SOCIAL PSYCHOLOGICAL ASPECTS OF COMMUNICATION AND AGING

Annual Review ofApplied Linguistics (2008) 28, 51-72. Printed in the USA.Copyright © 2008 Cambridge University Press 0267-1905/08 $16.00doi: 10.1017/S0267190508080112

3. SOCIAL PSYCHOLOGICAL ASPECTS OF COMMUNICATIONAND AGING

Marie Y. Savundranayagam and Ellen Bouchard Ryan

Language plays an important role in defining identities in older adulthood. Bothself-perception and others' perceptions of older adults are reflected through languageused by older and younger adults (see recent texts: de Bot & Makoni, 2005;Harwood, 2007; Hummert & Nussbaum, 2001; Nussbaum & Coupland, 2004). Inthis review, we outline key theoretical perspectives on the study of communicationwith older adults and provide evidence supporting these perspectives within thecontext of age stereotypes, intergenerational communication, cross-culturalcommunication, and health care encounters. Given that communication is aninteractive process, we discuss how older adults use language and communication torespond to age stereotypes and adaptively cope with age-related losses. We alsodiscuss communication interventions aimed at improving interactions between careproviders and older adults, and opportunities that technology brings to enhancecommunication within and across generations.

Age-Based Stereotypes Constraining Older Adult Communication

Communication Predicaments of Aging

Although age stereotypes are not unidimensional (Hummert, Shaner,Garstka, & Henry, 1998), interaction with older adults-and even among olderadults-tends to be dominated by age stereotypes of dependency and incompetence(Hummert, Garstka, Ryan, & Bonnesen, 2004; Kite, Stockdale, Whitley, & Johnson,2005). As suggested by the communication predicament of aging model,conversational partners' use of speech modifications based on negative agestereotypes can constrain communication opportunities and reinforce stereotypedbehaviors and eventually lead to lower self-esteem and disengagement by older adults(Barker, Giles, & Harwood, 2004; Ryan, Giles, Bartolucci, & Henwood, 1986). Thesenegative age stereotypes are reinforced when older adults are repeatedly spoken to ina patronizing manner. The danger with continuous exposure to this communicationstyle is that older adults might begin to both internalize and accept such stereotypes.

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52 SAVUNDRANAYAGAM AND RYAN

Thus, negative age stereotypes can become a self-fulfilling prophecy. The adaptedmodel by Barker et aI. (2004) incorporates both intergenerational andintragenerational encounters. Moreover, the extent to which age elicits negativestereotypes and drives automatic usage of age-adapted communication is seen torelate to the societal context, as well as characteristics of the individual within thecommunication situation (premature cognitive commitments, level of mindfulness,age-salience). Relevant aspects of the societal context that influence the likelihood ofpatronizing communication toward older adults include the prevalence of positive andnegative age stereotypes, group vitality (reflected by population size, sociohistoricalstatus, and institutional support), and filial piety norms, which hold that older adultsare to be respected and venerated, especially if they are family elders.

What the Media Communicate about Aging

The media (especially television) playa major role in influencing the statusof older adults and in socializing audience members to the roles and characteristics ofolder adults (Harwood & Anderson, 2002). The media are particularly powerful incultivating and reinforcing children's perceptions of aging (Robinson & Anderson,2006). Generally, older adults are underrepresented in the media. In fact, there hasonly been a 1% increase in the presence of older adults in children's programming inthe last 20 years (Robinson & Anderson). In contrast to the population statistics thatindicate there are more older women than older men and that there are increasingnumbers of minority older adults, both older women and minority older adults are ararity in the media (Robinson & Anderson; Zhang et aI., 2006). Cross-culturalresearch on how older adults are portrayed in Indian and American magazineadvertisements revealed that compared to American ads, ads in Indiaunderrepresented older adults to a larger extent and included far fewer olderwomen than older men (Raman, Harwood, Weis, Anderson, & Miller,2006).

When represented, older adults have been depicted as unidimensionalcharacters, holding either positive or negative characteristics, but not both. Forexample, some studies suggest that older adults depicted in children's programmingand in some advertising showed many positive portrayals (Bishop & Krause, 1984;Robinson, 1998). However, these positive portrayals must be viewed with cautionbecause older adults had minor roles and were experiencing health issues (Robinson& Anderson, 2006; Zhang et aI., 2006). Cultural values depicted in televisioncommercials featuring older adults tend to focus more on health than on technologyand achievement; the latter values are more predominant in commercials featuringyounger age groups (Zhang & Agard, 2004). These cultural values only fuelstereotypic and negative attitudes that younger adults might have toward older adults(Harwood, 2007). Generally, media representations of older adults includepredominantly negative characteristics (such as senile, villainous, and curmudgeon),minor roles, or traditional gender roles (Donlon, Ashman, & Levy, 2005; Ramanet aI., 2006).

SOCIAL PSYCHOLOGICAL ASPECTS OF COMMUNICATION AND AGING 53

The pervasiveness of negative images of aging on television and in othermedia can contribute to self-stereotyping by older adults. Coupland (2003) addressedthe ageist messages in skin care marketing that suggest that women can avoid thepitfalls of ageism by keeping their skin looking young. Donlon and colleagues (2005)found that television exposure was more strongly related to negative age stereotypesthan age, depression, education or self-rated health. However, they did not examinewhether increased awareness of how older adults are depicted actually decreasesnegative age stereotypes. Increasing awareness of the negative depiction of olderadults to older adults themselves can have serious consequences for the media. As thebaby boomers age, they are expected to be less complacent about negative andoffensive advertising. Older adults who categorized magazine advertisements asoffensive and harmful to their age group were less likely to purchase products fromsuch advertisers (Robinson, Popvich, Gustafson, & Fraser, 2003) and also attributedthe persistent negative portrayal of aging to the (younger) age profile of workers in themedia (Healey & Ross, 2002).

Influence of Stereotypes on Older adults

Given that older adults also hold negative age stereotypes, the naturalquestion is whether these stereotypes affect older adults in meaningful ways. Theresearch evidence suggests that both negative and positive self-stereotypes affectolder adults in terms of their functional and sensory abilities. The research onnegative self-stereotypes illustrates the power of internalized perceptions on variousabilities. When older adults were explicitly exposed to negative age stereotypes, theirperformance on memory tests was lower than older adults who were not exposed andto younger adults who were exposed (Hess, Auman, Colcombe, & Rahhal, 2003).When negative age stereotypes were presented at speeds that permit perceptionwithout conscious awareness, older adults experienced more cardiovascular stresseven before they had to deal with anxiety-producing stressors (i.e., mathematicaland verbal challenges) (Levy, Hausdorff, Hencke, & Wei, 2000). Finally, older adultswho held negative stereotypes, especially related to physical appearance, showedmore decline in hearing after 3 years (Levy, Slade, & Gill, 2006).

The influence of positive self-perceptions on functional health, mortality, andwill to live is promising. Levy and colleagues (Levy, Slade, & Kasl, 2002) found thatolder adults who held positive self-perceptions were more likely to report betterfunctional health, and that perceived control partially mediated the relationshipbetween self-perceptions of aging and functional health. In another study, Levy andcolleagues (Levy, Slade, Kunkel, & Kasl, 2002) found that older adults with positiveself-perceptions lived almost 8 years longer than those who held less positiveperceptions. They also found that the will to live partially mediated the relationshipbetween self-perceptions and longevity. Both studies found these compelling resultsafter controlling for baseline measures of functional health, self-rated health, age,gender, race, and socioeconomic status. Older adults who were subliminally exposedto positive age stereotypes showed improvements in motor function (Hausdorff,Levy, & Wei, 1999). These results suggest possibilities in terms of interventionsaimed at improving functional and cognitive abilities.


Perceptions of Intergenerational Communication

Within English-Speaking Contexts

Ageist stereotyping can lead to age-adapted ways of speaking to older adults.Patronizing talk to older adults and other targets such as those with disabilitythreatens the self-esteem of recipients whether it be directive talk (low care, highcontrol), baby talk (high care, high control), overly personal talk (high care, lowcontrol) and superficial talk (low care, low control) (Hummert & Ryan, 2001).Moreover, constrained by expectations of such talk, older adults can reinforce agestereotypes with painful self-disclosures (Bonnesen & Hummert, 2002).

Elderspeak is the accommodation of communication based on the perceivedneeds of older adults and includes simplified syntax and vocabulary, slow speakingrate, and exaggerated prosody. In a masterful series of experiments, Kemper andHarden (1999) elicited evaluations of different components of elderspeak used byyoung adults in a referential communication task with older adult listeners. Semanticelaborations and reducing grammatical complexity without shortening sentencesbenefited older adults in comprehension and self-rated performance, whereasreceiving short sentences, slow speech rate, high pitch, and pitch variation led olderadults to report more communication difficulties. Similarly, Gould, Saum, and Belter(2002) found a benefit in older adult memory when medication instructions weregiven in elderspeak, while younger and older adults agreed on the negative andpositive aspects of such talk.

Comparing evaluations of family communication with teens, peers, andelders, Williams and Garrett (2002) found that communication with older adults wasviewed more positively as respondent age increased across the adult range, and thatcommunication with both older adults and adolescents was viewed as problematic.Hummert and Morgan (2001) showed that direct control strategies were evaluatednegatively in decision-making conversational scenarios involving a middle-agedwoman with either her young adult daughter or her older adult mother, but were moreacceptable with the older mother.

Communication and stereotyping are mutually reinforcing in a variety ofways. Chen and King (2002) found that old adults expressed greater satisfaction withintergenerational communication than young participants, and that a positive agestereotype for the opposite age group was associated with higher levels ofintergenerational communication satisfaction for both groups. Interestingly, Polizziand Millikin (2002) supported the notion that researcher terminology can affectelicited attitudes toward older adults, with the term "70-85 years" eliciting morepositive attitudes than the terms "old" or "elderly."

Ryan, Anas, and Gruneir (2006) examined the meanings of overhelping andunderhelping in conversations between a salesperson and young or old targets with orwithout visible disability. Compared to a professional style, young and oldrespondents agreed that underhelping was the most negative, and that overhelping


was associated with reduced customer satisfaction and salesperson effectiveness."Blame the recipient" effects occurred in evaluations of both underhelped andoverhelped customers. Within a similar paradigm, Ryan, Anas, and Vuckovich (2007)evaluated young and older targets with or without hearing loss who showedcommunication problems. Regardless of age, targets were judged less severely forcommunication difficulties if known to use a hearing aid. These findings could helpthose counseling older adults with hearing loss, given that "faking it" can lead toserious interpersonal problems.

Perceptions of age excuses have also been the topic of several studies. Astudy of the conversational management of memory failures in older adults by Ryan,Bieman-Copland, Kwong See, Ellis, and Anas (2002) showed that while age excusesmay relieve socially awkward situations, they serve to reinforce age stereotyping ofthe older forgetter, especially from the perspective of young respondents. Erber andPrager (2000) showed that offering an age excuse for forgetting afterward servedtargets better than giving it before as a self-handicapping strategy. Newspaper contentanalysis supports the increasing usage of the term "senior moments" to describe arange of memory failures associated with old age (Bonnesen & Burgess, 2004).

There is evidence for acceptance of negative age stereotypes by older adultsin nursing home and hospital settings where cues of dependence are more salient thanin community settings (Hummert & Mazloff, 2001; Ryan, Kennaley, Pratt, &Shumovich, 2000). Interestingly, there are variations in the sources of patronizingspeech for older adults in community versus nursing home settings. Compared withfriends, same-age family members, younger family members, and familiar serviceworkers, community-residing older adults reported only receiving patronizing speechfrom unfamiliar service workers. However, nursing home residents receivedpatronizing speech from all speaker types (O'Connor & St. Pierre, 2004). Finally, wesee the blame the victim effect when older adults are evaluated negatively ininteractions where the other person uses patronizing speech (Hummert et aI., 2004;Savundranayagam, Ryan, Anas, & Orange, 2007).

Cross-Cultural Comparisons

How do perceptions of aging and communication with older adults differamong cultures? Many Eastern (Chinese, Japanese, Indian, etc.), Latino, and NativeAmerican cultures are collectivist and subscribe to filial piety (Barker & Giles, 2003;Gallois et aI. 1999; Harwood, 2007). This can include forms of address that honorolder adults and reinforce their higher status. Older adults, especially in NativeAmerican cultures, tend to be revered for their wisdom and lived experience, and holdthe responsibility for transmitting cultural traditions to younger generations(Graves & Shavings, 2005).

However, given the urbanization of many cultures, especially those in EastAsia, younger adults are moving into urban areas and leaving older adults in ruralareas. Moreover, while families have more generations living at one time, there arefewer family members within each generation to care for older adults. These changes


have resulted in more nursing homes in Eastern countries (Ikels, 2004), more negativeattitudes toward older adults in some societies (e.g., Hong Kong) than in NorthAmerica (Harwood, 2007; Harwood et aI., 2001), and fewer meaningful roles forolder adults (Bhat & Dhruvarajan, 2001).

Indeed, recent research revealed changing cultural values and moremultidimensional perceptions of aging in Eastern and Latino cultures, especially asthese societies become more Westernized. Research by Zhang and colleagues (Zhang,Harwood, & Hummert, 2005; Zhang & Hummert, 2001) support the idea thatyounger adults in Asian cultures are beginning to view the age hierarchy asundemocratic. Younger Asian adults also held fewer positive stereotypes of olderadults than Western younger adults, especially in terms of benevolence (Giles et aI.,2003; Pecchioni, Ota, & Sparks, 2004). Similarly, Ryan and colleagues did not findgreater positivity toward older adults within their Asian sample (Ryan, Jin, Anas, &Luh, 2004). In fact, they found that participants from Chinese, Korean, and Canadiancultures held both positive (i.e., storytelling and social skills) and negative beliefs(i.e., hearing and memory) about communication skills of older adults, with strongerpositive beliefs endorsed by older adults than younger adults from both East andWest. However, younger adults are not the only ones who hold negative perceptionsof aging. The research on self-stereotyping among older adults of different culturesalso suggests that they hold negative attitudes towards their age group (Boduroglu,Yoon, Luo, & Park, 2006).

The evidence on communication behaviors used with older adults mightreveal outcomes resulting from age stereotypes. Compared to their counterparts inWestern countries, both younger and older adults in Eastern countries evaluated theircommunication with nonfamily older adults as more problematic than with youngeradults (Pecchioni et aI., 2004). In both cases, older adults were perceived asnonaccommodating. Despite the generalized perspective that older adults ofdeveloping countries are more respected than older adults in Western countries, thereis evidence that the respect might stop at mere formalities. For instance, althougholder adults are generally healthy and socially active in rural Ghana, they receivedrespect at a very superficial level. The communication behavior of younger adultsrevealed that they did not listen to the wisdom or advice of older adults, andconsequently older adults experienced loneliness (van der Geest, 2004). Similarly,results from a large cross-cultural study on intergenerational communication revealedthat Asian younger adults' behavior was governed largely by obligation (Galloiset aI., 1999). Study results showed that Asian younger adults felt more obligated togive practical support to older adults than their Western counterparts, who reportedthat they would personally provide continued communication and contact with olderadults.

Grandparent-Grandchild Communication

Perceptions of grandparent-grandchild communication offer the mostpositive data concerning intergenerational interactions involving university-age adults(Harwood, 2007; Pecchioni & Croghan, 2002). Grandparents reported that


communication within this family relationship involves expressions of affiliation,pride, and mutual exchange, as well as the stress of physical and emotional distanceassociated with adolescence and leaving for college (Harwood & Lin, 2000).Grandchildren reported maintaining this relationship through face-to-face visits,telephone, and writing (letters, e-mail), with telephone contact being most linked torelationship quality (Harwood, 2000a). From both generations, accommodativecommunication behaviors are associated with solidarity between grandparents andgrandchildren (Harwood, 2000b).

Indeed, frequency and quality of grandparent contact has often been cited asthe primary way in which youth learn positive attitudes toward old age. This expectedlink between grandparent relationships and young adult attitudes toward older adultsin general has been examined through several multivariate studies. Soliz andHarwood (2003) explored the variation in relationships with multiple grandparentsand found links between variation in perceived communication and perceivedvariability in old age. However, varied experiences with different grandparents werelinked to more negative attitudes toward older adults in general. Based on complextheories of how intergroup contact can affect attitudes, Harwood and colleagues(Harwood, Hewstone, Paolini, & Voci, 2005) then incorporated the key variable ofage salience because grandparents are unlikely to be perceived as typical if they areseen as family and talked with in a person-centered manner. They found that contactwith the closest grandparent has more influence on attitudes toward older adults whenage is salient in the grandparent relationship. Moreover, accommodation mediated theeffect of contact on attitudes while self-disclosure and individuation influenced theeffect of contact on perceived variability among the old. Following up on agesalience, Soliz and Harwood (2006) found that personal communication (socialsupport and reciprocal self-disclosure) was correlated positively with perceptions ofshared family identity, whereas intergroup communication (under- andoveraccommodation) was related to age salience.

Communication During Medical Encounters

Communication predicaments are highly likely in helping situations, such aspatient-doctor interactions (Braithwaite & Eckstein, 2003; Braithwaite & Thompson,2000). The literature on patient-doctor interactions reveals many ways in whichphysicians treat older patients differently than their younger patients. Physicians tendto spend less time with older adults, use a more condescending and less patient tonewith older adults, overuse technical language, control the interview, ask older adultsfewer questions, use close-ended questions, do not include them in joint decisionmaking, and are less likely to recommend preventive strategies such as exercise(Allman, Ragan, Newsome, Scoufos, & Nussbaum, 1999; Thompson, Robinson, &Beisecker, 2004). These communication patterns are exacerbated within thehospital context, where the doctor primarily holds the power and control over thedoctor-older patient relationship, and care tasks (e.g., bathing, feeding, etc.)are based on staff needs instead of the older adult's needs (Coe & Miller, 2000).


Physicians' communication skills discussed earlier can decidedly affect thedegree of medical success achieved for older adults. Indeed, these barriers are moredissatisfying for women than men. Both not calling a person by name and calling aperson by first name were perceived as signs of unequal power between physiciansand patients (Allman et aI., 1999). Most older women in the United States useMedicare to cover their medical visits, and Medicare only pays for 80% of physiciancharges. Compared to women who have other sources of medical payment, poorerwomen were more likely to experience medical encounters that were tardy or rushed,or where physicians made little eye contact (Allman et aI.).

Older adults are more likely to be excluded or not fully included in thepresence of differences (e.g., age, disability, language differences). For example,family members may speak on behalf of older adults, making it difficult to voice theiropinions in future encounters (Adelman, Greene, & Ory, 2000). Compared to dyadicencounters where the older adult and doctor are more likely to have similar levels ofparticipation, older adults' levels of participation were reduced by about 17% intriadic encounters (Ishikawa, Roter, Yamazaki, & Takayama, 2005). In addition,family members tend to take more active roles during the encounter by directly askingquestions and providing information about the older patient, even if the doctoraddresses the patient directly (Coupland & Coupland, 2001). There is diversity in thetypes of roles family members occupy during health encounters. They includeemotional support, note taker, memory aid, advocate, and interpreter (Ellingson,2002). Despite this diversity, overhelping behaviors where family members speak forolder adults often result in patients deferring to family members for responses and cancontribute to excess disability (Ryan, Anas, & Friedman, 2006; Ryan, Bajorek,Beaman, & Anas, 2005). Moreover, when family members collude with doctors, theolder patient is likely to feel alienated or reprimanded for not following treatmentplans (Coupland & Coupland, 2001). The problem of family members dominatingconversations is not specific to medical encounters; it is also relevant within the familycaregiving context. Edwards (2001) advised caregivers to ask open-ended questions,avoid interrupting, and try to balance giving information with asking for information.

There are similar cautions when interpreters are used in medical encounters.When using interpreters, the patients' content, meaning, and affect of speech can bealtered. In addition, it is difficult to build rapport with a physician and be moreengaged in the treatment decision-making process when an interpreter is used(Aranguri, Davidson, & Ramirez, 2006). Similar findings are documented withminority patients, who are also less involved in decision making, experience lesspatient-centered communication, and are less trusting of physicians (Johnson, Roter,Powe, & Cooper, 2004; Johnson, Saha, Arbelaez, Beach, & Cooper, 2004). Eventhough these interpreter studies are not specific to aging, they are relevant to olderadults because the communication encounter might be worse when language barriersare combined with negative age stereotypes that are rampant in health care settings.

One of the most understudied yet prevalent issues related to language andaging within medical contexts is the impact of bi- or multilingualism on healthassessments. De Bot and Makoni (2005) cautioned that most research focuses on


monolingual contexts despite the reality that bi- or multilingual older adults are partof many of our communities. Baker (2000) contended that language-related diagnoses(e.g., aphasia) are more likely to be accurate if assessments are conducted in multiplelanguages because of possible residual abilities with one language. Baker also statedthat specific communication tasks within assessments must be in the language that theclient would have used previously. For example, if communication tasks involveinteracting with a grocery clerk or with family members, each task must be assessedin the language that the client would have used before the onset of the communicationdisorder. These points highlight the importance of diversifying the language abilitiesof health professionals.

It is important to appreciate the heterogeneity within the older adultpopulation and tailor health recommendations and medication instructions to theabilities and preferences of older adults. For instance, older adults with high levels ofcognitive ability tend to prefer standard pharmacy instructions that discuss druginteractions. However, older adults with lower levels of cognitive ability preferredpatient-centered instructions (e.g., large print, text-related icons, and simplifiedlanguage) that supported comprehension and memory by minimizing demands onsensory and cognitive abilities (Morrow, Weiner, Steinley, Young, & Murray, 2007).Zandbelt, Smets, Oort, Godfried, and de Haes (2007) investigated the extent to which(1) physicians facilitated or inhibited patients to express their perspective, and (2)patients actively contributed to the conversation. Patients were more likely to activelycontribute to conversations when the physician used facilitating communication.However, physicians' inhibiting behavior did not affect patient expression. Theauthors concluded that physicians may exhibit inhibiting behaviors as a response tothe increased participation by patients. Other considerations for physicians includenot denying older adults preventive health recommendations because of their age.Physicians also need to create a social environment that allows older adults todisclose sensitive issues such as loss, death, and abuse, especially because thoseissues might be the underlying reasons for the medical visit (Harwood, 2007).

The responsibility for effective communication encounters in the healthcontext also lies with older adults. As mentioned earlier, older adults do contribute tonegative stereotypes by using age excuses or internalizing the sick role in olderadulthood. In health encounters, older adults' responses to questions about how theyare doing almost always include an assessment of health given their age (Coupland &Coupland, 1999). In some cases, older adults view aging and medical ailments asinextricably linked, and use humor to lighten such self-disenfranchising remarks.However, their assessments are not always negative. Mentioning age within thecontext of health reflects a sense of pride for being healthy in older adulthood. Yet,Coupland and Coupland cautioned that this pride in and of itself suggests that goodhealth in older adulthood is exceptional. Some older adults are more resistant toexplanations by doctors that certain symptoms are not due to old age or that certainnegative health habits can be changed in older adulthood. Coupland and Couplandincluded a rare but fascinating account in which a physician vociferously challengedage excuses when used as justification not to quit smoking and drinking. This accountillustrates how difficult it is for physicians to contest self-stereotypes, but also how


important it is for both physicians and older patients to actively work towardinteractions that promote positive perceptions of health and aging.

The current cohort of older adults tends to prefer the power differential wherethe doctor is the expert. Consequently, they may ask fewer questions during medicalencounters, especially within the managed care context where doctor-patient time islimited. However, patients who actively participate during medical visits receive moreinformation from physicians on topics such as treatment options and side effects(Cegala, Street, & Clinch, 2007). Such information may increase patient complianceand positive health outcomes. Research on both doctors' and patients' perceptions ofwhat constitutes competent patient communication reveals that providing relevantinformation, asking questions, and being prepared for the medical visit with anagenda are all useful strategies (Cegala, Gade, Lenzmeier Broz, & McClure, 2004;Greene & Adelman, 2001). In addition, doctors preferred that patients prepare bythinking about medical concerns before the visit. They also want patients to learnabout the illness, provide a detailed medical history, and include other relevant issues.

Enhancing Communication

Older Adult Assertiveness

Several communication accommodation models address how interlocutorscan individualize their talk to older adults, thereby avoiding the pitfalls of patronizingcommunication (Barker et aI., 2004; Hummert et aI, 2004; Ryan, Meredith, MacLean,& Orange, 1995). To highlight options for people with disabilities to interrupt thenegative feedback loop of the communication predicament, Ryan et al. (2005)developed a model featuring selective assertiveness as the term for choosing one'sbattles and responding (vs. reacting) in a clear, calm, confident manner. Older adults'responses to patronizing advice (Hummert & Mazloff, 2001) reflected severalpotentially assertive options (direct, appreciative, and ignoring), with a clearindication that these are more likely in a community context than in a hospitalcontext. Within problematic clinical encounters in the community, young and oldevaluators agreed that assertive seniors were most competent and likely to be satisfiedin a future encounter (Ryan, Anas, & Friedman, 2006). Within the nursing home,Ryan et al. (2000) found less support for assertiveness (not part of the nursing homeresident role) in declining to participate in an activity. Indirect assertiveness(declining with humor) was more successful. Finally, a study of assertive versuspassive responses in problematic service encounters by visually impaired olderwomen needing help demonstrated higher evaluations of competence and futuresuccess for assertiveness and provided further evidence for the importance of contexts(Ryan, Anas, & Mays, 2008). The assertiveness advantage was greater in thecommunity than in the hospital setting and for the more serious situations. Thistheoretical perspective and these findings suggest specific ways in which older adultsmight be encouraged to respond more effectively by carefully choosing features ofassertiveness to match the demands of problematic situations.


Communication Between Nursing Home Staff and Residents

As a response to the negative outcomes reflected in the communicationpredicament of aging model (Ryan et aI., 1986), the communication enhancementmodel (Ryan et aI., 1995) delineates how social partners, especially health careprofessionals, can adjust their communication to meet the actual needs of olderadults. The model encourages interventions that emphasize appropriate speechaccommodations, supportive physical environments, and creating positive socialenvironments. Such interventions empower both the older adult and the social partner(Savundranayagam, Ryan, & Hummert, 2007). For instance, long-term care staff whoused personhood-based language were rated more positively than staff who useddirective language (Savundranayagam, Ryan, Anas, et aI., 2007). Residents withdementia were also rated more positively in the personhood scenarios even thoughtheir responses in both personhood and directive scenarios were identical. Carefullysimplified language, suggested by Kemper and Harden (1999) as an effectivelanguage modification, strengthened those effects by showing staff as less patronizingand residents as more competent. In support of the communication enhancementmodel, these results offer evidence that appropriate changes in staff communicationbenefit both staff and residents.

The research program of Williams also supports the communicationenhancement model. Williams and colleagues (Williams, 2006; Williams, Kemper, &Hummert, 2003, 2004) developed a brief intervention that informed long-term carestaff of the importance of socialization for older adults. The intervention also focusedon communication barriers specific to the nursing home context and the positive andnegative aspects of elderspeak. Using actual and simulated videotaped staff-residentinteractions, participants were able to (1) identify aspects of elderspeak in their owninteractions and those of others and (2) reenact the interaction using effectivecommunication strategies. Findings revealed that participants gained knowledgeabout their own communication patterns, especially their use of elderspeak. They alsoused fewer psycholinguistic features of elderspeak (e.g., diminutives, shortenedstatements, and simplistic vocabulary) after training. It will be helpful to find out ifthis intervention positively affects the residents as well, especially in terms of socialengagement.

Communication interventions focused on improving nursing home staff andfamily member interactions with residents also show promising results. Interventionsaimed at teaching staff to use memory aids and specific verbal and nonverbalcommunication skills were able to reduce depressive symptoms in residents withdementia (McCallion, Toseland, Lacey, & Banks, 1999) and improve communicationbetween staff and residents with mild and moderate cognitive impairment(Allen-Burge, Burgio, Bourgeois, Sims, & Nunnikhoven, 2001). However, anotherintervention for improving communication among residents, nursing staff, andvisiting family members showed that only family members improved communicationpatterns with residents. In tum, residents were improved in terms of depression,verbal behavior, and agitation (McCallion, Toseland, & Freeman, 1999).


Finally, interventions intended to improve communication between nursinghome staff and family members can have indirect benefits for residents in long-termcare, especially for residents who are unable to communicate their needs andconcerns due to cognitive impairments. As in the case of acute-care medicalencounters discussed earlier, family members play an important role in long-term carefacilities because they help staff by sharing the residents' life histories, preferences,and unmet needs (Port et aI., 2001). This type of help has been linked with lowerlevels of disruptive behaviors and increased levels of resident involvement (Dobbset aI., 2005; Foley, Sudha, Sloane, & Gold, 2003). By including family members andstaff, Pillemer and colleagues (2003; Robison & Pillemer, 2005) developed thePartners in Caregiving program that trained both groups on effective communication,empathy development, and conflict resolution. The most recent results stemming fromthis intervention show that there are improvements in communication between staffand families. What is most striking is that residents with dementia in the interventiongroup showed significant improvements in many disruptive behaviors such as cursingor verbal aggression, self-abuse, sexual advances, inappropriate dress, constantrequests for attention, and wandering (Robison et aI., 2007).

Computer-Mediated Relationships

Although there are interventions targeted to social partners of older adults,especially within the health care context, older adults themselves can remain activelyengaged in life through a variety of communication-based strategies. In this nextsection, we will discuss how technology is becoming a useful tool for older adults tomaintain a sense of self and competence, especially in the face of health and sociallosses that can be physically and socially isolating. Personal computers, software,teaching approaches, and accessibility options on computers and the Internet areincreasingly being improved to include and engage people with a variety of abilitiesand disabilities (Charness, Park, & Sabel, 2001).

Older adults are using the Internet to develop and maintain relationships withfamily members and friends, reconnect with past hobbies, gather information, beengaged with interest groups, increase personal control, and be mentally active (Foxet aI., 2001; McMellon & Schiffman, 2002). Older adults who participated regularlyin online groups received social support and companionship and also reported lowerscores on perceived stress (Wright, 2000). In addition, being a competentcommunicator also contributed to lower scores of perceived stress and greatersatisfaction with the support offered by their online network. These types of networksprovided more emotional support and validation than other types of social support(Query & Wright, 2003).

Online support networks offer older adults the opportunity to seek supportthrough a more diverse group of individuals who are not family members. Unlikefamily relationships that might hold obligations, online networks include morevoluntary relationships that are based on common interests or stressors, as in the caseof caregiving or disease-related forums (Wright & Query, 2004). With familymembers, older adults may not feel comfortable sharing their distress over concerns


such as health and disability. However, online support networks allow older adults tomaintain their identities in the face of adversities by communicating about sensitive orstigmatizing issues. Self-disclosure can be done more safely given the anonymity ofonline groups. Interestingly, older adults in online discussion forums tended to usemore positive than negative age identities themes. These included active engagement,a sense that their minds can overcome physical declines, wisdom and maturity, andthe freedom of age (Lin, Hummert, & Harwood, 2004). Moreover, communicatingwith others who are experiencing similar problems makes it easier for individuals toempathize with each other and exchange comforting messages (Preece & Ghozati,2001).

There still remains a digital divide in terms of the characteristics of olderadults who use computers. Typically, those who use computers are part of theyoung-old group, are male, and have greater education (Selwyn, Gorard, Furlong, &Madden, 2003). Selwyn and colleagues cautioned that the reasons for not usingcomputers are not limited to income, but are also related to the perceived relevance ofsuch technology in the lives of older adults. Training older adults to use computers isnot always enough to improve psychosocial factors such as loneliness or depression(White et aI., 2002). Perhaps training interventions may be more successful if theyexplained the relevance of computer use in the personal lives of older adults and usedless negative age-stereotypic outcomes such as loneliness and depression.

Conclusions

In this review, we have focused on the role of age stereotypes in influencingintragenerational and intergenerational communication within the context of familyrelationships, health care encounters, and computer-mediated relationships. We havediscussed the powerful role of self-stereotypes on cognitive and functional abilities ofolder adults. Some of the research findings send cautionary notes about (1) thedepiction of older adults in the media, (2) how easily age defines the person inmedical encounters, (3) how age is inextricably linked with ill-health, and (4) howtechnology needs to be personally relevant to older adults. Yet, other findings offerhope in the ability of older adults to (1) remain meaningfully connected with theirfamily members (especially grandchildren), (2) be actively engaged in healthmaintenance and promotion, (3) use appropriate features of assertiveness to matchsituational demands, and (4) create and maintain relationships through newtechnologies.

The positive findings reflect the Ryan et al. (2005) elaborated predicamentmodel of intergenerational communication, which illustrates the active role that olderadults can and do play in confronting negative stereotypes. Future research shouldconsider how contextually appropriate communication can to lead to increasedfunctional effectiveness, self-esteem, satisfaction, and well-being for older adults andtheir communication partners, as outlined in the Barker and colleagues (2004) model.Coupland and YHinne-McEwen (2005) called for a sociolinguistics of aging thatwould emphasize the diversity in conversational experiences among older adults,


especially with younger members of their families and service professionals. Suchdiscourse analyses (as in Coupland & Coupland, 2001) would reveal how language iscentral to the negotiation of age identities. Similarly, more research should be targetedtoward the grandparent-grandchild relationship because it holds promise for effectiveand satisfying intergenerational communication and also because kinship care isbecoming increasingly prevalent (Fuller-Thomson & Minkler, 2000).

As our communities become more multicultural and multilingual (de Bot &Makoni, 2005), it will be important to examine how older adults negotiate theiridentities in the face of multiple layers of differences, especially in contexts that arelikely to be disempowering. In addition, there is a dearth of research on aging inmultilingual contexts. Future research should investigate the strengths of older adultswho are bi- or multilingual, especially in light of recent evidence that bilingualismprotects older adults from declining executive functioning because of the lifelongmanagement of two languages (Bialystok, Craik, Klein, & Viswanathan, 2004). Inaddition, future research should also consider the challenges of aging withinmultilingual family and professional contexts.

Finally, the research community needs to reexamine the types of outcomesused to evaluate the effectiveness of interventions. We must not forget our ownresponsibility to combat ageism in terms of the research questions we pursue and theway in which we ask those questions. We too must be mindful of the heterogeneityand resilience of older adults as we examine the ways in which language andcommunication are used to negotiate age identities.

ACKNOWLEDGMENTS

We acknowledge financial support from a grant to E. B. Ryan from the Social Sciences andHumanities Research Council of Canada and grants to M. Y. Savundranayagam from the HartfordFoundation's Geriatric Social Work Faculty Scholars Program and the Center on Age & Communityat the University of Wisconsin-Milwaukee.

ANNOTATED REFERENCES

Barker, v., Giles, H., & Harwood, J. (2004). Inter- and intragroup perspectives onintergenerational communication. In J. F. Nussbaum & J. Coupland (Eds.),Handbook of communication and aging research (2nd ed., pp. 139-166).Mahwah, NJ: Erlbaum.

Barker and colleagues reviewed major theories and models onintergroup theories including communication accommodation theory, thecommunication predicament and enhancement models, social identity theory,and the stereotype activation model. Based on these theories and models,they present a new model that includes social structure and culturalvariability as key factors that influence inter- and intragenerational


communication. The authors also discussed strategies that can lead topositive communication encounters and challenge gerontologists and healthprofessionals to apply the model in their interactions with older adults,especially with those who are from minority or marginalized groups.

Harwood, J. (2007). Understanding communication and aging. Newbury Park, CA:Sage.

This book is a comprehensive overview of the contributions ofcommunication to the study of aging. Harwood covered a range of topics thathighlight the heterogeneity of older adults including age stereotypes,interpersonal, intercultural and intergenerational communication, mediaportrayals of aging, and health communication in older adulthood. The bookactively engages the reader not only to examine the existing research but alsoto consider the personal relevance of issues related to communication andagmg.

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In this chapter, the authors provided an update on research on howpositive and negative age stereotypes influence interpersonal communication.They paid special attention to relatively new areas of research: implicit agestereotyping and self-stereotyping. They framed these research findingswithin the context of the communication predicament of aging model and theage stereotypes in interactions model.

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SOCIAL PSYCHOLOGICAL ASPECTS OF COMMUNICATION AND AGING

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