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

根据阿尔茨海默病国际组织（2019年）的数据，全世界已经有超过5000万人被诊断患有痴呆症，预计到2050年将增加到1.52亿。这些人中的许多人在某个时候需要各种形式的护理，这也带来了自己的挑战。沟通在医疗保健中的重要性是众所周知的，但这在涉及患有痴呆症（PLWD）的人的情况下被认为是具有挑战性的（Griffiths等人，2014). Ryan et al.（1995）认为，个体根据对老年人无能和依赖的潜在错误假设或刻板印象来调整他们的沟通方式。这导致了可能被解释为光顾的交流，例如简单或孩子般的夸张言语（大声说话）和限制性话题。这也被称为老年语。Ryan等人认为，这种说话风格会导致其接受者的自尊心下降，抑郁和退缩。其他文献也从绝对负面的角度描述了老年人的语言，强调了其后果，并提供了如何识别和避免老年人语言的信息（例如，McLaughlin，2020年;威廉姆斯等人，2017;威廉姆斯等人，2009年; La Tourette和Meeks，2000年）。Lowery（2013）对这一主题进行了进一步的审查。尽管普遍认为老年人的语言是负面的，但Torres-Soto（2019）的初步调查发现，与中性互动相比，护理机构中的老年人在观看使用老年人语言的互动时没有表现出行为或情感差异。有趣的是，其他证据（Lombardi等人，2014; Hummel，2012）表明，背景可能对老年人说话的适当性产生影响。此外，格里姆等人（2015）发现，老年人的语言通常是出于善意使用的，因为一些医疗保健专业人员认为它对PLWD有用且更合适。因此，似乎需要进一步调查在不同情况下，艾滋病毒/艾滋病患者是如何接受老年人语言的。这就引出了以下研究问题。1）在什么情况下使用老年人的话在照顾老年痴呆症患者（PLWD），由谁？2)艾滋病毒/艾滋病患者如何接受和回应老年人的语言？3)当地的干预环境对艾滋病患者接受或拒绝老年人语言有什么影响？活动类型（例如，病史、服药与帮助他人进食）是否影响接收？MethodsConversation分析（CA）将被用来详细检查一个预先存在的数据集的视频记录的医疗保健专业人员和PLWD之间的互动，在急性医院设置。学生还将收集少量额外的录音，以补充数据集。NHS伦理批准将获得新的数据收集，使用现有的批准协议。分析将超越个人的心理倾向，通过深入审查和比较多个事件，以确定模式及其后果。与监督团队和其他专家CA分析师的数据会议将被用来提高结果的鲁棒性。该项目将有助于PLWD最佳实践沟通的经验文献。研究结果也将实际应用，旨在开发可提供给医护人员的培训资源。这种培训将以医院环境中发生的实际互动为基础，并将对工作人员自己确定的需求做出反应。研究结果将通过学术期刊、会议和摘要传播，并将发送给主要利益相关者（如痴呆症慈善机构和医疗保健专业人员）。

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).