。该分析将超越个人心理倾向，通过深入审查和比较多个事件来识别模式及其后果。与监督团队和其他专家 CA 分析师的数据会议将用于增强研究结果的稳健性。该项目将为 PLWD 最佳实践沟通的实证文献做出贡献。研究结果也将得到实际应用，旨在开发可以提供给医护人员的培训资源。该培训将以医院环境中发生的实际互动为基础，并将响应工作人员自己确定的需求。研究结果将通过学术期刊、会议和摘要发送给主要利益相关者（例如痴呆症慈善机构和医疗保健专业人员）。