Interpersonal Communication in Older Adulthood - Interdisciplinary Theory and Research 1994, SAGE

INTERPERSONAL
COMMUNICATION
IN OLDER
ADULTHOOD
O T H E R R E C E N T V O L U M E S IN THE
SAGE FOCUS EDITIONS
8 Controversy ( Third Edition) 152. Researching Sensitive Topics

Dorothy Nelkin Claire M. Renzctti and Raymond M. Lee
41. Black Families (Second Edition) 153. Women as National Leaders
HarrieUe Pipes McAdoo Michael A. Genovese
64. Family Relationships in I/afer Life 154. Testing Structural Equation Models
(Second Edition) Kenneth A. Bollen and J. Scott Long
Timothy H. Brubaker 155. Nonresidential Parenting
89. Popular Music and Communication Charlcne E. Depner and James H. Bray
(Second Edition) 156. Successful Focus Groups
James Lull David L. Morgan
133. Social Research on Children 157. Race and Ethnicity in Research Methods
and Adolescents John H. Stanfield II and
Barbara Stanley and Joan E. Sieber Rutledge M. Dennis
134. The Politics of Life in Schools 158. Improving Organizational Surveys
Joseph Blase Paul Rosenfeld, Jack E. Edwards, and
135. Applied Impression Management Marie D. T h o m a s
Robert A. Giacalonc and Paul Rosenfeld 159. A History of Race Relations Research
136. The Sense of Justice John H. Stanfield II
Roger D. Masters and Margaret Gruter 160. The Elderly Caregiver
137. Families and Retirement Karen A. Roberto
Maxtmiliane Szinovacz, David J. Ekerdt, 161. Activity and Aging
and Barbara H. Vinick John R. Kelly
138. Gender, Families, and Elder Care 162 Aging in Rural America
Jeffrey W Dwyer and Raymond T. Coward C. Neil Bull
139. Investigating Subjectivity 163. Corporate Political Agency
Carolyn Ellis and Michael G. Flaherty Barry M. Mitnick
140. Preventing Adolescent Pregnancy 164. The New Localism
Brent C Miller. Josefina J. Card, Edward G, Goetz and Susan E. Clarke
Roberta L. Paikoff, and James L. Peterson. 165. Providing Community-Based Services t o
141. Hidden Conflict in Organizations the Rural Elderly
Deborah M. Kolb and Jean M. Bartunek John A. Krout
142. Hispanics in the Workplace 166. Religion in Aging and Health
Stephen B. Knouse, Paul Rosenfeld, and Jeffrey S. Levin
Amy I.. Culbertson 167. Clinical Case M a n a g e m e n t
143. Psychotherapy Process Research Robert W. Surber
SbakiS G. Toukmanian and 168 Qualitative Methods in Aging Research
David L. Rennie .label F. Gubrium and Andrea Sankar
144 Educating Homeless Children 169. Interventions for Adolescent Identity
and Adolescents Development
James H. Stronge Sally L. Archer
145. Family Care of the Elderly 170. Destructive Behavior in Developmental
Jordan I. Kosberg Disabilities
146. Growth Management Travis Thompson and David B. Gray
Jay M. Stein 171. Advances in Social Network Analysis
147. Substance Abuse and Gang Violence Stanley Wasserman and
Richard E. Cervantes Joseph Galuskiewicz
148 Thir d World Cities 172. Identity and Development
John D, Kasarda and Allan M. Parnell Harkc A. Bosma, Tobi 1-, G. Graafsma,
149 Independent Consulting for Evaluators Harold D. Grotevant, and David J. de Levita
Alan Vaux, Margaret S Stockdale, and 173. Interpersonal Communication in
Michael J. Schwerin Older Adulthood
150. Advancing Family Preservation Practice Mary Lee Hummert. John M. Wiemann,
E. Susan Morion and R. Kevin Grigsby and Jon Γ. Nussbaum
151 A F u t u r e f o r Religion? 174. Gender Inequality at Work
William H. Swatos, Jr. Gerry A. Jacobs
INTERPERSONAL
COMMUNICATION
IN OLDER
ADULTHOOD
Interdisciplinary
Theory and Research
Mary Lee Hummert

John M. Wiemann
Jon F. Nussbaum
editors
SAGE PUBLICATIONS
International Educational and Professional Publisher
Thousand Oaks London New Delhi
Copyright © 1994 by Sage Publications, Inc.
All rights reserved. No part of this book may be reproduced or utilized

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Printed in the United States of America
Library of Congress Cataloging-in-Publication D a t a
Main entry under title:
Interpersonal communication in older adulthood: Interdisciplinary

theory and research / edited by Mary Lee Hummert, John Wiemann,
Jon F. Nussbaum.
p. cm—(Sage focus editions : 173)
Includes bibliographical references and index.
ISBN 0-8039-5116-7.—ISBN 0-8039-5117-5 (pbk.)
1. Aged—Communication—United States. 2. Interpersonal
communication. 3. Aging—Psychological aspects. 4. Old age—Social
aspects—United States. I. Hummert, Mary Lee. II. Wiemann, John
Μ. III. Nussbaum, Jon F.
HQ1064.U5I58 1994
305.26—dc20 94-17654
94 95 96 97 98 10 9 8 7 6 5 4 3 2 1
Sage Production Editor: Astrid Virding

Contents
1. Interpersona l Communication and Older Adulthood:

An Introduction 1
MARY LEE HUMMERT, JON F. NUSSBAUM,
and JOHN M. WIEMANN
2. Age-Based Perceptions of Conversational Skills
A m o n g Younger and Older Adults 15
ELLEN BOUCHARD RYAN, SHEREE KWONG SEE,
W. BRYAN MENEER, and DIANE TROVATO
3. Age-Related Problems in the Use of
Proper N a m e s in Communication 40
GILLIAN COHEN
4. T h e Effects of A l z h e i m e r ' s Dementia
on Language and Communication 58
SUSAN KEMPER and KELLY LYONS
5. Presbycusis, Communication, and Older Adults 83
WILLIAM A. VILLAUME, MARY HELEN BROWN,
and RIEKO DARLING
6. Verbosity in Older Adults 107
DOLORES PUSHKAR GOLD, TANNIS Y. ARBUCKLE,
and DAVID ANDRES
7. Talking Age and Aging Talk:
Communicating Through the Life Span 130
HOWARD GILES, SUSAN FOX, JAKE HARWOOD,
and ANGIE WILLIAMS
8. Stereotypes of the Elderly and Patronizing Speech 162
MARY LEE HUMMERT
9. Frailty, Language, and Elderly Identity: Interpretive
and Critical Perspectives on the Aging Subject 185
BRYAN C. TAYLOR
10. Friendship in Older Adulthood 20 9
JON F. NUSSBAUM
11. The Patient's Presentation of Self in
an Initial Medical Encounter 226
MICHELE G. GREENE, RONALD D. ADELMAN,
CONNIE R1ZZO, and ERIKA FRIEDMANN
Author Index 251
Subject Index 261
About the Authors 267
1
Interpersonal Communication
and Older Adulthood
An Introduction
MARY LEE H U M M E R T
J O N F. N U S S B A U M
J O H N M. W I E M A N N
Social scientists from a variety of academic disciplines have energeti

cally studied the aging process throughout the past two decades. Though
many of these researchers have called for interdisciplinary efforts in the
study of how individuals age, research that has incorporated diverse
theoretical and methodological perspectives remains quite rare. This
book features the best current research and theory on interpersonal
communication and older adulthood from diverse academic disciplines,
with the purpose of attaining a richer understanding of the complex
interactive world of older adults. To accomplish this goal, researchers from
the fields of communication, cognitive psychology, psycholinguistics,
sociolinguistics, and medical sociology have contributed chapters discuss
ing cognition, language, and the relational world of elderly individuals. 1
A U T H O R S ' N O T E : This book is based, in part, on the August 1992 special issue of
Communication Research, for which we served as editors. This chapter expands upon
some of the ideas that we advanced in the introduction to that special issue. W e would
like to thank Peter Monge, then editor of CR, for his assistance and encouragement of o u r
efforts, with both the special issue and this book. Preparation of this book was partially
supported by a grant from the National Institute on Aging to M. L. Hummert.
1
2 Interpersonal Communication and Older Adulthood
Why Study Interpersonal Communication

and Older Adulthood?
According to the most recent statistics compiled by the American

Association of Retired Persons (1991), there are approximately 31.1
million Americans over the age of 65, representing 12.5% of the total U.S.
population. The number of older adults is increasing at a rate nearly three
times that of the under-65 population. Further, examination of the census
data for the population over 65 shows that it is getting older itself: The
number of individuals aged 75 to 84 is growing at a faster rate than the
number aged 65 to 74, and the number over 85 is often cited as the fastest-
growing segment of our society. Not surprisingly, as Americans are living
longer and the overall percentage of older adults constitutes a larger propor-
tion of the total population, interest in investigating the biological, psy-
chological, sociological, and interactive behavior of this growing segment
of the population has increased. Reflecting this interest in research on
older adults is the $384 million Congress appropriated to the National
Institute on Aging (ΝΙΑ) in fiscal year 1992. This figure represented an
18.5% increase over ΝΙΑ funding for fiscal year 1991 and a 10% increase
over the request within the president's 1992 budget.
Beyond pure demographics and the political budgeting process, which
responds to possible blocs of voters, older adults are of interest to re-
searchers because of the simple notion that significant changes may occur
as we age that result in our experiencing a reality completely different
from that we have known in any previous state. These changes may not
be limited to the obvious physiological and biological imperatives that
are a direct result of living longer. Indeed, it is reasonable to expect that
as we age our communication and psychological needs, our attitudes, and
the very ways we function to cope with our changing physical abilities
also change. In addition, as we age the world around us is constantly
changing. Our marriages develop into more than pure sexual encounters,
our children progress through school and eventually leave home, we take
on more responsibility in our jobs, and our friendships wax and wane
depending on a variety of circumstances. It has long been obvious that
studies of college sophomores do not generalize very far into the life span.
Furthermore, it is becoming increasingly clear that as adults age, their
social world changes in significant ways. Not only do older adults live in
a world quite different from the one that existed 40 years ago, but their
world is also quite different from that of those currently living who are
40 years younger than themselves.
INTRODUCTION 3
We believe that at the core of this aging process, with its numerous
inevitable changes, lies the process of interpersonal communication. In a
very real sense, we do not age alone. Although it is true that our bones
become brittle, our muscles become less flexible, and our lungs may have
decreased capacity to enrich our blood, we as individuals maintain a
dynamic interactive presence throughout the entirety of our lives. The
abilities to interact and to maintain networks of relationships not only
provide us with such affective states as happiness and satisfaction, but
also function to meet our basic needs for companionship, success, and,
eventually, help us to survive. The interpersonal communication that fuels
our social world is as essential to our survival as any biological or physical
process that keeps us alive.
Cognition, Language, and

Interpersonal Relationships in Older Adulthood
Although it is quite common to classify elderly adults as neatly fitting

into stereotypical patterns of behavior, research has shown that they are
heterogeneous in their communication skills: Many exhibit no significant
receptive or expressive impairments, either cognitive or physical (Kemper,
1992b; Light, 1990; Ryan, 1991). Furthermore, when communicative
differences between elderly and young adults have been observed, those
differences have revealed that in some areas the elderly perform better than
the young. For instance, Kemper, Kynette, Rash, and O'Brien (1989) found
that although messages produced by the elderly contained less complex
sentences and more sentence fragments than did those of the young, the
narratives of the elderly were perceived as more interesting and as clearer
than those of the young. Likewise, research measuring cognitive, person
ality, and social behavior across the life span has "demonstrated that
interindividual variability, multidimensionality, and multidirectionality
characterize the nature of human aging" (Heckhausen, Dixon, & Baltes,
1989, p. 110).
We wish to emphasize the life-span developmental perspective in this
book as the way to view the aging process. It is important that scholars
interested in the interpersonal behavior of older adults consider that
individual differences do exist as we develop throughout the life span. In
one sense, these individual differences represent the multiple paths people
can take to achieve their multiple life goals. Related to this is the notion
that the aging process is not a simple process of decline. The positive as
well as negative effects of the aging process on language production,

relational satisfaction, and other communication-related phenomena should
be highlighted. The richness of the aging process is perhaps best demon
strated by the adaptive interpersonal behaviors of older adults as they
cope with the various pleasures and difficulties of life.
Cognition
Evidence gathered by cognitive psychologists suggests that a decline

in working memory capacity negatively influences the syntactic and
discourse-processing abilities of older adults, even though their semantic
knowledge remains intact (Kemper, 1992b; Light, 1990; Ryan, 1991). As
a result, older adults may have more difficulty than younger adults in
accomplishing communicative tasks that place extreme demands on working
memory resources, for example, processing and producing complex syn
tactic structures (Kemper et al„ 1989) and understanding poorly organ
ized messages (Light, Zelinski, & Moore, 1982). Kemper (1992a) has
shown that word-retrieval problems and working memory capacity inter
act to affect the types of sentence fragments produced by young-old
(60-74) and old-old (75-90) adults. Researchers stress, however, that
working memory capacity does not decline equally in all older adults and
that older adults often develop strategies that mitigate the effects of any
decline on interaction (Light, 1990; Ryan, 1991).
Beliefs and attitudes (cognitions) about the communicative compe
tence (Wiemann, 1977) of people of different ages can influence individu
als' linguistic and paralinguistic choices in conversation. Ryan, Kwong
See, Meneer, and Trovato (1992) have developed an important line of
research on these beliefs and attitudes. Their results reveal differing
expectations of performance for younger and older adults, expectations
that are shared across age groups. To a large extent, these expectations
conform to stereotypes of the elderly and young adult populations. Even
though both positive and negative stereotypes of elderly and young adults
have been identified (Crockett & Hummert, 1987; Hummert, 1990),
language beliefs and attitudes tend to reflect primarily negative stereo
types of the elderly and positive stereotypes of the young (Ryan et al.,
1992).
We believe that further study into the cognition of adults is essential
for a complete understanding of older adult interpersonal communication
behavior. The pragmatic effects of how working memory, beliefs, and
attitudes contribute to successful interaction for older adults need further
explication. Evidence does exist that the attitudes and beliefs held by
INTRODUCTION 5
younger participants in intergenerational interactions can lead to in

stances of inappropriate communication or miscommunication (Coupland
& Coupland, 1989; Ryan, Giles, Bartolucci, & Henwood, 1986).
Language
Although older adults are heterogeneous in their language skills, they

do report more problems with receptive and expressive skills than do
younger adults (Ryan et al., 1992; see also Ryan, Kwong See, Meneer,
and Trovato, Chapter 2, this volume). Younger adults may adapt to
presumed receptive and expressive deficits of older adults, producing a
speech style that has been variously termed "patronizing speech" (Ryan
et al., 1986) and "elderspeak" (Cohen & Faulkner, 1986). According to
Ryan et al. (1986), this speech style is distinguished from normal adult
speech by the presence of simplification strategies (e.g., slow speech, low
grammatical complexity), clarification strategies (e.g., careful articulation,
loud speech), and other content and paralinguistic adaptations to stereo
typical c o g n i t i v e and physical i m p a i r m e n t s a s s o c i a t e d with a g i n g .
Montepare, Steinberg, and Rosenberg (1992) have found not only that
young adults simultaneously produce patronizing speech when address
ing elderly adults within their families but also that the characteristics of
this speech style are readily apparent to naive judges and even sufficient
to indicate, in some instances, the identity of the target. At its most
extreme, patronizing speech becomes baby talk directed to older adults
(Caporael, 1981; Caporael & Culbertson, 1986).
We believe that the study of language as it is shared within interaction
produces a more complete understanding of the interpersonal communi
cation process. The potentially negative social implications of patronizing
speech directed toward the elderly have been discussed by Coupland,
Nussbaum, and Coupland (1991). In addition, Taylor (1992; see also Taylor,
Chapter 9, this volume) has shown how discourse centered on frailty may
serve to incorporate that characteristic into the identities of elderly indi
viduals, affecting their orientation toward illness and death.
Relationships
Our relationships with others are accomplished through a complex

communicative process that incorporates both individual cognition and
language. Although relationships are crucial throughout the life span,
family relationships, friendships, and caregiver relationships at times
function in quite unique ways as individuals age. Indeed, the importance
of these relationships in terms of mutual influence (control) and affiliation

underscores the social character of older adults' well-being (Wiemann,
Gravell, & Wiemann, 1990). Nussbaum (1983a, 1983b, 1985) found a
positive relationship between the quality and frequency of elders' rela
tional interactions and life satisfaction. Consistent with the social support
literature (e.g., Rook, 1990), Barbato and Perse (1992) found that the
communication motives of older adults center on pleasure and affection
or control and comfort, depending on their levels of health, social activity,
and mobility. These differing motives carry relational consequences for
the elders involved, consequences that may either enhance or reduce their
own and their partners' satisfaction with their lives and relationships.
Relationships and the language utilized within specific relationships
have been shown to have impacts upon the identity of those involved
within the relationships throughout the life span (Coupland & Nussbaum,
1993). Coupland and Coupland (1989) have argued that conceptions of
aging are socially constructed through discourse with others, so that
elders and their relational partners jointly create definitions of their own
identities and relationships. In a study of intergenerational communica
tion between women, these researchers and their colleagues have identi
fied a type of discourse produced primarily by elderly women that they
label "painful self-disclosure" (Coupland, Coupland, Giles, & Wiemann,
1988; Coupland, Coupland, Giles, Henwood, & Wiemann, 1988; see also
Giles, Fox, Harwood, & Williams, Chapter 7, this volume). As the name
suggests, this type of self-disclosure contains intimate information about
painful experiences of the discloser (e.g., current illness, death of a child)
and creates a potentially awkward situation for the recipient of the
disclosure. Yet a close analysis of such interactions reveals that young
and elderly participants collaborate in the production of these episodes,
and the researchers suggest that the episodes may accomplish positive, as
well as negative, identity and relational functions for the participants.
Likewise, Taylor (1992) has shown that discourse focusing on elderly
frailty, jointly accomplished by the participants, can both reflect and
influence power relationships between older adults and their relational
partners (see also Chapter 9, this volume).
The physician-patient relationship becomes increasingly important as
we age beyond 70. In fact, research has indicated that this relationship
carries serious implications for older adults' quality of life (Giles, Coupland,
& Wiemann, 1990). Issues such as patient desire for information (Beisecker,
1988), influence of a companion on the interaction between the doctor
and the elderly patient (Beisecker, 1989), and doctor behaviors indicating
INTRODUCTION 7
aging (Greene, Adelman, Charon, & Hoffman, 1986) have been examined.
Adelman, Greene, Charon, and Friedmann (1992) and Greene, Adelman,
Rizzo, and Friedmann (Chapter 11, this volume) have found that physicians
tend to control the content of interactions with older patients, focusing
primarily on medical issues. Despite conventional wisdom within medical
disciplines emphasizing interactive partnership within the physician-
patient relationship and stressing good listening behavior by the physician
as well as the need to investigate nonmedical issues with potential health
effects, this pattern of relational control by the physician remains perva
sive (e.g., Street & Wiemann, 1987).
We believe that a comprehensive study of the relational world of older
adults will produce a more complete understanding of both the process
and the experience of aging. The maintenance of this relational world is
dependent upon the ability of older adults to adapt their interpersonal
communication behaviors to the various changes that occur with advanc
ing age. The interpersonal competencies associated with this continual
adaptation process function to maintain significant relational networks
that contribute greatly to the ability of older adults to age successfully.
Methodologies for the Study of

Interpersonal Communication and Older Adulthood
As exemplified by the chapters in this book, we believe that a variety

of methodologies are not only appropriate but essential for the study of
interpersonal communication and older adulthood. Researchers who in
vestigate the interpersonal behavior of older adults must often be flexible
and inventive in the methodologies they use in the collection of their data.
As Schaie (1988) points out in his discussion of methodological issues in
aging research, each researcher must choose the appropriate methodology
and design for the research question of interest, rather than employ a
particular method or design simply because it has been used by other
researchers on aging (see Wiemann et al., 1990). There is one particular
methodological problem that needs to be addressed: Researchers studying
communication of, to, and with older adults need to pay more attention
to the evaluations that these older adults make of specific types of
messages and message strategies directed toward them and used by them.
Ideologically based ascriptions about the presumed negative (or positive,
for that matter) impacts of certain types of messages must give way to the
empirical exploration of self-reported evaluations.
In addition, it is important for researchers as well as readers to be open

to different data analysis techniques. The researchers whose work is repre
sented in this book have used techniques that range from the purely quanti
tative to the purely interpretive. The following chapters provide excellent
examples of the utilization of appropriate methodologies and techniques
for data analysis that fit the diverse research questions explored.
Theories of Aging and Interpersonal Communication
For many decades, scientists have speculated about why every living
organism ages. In recent years, social scientists have advanced numerous
disengagement-related theories and activity theories as explanations of
how human beings can age successfully. In their review of the status of
theory in the psychology of aging, Birren and Birren (1990) advance an
ecological theory of aging. That is, they see a need for a theory that treats
the aging human being not only as a set of genes but also as an individual
whose heredity is expressed in a particular physical and social environment.
Birren and Birren propose that only such an integrative theory can account
for the co-occurrence of increases, declines, and stabilization of individ
ual abilities (preferences, behaviors, and so on) with advancing age.
Likewise, Kenyon (1988) laments the diversity of theoretical perspec
tives on aging. In his view, this diversity has resulted in scholars' focusing
on individual variables such as cognition, life satisfaction, and memory,
without exerting comparable effort to integrate the findings from the
various perspectives. Kenyon argues that aging research must necessarily
be grounded in a view of human nature as personal existence. This meatls
that "human beings, as persons, are not conceptualized exclusively as
either individual entities or socially constructed entities. Rather, they are
self-creating, but within contexts that involve various kinds of biological
and social constraints. The unit of analysis here becomes the dialectical,
creating-created process itself' (p. 7).
This conception of human beings as engaged in a dialectical process of
negotiating the self within environmental constraints is consistent with
current theoretical views of interpersonal communication, including con
structivism (Delia, O'Keefe, & O'Keefe, 1982) and communication ac
commodation theory (Giles, Mulac, Bradac, & Johnson, 1987). In fact,
this dialectical process may be viewed as the essence of interpersonal
communication, that is, as interpersonal communication. Thus we believe
INTRODUCTION 9
not only that interpersonal communication research can provide the

integrative approach to the study of aging called for by Birren and Birren
(1990) and Kenyon (1988), but also that it is essential for a full under
standing of the aging process as it is enacted in individual experience. As
exemplified by the chapters in this book, interpersonal communication
research crosses disciplines and provides a unifying perspective on aging.
The Chapters
The chapters in this book address the interrelationships among cogni

tion, language, and relationships in the interpersonal world of older
adults. As we noted at the beginning of this chapter, the authors represent
the fields of communication, cognitive psychology, psycholinguistics,
sociolinguistics, and medical sociology.
In Chapter 2, Ryan, Kwong See, Meneer, and Trovato focus on the
nature of self-perceptions and age-based beliefs about the conversational
language competence of older and younger adults. The authors include a
report of a study assessing those self-perceptions and beliefs. In addition,
however, they show how those perceptions and beliefs may affect lan
guage performance of older adults, just as individual differences in ability
may affect that performance. A multidimensional model for understanding
language in later life clarifies the multiple influences on the language
performance of older adults.
Ryan et al. include the individual's information-processing strategies
as one of the multiple influences on language performance. In Chapter 3,
Gillian Cohen considers a particular type of information processing:
retrieval of proper names. Cohen examines how difficulty in retrieving
proper names may affect the communication of older adults. As she
shows, recalling names is a problem that many older adults report as
particularly troublesome in interpersonal interactions. Cohen reviews the
research that has attempted both to document and to understand the source
of this memory-related problem of normal aging.
As we have noted above, older adults vary greatly in their communica
tion abilities. Chapters 4,5, and 6 consider the interpersonal communication
performance of some special populations of older adults. In all three chap
ters, differences in individual abilities of older adults, either cognitive or
physical, are examined for their impacts on interpersonal communication. In
Chapter 4, Kemper and Lyons provide a thorough discussion of the effects
of Alzheimer's dementia on language and communication. They include

a review of the research on Alzheimer's dementia and language, focusing
particularly on semantic memory impairments and the preservation of gram
matical structures that accompany the disease. As Kemper and Lyons show,
these two aspects of the disease carry pragmatic implications for interper
sonal communication with those who have Alzheimer's dementia.
In Chapter 5, Villaume, Brown, and Darling consider how age-related
hearing loss (i.e., presbycusis) affects the communication of older adults
with moderate to severe hearing loss. The authors begin with a review of
the literature on presbycusis and communication and present presbycusis
as occurring along two dimensions: content and relational. They then
present conversational data from older adults that show how these indi
viduals cope with the inability to hear content and/or relational aspects
of interpersonal interactions.
Gold, Arbuckle, and Andres, in Chapter 6, examine verbosity in older
adults, a type of talk they define as prolonged irrelevant speech. As these
researchers make clear, only some older adults engage in verbose speech.
Gold et al. report on their efforts to document and measure verbosity in
older adults, as well as to understand its cognitive basis. As they demon
strate, verbosity carries implications for the social functioning of older
adults in interpersonal situations.
Whereas Chapters 4 through 6 focus on individual differences in the
abilities of older adults as they affect interpersonal communication,
Chapters 7 and 8 characterize the social psychological processes that
affect communication choices of older adults and their coconversants. In
Chapter 7, Giles, Fox, Harwood, and Williams provide an overview of a
program of research centered on sociolinguistic aspects of intergenera
tional talk. The authors show how both younger and older adults collaborate
in creating intergenerational communication patterns. In their epilogue,
they present a persuasive argument for approaching intergenerational
communication from both developmental and intercultural perspectives,
showing how cultural influences affect interpersonal interactions be
tween younger and older individuals.
As discussed by Giles et al. in Chapter 7 and Ryan et al. in Chapter 2,
stereotypes are often implicated in discussions of the nature of commu
nication by and with older adults. In Chapter 8, Hummert reviews the
literature on stereotypes of the elderly and presents a model illustrating
the role of stereotypes of the elderly in interaction, in particular in the
production of patronizing speech toward the elderly. As Hummert points
INTRODUCTION 11
out in her review of the stereotype research, both positive and negative
stereotypes are included in our conceptions of older adults. The model
that Hummert presents addresses the implications of both types of stereo
types for interpersonal communication.
In Chapter 9, Taylor moves the reader from a consideration of the social
psychological aspects of interpersonal communication to the ways in
which that communication serves to create the older adult's subjective
experience of aging. Taylor focuses on the interrelationship between
interpersonal communication and the enactment of frailty. He shows how
interpretivist and critical perspectives can be used to enhance our under
standing of that interrelationship.
The final two chapters examine two types of interpersonal relationships
central to the lives of older adults: friendship and the relationship between
physician and patient. In Chapter 10, Nussbaum reviews the literature
concerning friendship in older adulthood across the social sciences. Until
very recently, the subject of friendship in later life was virtually ignored.
Nussbaum presents data that indicate the complexity of friendship for
older adults and proposes a future research agenda that addresses the
negotiation of friendship as we age.
Greene, Adelman, Rizzo, and Friedmann, in Chapter 11, take a close
look at the elderly patient's presentation of self in the initial meeting with
a physician. As Greene et al. show, patients try to create personal images
of themselves when they meet physicians. The physicians' responses may
either confirm or disconfirm those images. The chapter includes an
analysis of patients' presentations of self from recorded office visits and
discussion of the impact of physician responses on patient identity in
those visits.
Summary
Our purpose in organizing and editing this book is to bring together the
best researchers interested in interpersonal communication in older adult
hood and provide them with a forum from which they can add to our
understanding of the aging process. The strength of this book rests within
the multidisciplinary, multitheoretical, and multimethodological ap
proaches exemplified in its chapters. We feel that this diversity is the key
to a better understanding of interpersonal communication across the life
span.
References
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Manchester University Press.
1
Age-Based Perceptions of
Conversational Skills Among
Younger and Older Adults
ELLEN B O U C H A R D RYAN
SHEREE ΚWONG SEE
W. B R Y A N M E N E E R
DIANE TROVATO
Difficulties encountered in intergenerational conversations may fre-

quently be attributed to competence decline in older individuals—by a
variety of interlocutors, from physicians and bank tellers to students
and family members. We begin this chapter with the presentation of a
model highlighting the multitude of alternative explanations for such
conversational problems. Stereotyped expectations about changes in
language performance across adulthood play an important role in this
model, hence the heart of the chapter is a study of self-perceptions and
beliefs about age-related changes in conversational language perform-
ance. Although our discussion will be confined to these topics, we will
A U T H O R S ' NOTE: This chapter is based on an earlier article by the same authors,
"Age-Based Perceptions of Language Performance A m o n g Younger and Older A d u l t s , "
which appeared in the August 1992 issue of Communication Research. Preparation of this
chapter was partially supported by a grant f r o m the Social Sciences and Humanities
Research Council of Canada. The cooperation of the Ontario Science Centre and the
assistance of Maryanne Mac Lean are gratefully acknowledged. Reprints may be requested
f r o m Ε. B. Ryan, Department of Psychiatry and O f f i c e of Gerontological Studies,
M c M a s t e r University, Hamilton, Ontario, Canada L8N 3Z5.
15
16 Interpersonal CommunicationandOlder Adulthood
introduce a multidimensional model for understanding language in later

life that offers a potentially useful framework for integrating subsequent
chapters of this volume.
Beliefs About Age-Based Changes in Competence
Multiple Influences on Language Performance
Although linguistic knowledge appears to remain stable among healthy

individuals in later life, age-related sensory and cognitive changes can
limit linguistic performance (see Kemper, 1992; Light, 1990; Ryan,
1991). For instance, although there are no age differences across the adult
age range (from the 20s to the 70s) in performing sentence disam
biguation, utilization of complex grammatical structures has been shown
to be reduced among older adults (see Bayles & Kaszniak, 1987). Kemper
and her colleagues, for example, have shown that older adults have more
difficulty in comprehending, imitating, and producing complex syntactic
structures, such as sentences with left-branching clauses (see, e.g., Kemper,
1992). Typically, studies showing age-group differences in linguistic
performance have involved language tasks placing high demands on
sensory processing and memory.
Much research has focused on elucidating the relative impacts of
factors such as hearing, speed, memory, and inhibitory mechanisms of
attention on older adults'discourse-processing skills (Fozard, 1990; Hasher
& Zacks, 1988; Light, 1990; Stine, Wingfield, & Poon, 1986). These
information-processing factors have been implicated as important determi
nants of receptive and expressive communication, at least under laboratory
conditions. Furthermore, Burke and Laver (1990) stress the value of separat
ing receptive and expressive language skills as they involve different
combinations of information-processing skills and differing access to
one's knowledge base. Nevertheless, these studies have also served to
point out the heterogeneity among older adults in language performance.
Although language performance depends to a large extent on individual
differences in information-processing abilities, communicative success is
also influenced by the interpersonal and environmental situations in
which communication occurs. Ryan, Giles, Bartolucci, and Henwood
(1986) have argued that the social context of language has been largely
ignored in psycholinguistic and clinical studies of age-related changes in
language (see also Coupland, Coupland, & Giles, 1991).
PERCEPTIONS OF CONVERSATIONAL SKILLS 17
INDIVIDUAL ABILITY
Knowledge
Information Processing
Strategics
Figure 2.1. Multiple Influences on Language Performance in Later Life

SOURCE: Ryan, Kwong See, Meneer, and Trovato (1992, p. 425). Adapted from Ε. B. Ryan, "Lan-
guage Issues in Normal Aging," in R. Lubinski (Ed.), Dementia and Communication. 1991. Toronto:
B. C. Decker. Copyright © Mosby—Year Book, Inc. Used by permission.
The multiple factors contributing to variability in conversational skill

during later life are incorporated into the framework presented in Figure
2.1. Within this framework, conversational skill is seen as a function of
individual differences in acquired knowledge, information-processing
abilities, and social and cognitive strategies, as well as variations in the
immediate situation. These factors in turn are seen to interact with the
individual's life history and current environmental experiences.
Conversation-relevant differences in knowledge are the accumulation
of influences such as language aptitude, educational background, and
whether the individual is a native speaker or second-language user (see
Hultsch & Dixon, 1984; Kemper, 1992). Key information-processing fac-
tors identified from the cognitive aging literature relate to age-associated
changes in sensory abilities, most notably reduced hearing, speed of
processing, working memory capacity, and inhibitory mechanisms that
underlie attention (see Fozard, 1990; Hasher & Zacks, 1988; Light, 1990;
Stine et al., 1986).
The advantage of this model is that it highlights the potential influences

of determinants beyond knowledge and information processing that can
constrain understanding of poor conversational performance on the part
of an older person. Off-target verbosity, for instance, has been linked with
the failure of some older adults to inhibit objectively irrelevant internal
thoughts adequately (Arbuckle & Gold, 1993; see also Gold, Arbuckle,
& Andres, Chapter 6, this volume). In conjunction with cognitive factors,
however, older persons may entertain intentions different from those
anticipated by an interviewer (e.g., communication for diversion versus
display of cognitive expertise). Moreover, the communication styles
employed by some older individuals may reflect strategies used to com
pensate for declines in hearing and memory or to cope with conversational
partners who are condescending or poor listeners.
The immediate language situation consists of the interaction between
two forces: task demands and interpersonal factors. Task demands include
not only the physical conditions surrounding the communication task
(e.g., trying to follow a conversation at a noisy social gathering or
speaking on the telephone without supporting nonverbal cues) but also
the nature of the task itself (e.g., a clinical assessment or asking for
directions while traveling). Tasks vary in the modes of responding re
quired and employ differing criteria for communicative success as well
as differing levels of emotional involvement. Correspondingly, each task
involves an interpersonal exchange. Key are the expectations and atti
tudes communicators bring to the interpersonal situation. Beliefs and
attitudes not only influence communication behavior but also affect the
evaluation of the exchange.
Although depicted in Figure 2.1 as separate contributors to language
performance, individual abilities and factors associated with the immedi
ate situation are not independent. For instance, individual abilities such
as memory are likely to be utilized to differing degrees, depending on
subjective evaluations of task relevance (Botwinick, 1984). Moreover,
components within each factor are not mutually exclusive. Expectations
are likely to influence communication behavior, which in turn may
increase or decrease emotional involvement. Heightened levels of emo
tional arousal may serve to magnify task difficulty.
Finally, the language-relevant individual differences and the immedi
ate situations in which persons find themselves are influenced by individ
ual life histories and the sociocultural e n v i r o n m e n t s within w h i c h
individuals have lived. Life history and the social environment jointly
affect each other in contributing to language performance in later life.
PERCEPTIONS OF C O N V E R S A T I O N A L SKILLS 19
For our present purposes, we would like to emphasize the role of the
expectations and attitudes that communicators bring to the interpersonal
language situation. Beliefs and attitudes can significantly influence com
munication behavior and also contribute to participants' evaluations of
exchanges (Giles & Coupland, 1991). To the extent that younger and older
adults themselves anticipate difficulties in everyday language perform
ance in later life, these expectations are likely to guide both behaviors and
their interpretations. Heightened levels of emotional arousal in response
to perceived low expectations may serve to magnify task difficulty and to
reduce effort.
Negative expectations about language performance in old age can pose
barriers to successful language performance. For example, expectations
that older individuals cannot communicate adequately or have poor m e m
ory may lead interlocutors to misinterpret effective communications by
older persons or to use patronizing behaviors such as oversimplified
speech or baby talk (Caporael, 1981; R o d i n & L a n g e r , 1980; Ryan & Cole,
1990; Ryan & Laurie, 1990). In laboratory evaluations or clinical assess
ments, older adults' self-appraisals in light of others' negative expecta
tions of language performance can lead to underachievement. Meeting
challenges with appropriate, effortful strategies depends on a strong sense
of one's capabilities (Hultsch, Hertzog, Dixon, & Davidson, 1988; Rodin
& Langer, 1980). Consequently, the focus of the present chapter is to
examine self-ratings and expectations about language performance in
later life.
Positive expectations about the language performance of older indi
viduals can encourage and enhance the richness of communication ex
change. Three examples are addressed in this research. First, the size of
vocabulary is a characteristic of older adults that continues to grow into
old age (Salthouse, 1988). Second, the storytelling of older persons has
been judged to be better than that of younger adults in two studies
(Kemper, Rash, Kynette, & Norman, 1990; Pratt & Robins, 1991). Third,
older adults are typically viewed more positively than younger adults on
sociability traits such as friendliness, warmth, and sincerity (Louis Harris
& Associates, 1975).
Perceptions of Later-Life Competence
Implicit theories of life-span development have become the focus of

research because of their implications for the understanding of societal
age biases, construction of personal histories, self-perceptions, and the
relation between self-efficacy and performance (Cavanaugh & Green, 1990;
Ross, 1989). Repeated-measures paradigms have revealed adults' implicit

theories of old-age declines in memory, generativity, dealing with nov
elty, health, and speed as well as old-age increases in wisdom, experience,
knowledge, verbal intelligence, and everyday competence (Berg & Sternberg,
1992; Heckhausen, Dixon, & Baltes, 1989; Ross, 1989; Ryff, 1984).
Evaluations and beliefs about old age and older persons have been
studied extensively by social psychologists and social gerontologists.
Even though procedures and findings across investigations have been
highly variable (Kogan, 1979; McTavish, 1982), a number of studies
report evaluations of older adults as less competent than young adults in
competence-stressing situations (e.g., Kite & Johnson, 1988; Rodin &
Langer, 1980; Ryan & Laurie, 1990). As Hummert discusses fully in
Chapter 8 of this volume, the likelihood of the presence of a negative
attitude depends on whether the situation elicits a negative or positive
prototype of aging.
Perceptions of competence have been examined within various cogni
tive domains. In the first such study, young adults exhibited lower expec
tations for elders than for young and middle-aged adults on their ability
to perform cognitive tasks such as discussion of moral issues, map
following, and puzzle solutions (Rubin & Brown, 1975). As the target age
comparisons were elicited in a within-subjects paradigm, it is important
that subsequent studies have found that similar social perceptions of older
adults' competence can be shown with the more conservative between-
subjects paradigm (Kite & Johnson, 1988).
Hendrick and colleagues asked undergraduates to estimate the perform
ance of one of four target age groups on an intelligence test (Hendrick,
Gekoski, & Knox, 1991; Hendrick, Knox, & Gekoski, 1986). On all five
subscales of the test, respondents anticipated poorer performance for
older women targets (ages 64 and 84 years) than for younger women
targets (ages 24 and 44 years). Using a different intelligence test and only
two target ages (21 and 71 years of age), Hendrick, Knox, Gekoski, and
Dyne (1988) also found estimates in favor of younger targets on subtests
related to memory and psychomotor speed. Highlighting the multifaceted
nature of perceptions of later life, however, old targets were rated more
favorably than the young on a subtest that assessed practical judgment
and acquired knowledge.
In the domain of memory, several studies have found that memory is
expected to be poorer for older adults than for the young (e.g., Erber,
Szuchman, & Rothberg, 1990). In order to address specific social percep
tions of memory problems for young and old adults, Ryan (1992; Ryan &
Kwong See, 1993) has adapted well-known self-report questionnaires

about memory. In the first study, adults (Μ = 36 years) completed the
Short Inventory of Memory Experiences (Herrmann & Neisser, 1978) in
eight domains of everyday life for themselves in the usual manner first
and then completed it with reference to typical adults of particular target
ages. In a repeated-measures design, respondents reported significantly
more positive expectations for the memory experiences of persons aged
25 years than for those aged 70 years. A second experiment reported by
Ryan (1992) used a between-subjects design to determine whether the
target age differences would be sustained. Moreover, the anticipated slope
of decline across the adult life span was examined with four target ages
( 2 5 , 4 5 , 6 5 , and 85 years). Beliefs about the memory of 25-year-olds were
significantly more positive than those for 45- and 65-year-olds, which
were correspondingly higher than for 85-year-olds. With an adapted form
of the Dixon and Hultsch (1983) Metamemory in Adulthood scale, Ryan
and Kwong See (1993) elicited similar views regarding age decline for
two self-efficacy scales. In this study, the anticipated differences between
target ages 45 and 65 were observed. Moreover, this study demonstrated
that respondents' expectations for memory decline displayed for typical
adults also applied to their views of themselves in the future.
In summary, the influence of target age on social perceptions depends
on the particular cognitive domain or subdomain being assessed. For
example, the greatest negative impact of age on competence perceptions
was seen on tasks requiring memory, inductive reasoning, and processing
speed. A task focused upon common sense elicited a positive age bias.
Expectations that communicators bring to intergenerational and intragen-
erational language exchanges, therefore, are likely to be highly diverse.
It is anticipated that most would be performance limiting (e.g., poor
hearing), although some are likely to be performance enhancing (e.g.,
enjoyable storytelling).
Perceptions of Age-Based
Differences in Conversational Skills
Purpose of the Study

The present study was designed to develop a self-report instrument for
language and to apply the methodology developed in recent studies of
age-based social perceptions of intelligence and memory to the domain
of language performance. Based on aging research, a Language in Adult-
hood questionnaire (LIA) was developed concerning receptive and ex

pressive language skills that are important for conversation (see Ryan,
1991). The same questionnaire was also used to elicit beliefs about the
skills of younger and older adults.
A preliminary exploration by de Bot and Lintsen (1989) had tentatively
identified changes in self-perceptions of language among elders of differ
ent ages. Watson and Williams (1988) obtained more detailed information
about self-perceptions by administering the Inventory of Communication
Attitudes to adults ranging in age from 20 to 79 years. Participants rated
their enjoyment and skill in 13 different types of speaking situations
(including conversation with family and friends, with strangers, and with
authority figures), their beliefs about the relative enjoyment and skills of
others in these situations, and the frequency with which they currently
encounter each situation. A number of the situations (e.g., group conversa
tion, argument with a stranger, conversation with a friend/family member)
were rated as less frequent in the lives of those in their 60s and 70s. The
anticipated pattern of more negative self-ratings for older participants did not
occur, but the combination of enjoyment and skill ratings in the analyses
precluded a clear interpretation of the findings. As the second version of the
questionnaire focused on others in general, these data were not relevant
to the question of age-based beliefs about conversational skills.
Two other studies have provided some intriguing information about
social perceptions of talk by older people. Shadden (1988) interviewed
small numbers of older adults, adult children of elders, and professionals
working with elders about their views of the communication skills of
older people. Although there was little clear consensus in response to
open-ended interview probes, the most frequently mentioned issues were
as follows: (a) Older people don't work to find a common topic of
conversation, (b) they talk about the past, (c) they ramble, (d) they crave
information, and (e) they have problems attending to the right informa
tion. Relevant to the findings presented in this volume by Hummert
(Chapter 8) and Giles, Fox, Harwood, and Williams (Chapter 7), there
was greater consensus about the modifications younger people make in
communicating to elders. In the second study, Giles, Coupland, and
Wiemann (1992) compared the beliefs of young and old adults about the
functions of talk. Their factor-analytic study revealed that older adults
believed other older persons to experience more communication prob
lems than they did themselves and placed greater positive value than
younger counterparts on the recreational value of talk for itself rather than
only as a means to an end.
P E R C E P T I O N S OF C O N V E R S A T I O N A L S K I L L S 23
In order to measure the language-relevant self-perceptions and social

expectations that individuals bring to intergenerational and intragenera
tional communication, we selected two age groups, young adults (18-40
years) and older adults (61-88 years), and asked the respondents to rate
their own language performance as well as their social perceptions of
typical adults aged either 25 or 75 years. Although most items were
anticipated to be associated with age-related decline, three pro-aged items
were included for which the evidence would suggest maintenance or
relative improvements in later life (i.e., recognition of vocabulary, sincer
ity in conversation, and enjoyable storytelling).
We made the following predictions about ratings of estimated language
performance:
1. Self-perceptions of both receptive and expressive language performance

were expected to be more favorable for the young adults than for the older
adults, except for the pro-aged selected items.
2. Social perceptions of both receptive and expressive language performance
for typical persons aged 25 were anticipated to be more favorable than for
typical persons aged 75 years, except for the three pro-aged items, for both
young and old adult respondents.
3. Because people can compensate for hearing and memory problems in
conversation, differences in self-perceptions between younger and older
respondents were predicted to be less for conversational skills than for
memory or hearing.
4. Both respondent groups were expected to differentiate less between the
conversational skills of typical persons age 25 years versus 75 years than
between their memory or hearing.
Method
Adult volunteers in two age groups were recruited: 60 young adults (mean
age = 26 years, ranging from 18 to 40 years) and 60 older adults (mean age
= 73 years, ranging from 61 to 88 years). The young adults were visitors at
a metropolitan science center; the older adults were recruited through per
sonal contacts. Both groups were well educated, with a mean level of
education for the younger group of 13.9 years and for the older group of
12.0 years.
The Language in Adulthood questionnaire was developed for this study
to measure self-perceptions of conversational language performance as a
parallel to the self-report questionnaires for memory (e.g., Short Inven
tory of Memory Experiences, Herrmann & Neisser, 1978; Metamemory
in Adulthood, Dixon & Hultsch, 1983). The LIA consists of 20 items: 10

pertain to receptive language skills (e.g., losing track of the topic in
conversation), 9 pertain to expressive language skills (e.g., using fewer
difficult words when talking), and 1 reflects overall conversation skill.
The format of the LIA involves the presentation of a series of statements
about the individual's language skills (e.g., "I often lose track of who said
what in a group conversation"). Respondents were directed to indicate degree
of agreement using a 7-point Likert-type scale, ranging from 1 for strong
disagreement to 7 for strong agreement. Most of the items were negatively
worded. McTavish (1982) has noted that the use of negatively scaled
items appears to have greater reliability with older respondents on attitude
scales. Three items (recognizing the meaning of more words, sincerity in
conversation, and telling enjoyable stories) were positively worded. Scores
on the positively worded items were transformed so that high scores always
indicated problems with language. The few responses that were omitted
were scored as 4, neither agree nor disagree. This presentation format
was adapted for assessing social perceptions. In this case, the statements
were reworded from the perspective of typical 25- or 75-year-olds.
The response booklet completed by participants therefore consisted of
two main parts: the LIA with statements worded from the perspective of
the self, and the LIA in which statements were worded from the perspec
tive of either typical 25-year-olds or typical 75-year-olds. Participants
first completing the questionnaire with respect to their own language
performance provided a concrete basis upon which to generalize to the
typical target adults. This presentation format also allowed for direct
comparison of the findings for self-perceptions and aged-based social
perceptions based on the same instrument. In both the self-rating and
target-rating sections, the response booklet also contained single items
assessing views of the difficulty of intergenerational communication
(talking with older people, talking with young people) and overall beliefs
about hearing and memory.
Participants were asked to complete the response booklets individually
and at their own pace. Time for completion varied, usually taking between
15 and 30 minutes.
Results
Intratest reliabilities of the three versions of the Language in Adulthood

questionnaire (self, typical 25-year-olds, and typical 75-year-olds) were
high. Moreover, the intratest reliabilities for the Receptive subscale were also
high. However, because the reliabilities of the Expressive subscale were

only moderate, we did not compute mean scores for the two subscales.
Multivariate analyses of variance, with Respondent Age Group as the
between factor, were conducted separately for self-perceptions on the
Receptive and Expressive items of the LIA. In addition, multivariate
analyses of variance, with Respondent and Target Ages as between fac
tors, were conducted separately for social perceptions on Receptive and
Expressive items.
Receptive Skills
For Receptive self-perceptions, the respondent age group comparison

yielded a significant multivariate effect, reflecting age differences in
self-perceptions for six of the ten items (see Table 2.1). As predicted,
younger respondents reported fewer problems than did older respondents
with hearing (others speaking too softly and frustration with not hearing),
with speed (others talk too fast), and with memory (keeping track of topic,
difficulty with long sentences). Contrary to prediction, younger respon
dents also reported more confidence in their increasing recognition of
vocabulary than did older respondents. This last perception may derive
f r o m the link of this item with learning, which is more associated gener
ally with youth than with later life. Rewording this item to focus simply
on size of recognition vocabulary, rather than its rate of increase, may
make this item more favorable to older adults.
For social perceptions regarding Receptive skills (see Table 2.2), the
only significant effect was for Target Age. All but one of the items in the
Receptive subscale showed reliably more positive perceptions of typical
young adults compared with typical older targets. Like the self-percep
tions, the social perceptions also reflected a more positive view for the
young adults regarding recognizing more and more words despite expec
tations to the contrary.
Expressive Skills
The significant multivariate effect for self-perceptions on the Expres

sive scale reflected respondent age differences for five of the nine items
(see Table 2.3). As predicted, younger participants reported fewer prob
lems with memory-related aspects of conversation (keeping track of their
topic, words on the tip of the tongue, diversity of vocabulary, and recalling
facts) than did older participants. Contrary to prediction, the young adults
Table 2.1 Mean Self-Perceptions of Receptive Language

Performance of Younger and Older Adult Respondents
Respondent Age Group

Younger Older
Items (N = 60) (N = 60)
People speak too softly 3.73 4.45*

Hard to understand when noisy 5.58 5.42
Frustrated when do not hear 2.68 3.73**
Lose track of who said what 3.13 3.63
People use long sentences 2.55 3.47**
People speak too fast 3.02 3.92**
Ask for repetition 3.68 4.23
More to blame when not understand 3.70 3.98
Lose track of topic 2.63 3.35**
Recognize more words 2.43 3.22***
*p < 0.05; **p < 0.01 ;***/) < 0.001.
were more likely to report talking most in a conversation than were their
older counterparts. Although this item was included because of concerns
about verbosity in later life (Gold, Andres, Arbuckle, & Schwartzman,
1988), it could also be interpreted in terms of self-confidence and conver
sational dominance, which would favor young people (see Dowd, 1981).
The two expressive items predicted to elicit more positive self-perceptions
for the older respondents failed to yield a significant difference between
respondent groups. Thus Prediction 1, of age group differences in self-
perceptions of receptive and expressive language performance, was es
sentially supported.
For Expressive social perceptions (Table 2.4), the Target Age effect was
modified by an interaction between Target Age and Respondent Age.
Seven of the nine expressive items elicited a reliable difference in per
ceptions of the two target groups. All of these differences were in favor
of the young target adults, except for the two expressive items included
to elicit a positive belief about language in aging. Stories told by typical
adults aged 75 were expected to be more interesting than those told by
young adults, and sincerity in conversation was more closely associated
with the older adults than with their younger counterparts.
The multivariate interaction effect was caused by significant univariate
interactions for two Expressive items. The item "hard to speak if pressed
P E R C E P T I O N S OF C O N V E R S A T I O N A L SKILLS 27
Table 2.2 Mean Social Perceptions of Younger and Older Adult

Respondents for Receptive Language Performance of Two
Target Age Groups

Younger Older Target
Target Age Target Age Age
25 75 25 75 Effect
Items (N = 31) (N = 29) (N = 32) (N = 28)
People speak too softly 3.26 5.66 3.78 4.75 ***
Hard to understand when noisy 4.48 6.17 4.09 5.68 ***
Frustrated when do not hear 3.06 5.41 3.22 5.14 ***
Lose track of who said what 3.13 4.72 3.22 4.43 ***
People use long sentences 3.26 4.21 3.41 3.75 *
People speak too fast 3.16 4.90 3.09 4.50 ***
Ask for repetition 3.06 5.24 3.16 4.93 ***
More to blame when not understand 3.65 4.28 3.38 3.61

Lose track of topic 3.13 4.28 2.81 3.86 ***
Recognize more words 2.45 3.93 2.88 3.86
NOTE: Asterisks indicate level of significance of the Target Age main effect.
*p< 0.05; ***p< 0.001.
for time" elicited a more positive response for the young targets than for
the older targets from young respondents, but not from older respondents.
On the other hand, only older respondents perceived more difficulty with
the tip-of-the-tongue phenomenon for typical elders. Thus one of the inter
actions showed more sensitivity to target age for the younger respondents
and the other indicated more sensitivity among the older group.
Overall, the two respondent groups basically agreed on their expecta
tions about age group differences. Generally, then, Prediction 2, about
target age differences in social perceptions of language performance, was
supported.
Intergenerational Comparisons
In an exploratory addition to the main study, we performed an analysis

of variance on the two self-rating items on avoidance of talk with different
age groups, with Respondent Age as a between factor and Avoidance of
Talk With Young or Old as a repeated factor (see Figure 2.2). The main
Table 2.3 Mean Self-Perceptions of Expressive Language

Performance of Younger and Older Adult Respondents

Younger Older
Items (N = 60) f Ν = 60)
Hard to speak if pressed for time 4.12 4.32

Talk most 4.18 3.25**
Enjoyable storytelling 4.00 4.27
.Sincere when talking 2.13 2.43
Prefer to talk with people own age 3.95 4.33
Lose track of topic 2.92 3.87**
Tip of tongue 4.40 4.92*
Trouble with facts in story 2.97 3.57*
Use fewer difficult words 3.22 4.10**
*p< 0.05; **p< 0 01.
and interaction effects indicated that older respondents rated themselves

as having less difficulty talking with older people than with younger
people. For the social perceptions, Respondent and Target Age were
between factors and Avoidance of Talk With Young Versus Old was a
repeated factor (see Figure 2.3). The stronger intergenerational pattern
for social perceptions revealed a crossover interaction in which each
target age group is expected to exhibit greater avoidance of conversations
with the other age group.
Domain Comparisons
To determine how conversation skills compare with those for memory

and hearing, we performed a two-factor mixed analysis of variance on the
self-perception items for these domains (Respondent Age x Domain) (see
Figure 2.4). Two main effects were observed: Older respondents rated
themselves more poorly than did young respondents across domains, and the
conversation domain was rated more highly than the other two domains for
both respondent groups. The interaction between respondent age group and
domain (Prediction 3) was not observed for self-perceptions.
We conducted a mixed univariate analysis of variance on the social
perceptions across the three domains: Respondent Age x Target A g e x
Table 2.4 Mean Social Perceptions of Younger and Older Adult

Respondents for Expressive Language Performance of
Two Target Age Groups

Younger Older Target
Target Age Target Age Age
25 75 25 75 Effect
Items (N = 31) (N = 29) (N = 32) (N = 28)
Hard to speak if pressed for time 3.65 5.28 4.12 4.61 ***
Talk most 4.39 4.24 4.28 4.04

Enjoyable stories 3.55 3.28 3.69 2.75 *
Sincere when talking 3.10 2.14 3.25 2.43 ***
Prefer to talk with people own age 5.03 4.52 5.09 5.07
Lose track of topic 3.35 4.45 2.94 4.25 ***
Tip of tongue 4.13 4.31 3.16 4.86 ***
Trouble with facts in story 3.32 ***

4.14 3.16 4.39
Use f e w e r difficult words 2.87 4.24 3.03 3.89 ***
NOTE: Asterisks indicate level of significance of the Target Age main effect.
* p < 0.05; ***p< 0.001.
Domain (see Figure 2.5). Typical 75-year-olds were expected to have

more problems than their 25-year-old counterparts across all domains.
Also, conversation was viewed to be less problematic than the other two
domains. Follow-up of the Target Age χ Domain interaction indicated that
the domains did not differ among themselves at target age 25 but did at
target age 75. Moreover, as predicted, this interaction indicated less
differentiation between target ages for conversation than for the other
t w o domains. As anticipated f r o m the receptive and expressive analy-
ses, respondents did differentiate between the two target ages for each
domain.
Discussion
Individual differences based on life history and diversity in experienc-

ing the sociocultural environment result in variability among older adults
in their performance. Within the framework presented in Figure 2.1,
language performance is seen as a function of these individual difference
factors as well as variations in the immediate communication situation.
The present findings illuminate the types of expectations shaping older
Conv. Skills Memory Hearing
Figure 2.2. Self-Perceptions of Younger and Older Adult Respondents of

Overall Conversational Skills, Memory, and Hearing
persons' interactions with their environments, influencing their motiva

tion and effort in given situations, and guiding the intergenerational
behavior of young adults communicating with them.
Self-Perceptions of Conversational Use of Language
As anticipated, the younger adults perceived their language perform

ance more positively than did the older adults on most of the Receptive
and Expressive subscale items. The differential self-reports in favor of
the younger respondent group confirm that older respondents are aware
of subtle changes in language with age. These less favorable self-perceptions
generally correspond to the actual changes in information processing iden
tified in the cognitive and perceptual literature (Bayles & Kaszniak, 1987;
Light & Burke, 1988; Olsho, Harkins, & Lenhardt, 1985).
Within the model presented, individuals' poorer self-perceptions of
their own language performance are viewed as influencing the individu
als' current behavior and future language performance. That is, awareness
of one's limited memory, hearing, and/or ability to process information
Figure 2.3. Social Perceptions of Overall Conversational Skills, Memory, and

Hearing of Two Target Age Groups
quickly can lead to selection of different cognitive and social strategies,

to altered levels of motivation and anxiety, to avoidance of challenging
situations, and to lowered expectations for subsequent performance (Rodin
& Langer, 1980; Ryan et al., 1986).
Good internal reliability was demonstrated for the Language in Adult
hood questionnaire as a whole and for the Receptive subscale. T h e lower
reliability of the Expressive subscale reflects the greater variation in the
content of the items. Further refinement of this subscale is needed, and
the findings for the Expressive subscale must be interpreted in light of the
relatively weak reliability observed. Nevertheless, the significant multi
variate difference between age groups in self-perceptions supports the
validity of the Expressive component of the questionnaire.
Self-report questionnaires of memory in later life have been used
frequently in research about normal aging as well as for clinical research
(e.g., Dixon & Hultsch, 1983; Gilewski & Zelinski, 1986). Questionnaires
for language and communication have been developed for clinical popu
lations (e.g., Bayles & Tomoeda, 1991; Holland, 1980). The Language in
Adulthood questionnaire used in this study begins to fill the gap in terms
Figure 2.4. Self-Perceptions of Avoidance of Talk With Young and Old People
of a self-report instrument about language and communication in every

day situations for healthy older people.
Self-perceptions of overall conversation, compared with memory and
hearing, affirmed the generality of self-perceived differences in all three
domains. Future research will be needed to address age differences in
perceptions among the elderly. In addition to overall conversational skill,
it will be of interest to explore differences among elders' self-perceptions
about change in expressive and receptive communication (including
reading and writing). As a first step in this direction, community-dwelling
seniors participating in the Canadian Study of Health and Aging, a
nationwide epidemiological study of the prevalence of dementia, were
surveyed about their English-language skills. 1 The sample consisted of
444 randomly selected seniors ranging in age from 65 to 90 years.
Participants rated their current skills in speaking, listening, reading, and
writing in comparison with those skills 10 years ago. Significant, though
modest, correlations between participant age and self-ratings of decline
were found for listening, reading, and writing in English. The parallel
correlation for speaking was not significant. These preliminary results
extend the findings revealed with the Language in Adulthood question
I Target Age 25
Talk With Young People Talk With Old People 0 Target Age 75
Figure 2.5. Social Perceptions of Avoidance of Talk With Young and Old People
naire to include evidence of awareness of some changes in three of four

communication modalities during three decades in later life. The more
detailed items incorporated in the LIA would be useful in determining
whether the lack of overall correlation between speaking and age within
later life would be true for all items or whether there may be some
trade-offs among declines and gains in expressive conversational skills.
Social Perceptions of Conversational Use of Language
Based on perceptions of older target persons in other cognitive do

mains, we made several predictions about ratings of estimated language
performance. Social perceptions of typical persons aged 25 were antici
pated to be more favorable than for typical persons aged 75 years.
Furthermore, the proportion of variance accounted for by age was sub
stantially higher for social perceptions than for the two age groups'
self-perceptions. For most of the Receptive and Expressive items, typical
older adults were perceived as experiencing more language difficulty than
typical young adults. Despite the prediction, it is reasonable to find that
expectations for receptive vocabulary fit within the general overall paradigm
of declining memory, because the literature regarding vocabulary growth

is complex and the findings are different for expressive versus receptive
vocabulary (Salthouse, 1988). The predicted exceptions for positive so
cial perceptions of elders' storytelling ability and sincerity in conversa
tion highlight the potential complexity of age-based expectations.
Moreover, the differences between social perceptions of typical 25- and
75-year-olds were generally the same for both respondent groups. The
multivariate interaction for the Expressive items reflected opposing ten
dencies by the two respondent age groups on the two items with signifi
cant univariate interactions. On the one hand, the older participants might
have been expected to be more sensitive to decline (see Ryan, 1992). This
was indeed the case for the tip-of-the-tongue phenomenon, known to be
troublesome for older adults (Burke, Mac Kay, Worthley, & Wade, 1991).
On the other hand, older respondents might have been expected to be more
aware of the variable patterns of aging and less focused on decline (Crockett
& Hummert, 1987; Jackson & Sullivan, 1988). This pattern occurred with
regard to younger respondents' greater anticipation of elder difficulty with
time pressure in speaking. Overall, older and younger respondents distin
guished to the same degree between 25- and 75-year-old target persons,
a conclusion that adds to the generality of the main analyses.
The two respondent groups also agreed on the comparative extent of
target age differences in conversation, memory, and hearing. Relative to
young adulthood, social perceptions of conversational problems in later life
were significantly less than those for memory and hearing. These social
perceptions reflect the literature indicating that some losses of hearing
and memory can be sustained without extensive impact upon everyday
conversational uses of language (Light & Burke, 1988; Ryan, 1991).
For two of the items that were expected to be more positively related
to aging (enjoyable storytelling and sincerity in conversation), typical
75-year-old targets were rated more positively by both respondent groups.
This suggests that not all aspects of language performance are associated
with decline. Enhancement is expected in selected areas in later life. This
pattern of a small number of positive perceptions of elder language
performance combined with a greater number of negative perceptions is
similar to patterns found in earlier studies measuring intelligence (e.g.,
Hendrick et al., 1988). In addition, differentiation in favor of older
respondents contrasts with the failure to observe corresponding differ
ences between younger and older respondents in self-perceptions on these
same items. It remains for future research to determine if this contrast
represents a consistent pattern.
For the specific cross-generational contact items, social perceptions

showed anticipation of greater comfort in talking with same-generation
peers. Older respondents' self-ratings supported this notion, whereas the
younger respondents did not report any differential avoidance of older
conversational partners. These data provide empirical support for some
of the concerns raised about intergenerational communication by other
contributors to this volume (see Giles et al., Chapter 7; Hummert, Chapter
8). Future research on this specific topic might fruitfully focus on the
reasons for avoiding talk across generations—exploring the relative im
portance of beliefs about communication competence, topics of overlap
ping interest, and frequency of opportunity.
Our findings illuminate the types of expectations shaping older per
sons' interactions with their environments, influencing their motivation
and effort in given situations, and guiding the intergenerational behavior
of young adults communicating with them. For example, a 71-year-old
gentleman attending classes at McMaster commented: " I ' m a student here
at the university. Some of the younger students and I get along just great.
We sit together in class and have a lot to talk about. Others seem not to
know quite what to say to me. I think they presume we have nothing in
common. We do have many differences, but we are all students."
If we had sampled more aspects of language expected to be positively
related to aging (e.g., the giving of wise advice, willingness to listen), we
may have been able to offer a clearer overall picture of age-based differ
ences in positive and negative perceptions (Berg & Sternberg, 1992;
Heckhausen et al., 1989). Nevertheless, using a between-subjects design,
we have demonstrated with this study that expectations for change in
language performance with age exist among both young and old adults.
The finding of much higher proportions of variance associated with target
ages than with respondent ages suggests that further research should
examine whether group expectations are exaggerated forms of self-
perceptions. Future studies should also include more than two target ages.
Documenting the pattern of change anticipated in language performance
will necessitate incorporating ages spanning adult life, as has been done
for intelligence and memory perceptions (Hendrick et al., 1986; Ryan,
1992; Ryan & Kwong See, 1993).
A more complete assessment of conversational skills would also in
clude attention to pragmatics (e.g., turn taking, topic management, con
v e r s a t i o n a l repair, s p e e c h act use) and to n o n v e r b a l a s p e c t s of
communication (e.g., facial expressions, tone of voice, gestures). Thus it
would be valuable to identify whether self-perceptions and age-based
social perceptions about later-life changes highlight areas of particular

success among older adults as well as areas of decline (see Malatesta,
Izard, Culver, & Nicolich, 1987; Ulatowska, 1985).
Conclusion
Within the multiple influences model depicted in Figure 2.1, beliefs

and attitudes that communicators bring to language exchange have an
important bearing on communicative success or failure. In accordance
with the aging attitude literature, the results of our study of age-based
beliefs about conversational skills suggest that when conversing with an
older individual, a communicator is likely to bring multiple expectations
to the interpersonal exchange. Perceptions of the older adult as likely to
experience difficulty with reception and expression of language can
influence communication behavior and subsequently the overall success
enjoyed by the older person in conversation (see Coupland et al., 1991;
Ryan et al., 1986). Similarly, the older person's lower sense of self-efficacy
with respect to conversational language may reduce opportunities and
contribute to the negative consequences of inappropriate communication
strategies by his or her conversational partners (see Giles et al., Chapter
7, and Hummert, Chapter 8, this volume). Expectations about the func-
tions of talk for members of different age groups can also be important
and deserve extensive examination (see Giles et al., 1992). The influence
of our expectations about language performance (based on implicit theo-
ries about language-relevaiit changes with age) cannot be ignored in
attempts to achieve a balanced understanding of interpersonal communi-
cation in later life.
Note
1. The data reported in the discussion section of this chapter were collected as part of the
Canadian Study of Health and Aging. This was funded by the Seniors Independence Research
Program, administered by the National Health Research and Development P r o g r a m of
Health and Welfare Canada. The study was coordinated through the University of O t t a w a
and the Canadian federal government's Laboratory Centre for Disease Control.
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(pp. 2-40). Baltimore: Williams & Wilkins.
Stine, E. L „ Wingfield, Α., & Poon, L. W. (1986). How much and how fast: Rapid processing
of spoken language in later adulthood. Psychology and Aging, 1, 303-311.
Ulatowska, Η. K. (Ed.). (1985). The aging brain: Communication in the elderly. San Diego,
CA: College Hill.
Watson, J. B„ & Williams, S. E. (1988). Communication attitudes and aging. International
Journal of Aging and Human Development, 27, 45-55.
1
Age-Related
Problems in the Use of
Proper Names in Communication
GILLIAN COHEN
Until recently, questions about the nature and function of proper names
were left to philosophers, but difficulty in remembering proper names
is one of the most common and most frustrating of the problems that
occur in the course of normal aging, and cognitive psychologists have
begun to ask why there should be this special difficulty in the recall of
proper names and why proper names should be so peculiarly vulnerable
to the effects of aging. So far, these issues have been addressed in the
context of research on memory, but in this chapter I will argue that
retrieval failures for proper names should be treated in the context of
communication. Age-related changes in memory ability necessarily
affect the use of language and the quality of social interactions.
The Role of Memory in the Use of Language
The maintenance of communicative competence is a highly important

element in successful aging and involves both social and language skills.
However, language ability cannot function in isolation from the rest of
'the cognitive system. The use of language depends on other cognitive
A U T H O R ' S NOTE: Some of the research reviewed in this chapter was supported by the
ESRC, U.K.
40
P R O B L E M S IN THE USE O F P R O P E R N A M E S 41
components, such as perception, reasoning, and memory. Several of the

age-related problems that have been identified in the use of language stem
from changes in memory ability rather than changes in linguistic ability. For
example, both written and spoken language production show age-related
decline in the use of more complex syntactic structures (Kemper, 1988),
but this is related to a corresponding decline in the capacity of working
memory. Working memory is also implicated in age-related difficulties in
language comprehension, conversational tracking, and output monitor
ing. In comprehension, older adults may have difficulty in handling
anaphoric reference (Light & Albertson, 1988) and in generating infer
ences and integrating items of information that are not adjacent in dis
course (Cohen, 1979). Memory for the source of information also declines
with age (Cohen & Faulkner, 1984; Mclntyre & Craik, 1987), so that, in
conversation, elderly listeners may remember what has been said but have
difficulty remembering who said what. Defective output monitoring,
which is also associated with aging (Koriat & Ben Zur, 1988), has several
consequences. One is that elderly people tend to repeat themselves,
forgetting that they have already said particular things to particular
persons. Another is that they may forget to say what they had intended to
say, or they may initiate themes and fail to complete them, "losing the
thread" of what they are saying (Winthorpe & Rabbitt, 1988). In all these
examples, the use of language and the quality of communication are
affected by a reduction in memory capacity.
Although these memory deficits are detectable in laboratory experi
ments, they may be less noticeable in informal conversation. In naturally
occurring communication, memory is supported by the context of the
exchange and by cues and prompts supplied by other speakers. Moreover,
conversation normally includes a great deal of redundancy and repetition,
so that the demands on memory are reduced. In one-to-one conversations
about familiar topics, elderly people with normal hearing may not expe
rience much difficulty.
However, some memory problems cannot be circumvented and do
affect communication. In elderly people, language production is impaired
by a highly specific deficit in word finding that primarily affects the
retrieval of proper names. When older people are asked to report their
subjective impressions of the effects of increasing age, difficulty in
retrieving proper names is the problem most frequently cited (Cohen &
Faulkner, 1984, 1986; Sunderland, Watts, Baddeley, & Harris, 1986).
Temporary retrieval blocks in which a name that is known cannot be
recalled are reported as occurring with increasing frequency. In this
chapter, I will review the evidence for an age-related deficit in ability to

retrieve proper names and discuss the nature of the deficit, the underlying
mechanisms, and the effects on communication.
The Function of
Proper Names in Communication
Burke and Laver (1990) report the plea of an older adult participant in
one of their experiments: "If you want to study something really useful,
find out why I cannot remember the name of my friend of 20 years when
I go to introduce her" (p. 281). This request reflects and underlines the
importance of proper names in everyday social exchanges. In communi
cation, proper names are used in two different ways: confrontation nam
ing and referring. In confrontation situations, names are used to greet, to
address, to summon, or to introduce. In face-to-face conversation names
are also inserted in the discourse for emphasis or as attention holders (e.g.,
" D o you remember, Anne, that time we went to the seaside?"). Different
cultures and different generations have different conventions about the
use of proper names in spoken and written communication. For example,
older people tend to use surnames in some relationships where young
people would use first names. However, despite these variations, it is
impossible to avoid the use of names, and failure to recall a name
inevitably affects the quality of social interaction, causing considerable
confusion, frustration, and embarrassment and sometimes giving offense.
It may also affect the success of communication, as it may be unclear who
is being addressed or summoned.
In nonconfrontation situations, the function of proper names is to refer
to people or places not present at the time. When speakers are unable to
recall a name they usually attempt to achieve reference by substituting a
definite description (e.g., "You know who I mean, the woman who lives
in the brick house by the bus stop and has two boys, aged about 6 and 9").
Such descriptions tend to be cumbersome; they may be ambiguous if more
than one person fits the description or if the hearer does not share the same
knowledge base. Retrieval failures for proper names are not a trivial
problem: They make communication difficult and unsatisfactory. The
exchange of information is hampered, and anecdotes and small talk may
be rendered incomprehensible. It is not surprising, therefore, that elderly
people are concerned about this kind of memory lapse.
P R O B L E M S IN T H E U S E O F P R O P E R N A M E S 43
Age and Memory for Proper Names
A number of recent studies have begun to investigate age effects in

memory for proper names and the nature of retrieval blocks. In a typical
name retrieval block, the speaker remembers all that he or she knows
about the target person or place but cannot retrieve the target name. A
tip-of-the-tongue state may accompany the block. Typical retrieval blocks
are partial, temporary, and occasional. That is, partial information about the
blocked name is often available, so that the subject can recall phonological
features such as the first letter, number of syllables, or approximate length
of the name. It is also common for the subject to recall other names instead
of the target name. These other names, variously known as blockers
(Reason & Lucas, 1984), interlopers (Jones, 1989), persistent alternates
(Burke, MacKay, Worthley, & Wade, 1991), and nontarget candidates
(Cohen & Faulkner, 1986), are names that resemble the target name,
sharing phonological or semantic features with it. Retrieval of these
similar, but incorrect, names indicates that partial information about the
target has been activated. Retrieval blocks are temporary, as a very high
proportion (80-90%) are resolved without resort to external help, such as
asking someone else or looking the name up in a book. Resolution of the
block may occur within a few minutes or may take days. And blocks of
this kind are occasional in that they occur for target names that, on other
occasions, are recalled without any difficulty. These characteristics have
emerged from studies of naturally occurring retrieval blocks (Burke et al.,
1991; Cohen & Faulkner, 1986) and f r o m laboratory experiments in which
retrieval blocks have been induced (May lor, 1990), and all of these studies
have included detailed analysis of age differences in the nature of name
blocks. Everybody experiences name blocks from time to time, but they
occur more frequently in times of stress or fatigue and in old age, when
the level of arousal in the system is either too high or too low to mediate
accurate recall.
Evidence for Age Effects

in the Retrieval of Proper Names
Diary Studies
Cohen and Faulkner (1986) carried out a diary study in which 40 young
participants (ages 20-39, mean age 31), 4 0 middle-aged participants (ages
40-59, mean age 47), and 40 elderly participants (ages 60-80, mean age
71) recorded details of naturally occurring name blocks in structured

diaries over a 4-week period. The groups were matched for level of
education, for scores on the WAIS vocabulary test, and for digit span.
They were all healthy, active people living at home. The incidence of
blocks was significantly greater for elderly people than for the middle-
aged or young groups, thereby confirming the anecdotal reports. The more
interesting and unanticipated finding was that the blocks experienced by
the elderly were different in character from blocks experienced by younger
people. When elderly people failed to retrieve a target name they were less
likely to recall any partial information about the name. Thus they were
less likely to recall any phonological features of the name and less likely
to recall any nontarget candidates. Typically, they reported a complete
mental blank. For all age groups, blocks occurred more frequently for
names of acquaintances (65%) than for famous names (17%), names of
places (12%), or other kinds of proper names, such as titles of books and
films or brand names (6%). The differing incidence of blocks for different
types of names may, however, reflect the relative frequency of recall
attempts. It is probable that attempts to retrieve names of acquaintances
would be most frequent. More surprisingly, for all age groups, the major
ity of the blocks occurred for names that were rated as well known and
that were retrieved easily on other occasions rather than for names that
were unfamiliar. However, this may also be because people try to recall
well-known names more often than they try to recall unfamiliar ones.
These findings led Cohen and Faulkner (1986) to conclude that name
retrieval depends on a dynamic mechanism with fluctuating levels of
activation. When activation is sufficient to exceed the retrieval threshold,
the name is successfully recalled. When activation is below the threshold
level, it may still be sufficient to trigger some of the phonological
characteristics or to trigger other similar names that have lower thresh
olds. If the level of activation is even lower, nothing at all will be triggered
and the subjective experience is, as the elderly described, a mental blank.
According to this account, the thresholds for proper names vary with
frequency and recency of usage and activation levels vary with the
strength of the retrieval cues. The age differences in name blocking can
be explained if aging is accompanied by either lowered levels of activa
tion or higher retrieval thresholds.
This explanation is also consistent with additional previously unre
ported findings from the Cohen and Faulkner (1986) study about the
incidence of name confusions. Name confusions occur when the wrong
name is used inadvertently to address or to refer to someone. Diarists in
P R O B L E M S IN T H E USE O F P R O P E R N A M E S 45
the Cohen and Faulkner study were asked to record details of naturally
occurring name confusions. They were asked to record the target name;
the incorrectly substituted name; the relationship, if any, between the
names; the estimated frequency with which each name was used; the
context in which the error occurred; and whether they noticed the error
themselves or it was pointed out by someone else. The oldest group of
participants reported significantly more of these name confusions (the
mean was 2.3 per week in the 4-week period). For them, the most
commonly occurring type of confusion was one in which the name of one
member of the participant's family was substituted for the name of another
member of the family, so the confused names were contextually related.
The substituted names were of the same gender and, in most cases, of the
same generation. Young and middle-aged participants reported fewer
confusions (the means were 0.3 and 0.2 per week, respectively). Their
name confusions included fewer names of family members but more
names of friends, politicians, and pop groups. As in the oldest group,
however, almost all of the confused names were contextually related (e.g.,
both were names of politicians). For all age groups, estimated frequencies
of usage showed that the substituted name was one that had been used
more frequently or more recently.
These findings suggest that name confusions occur when a contextually
related name has a lower threshold than the target name. In elderly people,
the lowered level of activation is sufficient to elicit the substitute but not
enough to exceed the higher threshold of the target. It is worth noting that
the numbers of name confusions reported by the elderly participants are
likely to be underestimates of actual occurrences, because only 5% of
their errors were corrected by someone else. In contrast, 53% of the errors
made by the young were pointed out by hearers. It seems likely that
hearers are reluctant to correct elderly speakers and thus errors may go
undetected. This reluctance can be seen as an example of the overaccom
modation people employ in communicating with the elderly (Giles &
Coupland, 1991; see also Giles, Fox, Harwood, & Williams, Chapter 7,
this volume).
Burke et al. (1991) have also carried out a diary study of retrieval blocks
that strikingly confirms and further extends the findings of Cohen and
Faulkner. Their study included 50 young (mean age 19), 30 middle-aged
(mean age 39), and 50 older (mean age 71) participants. All were healthy
and community dwelling. The middle-aged and older groups had more
years of education and higher vocabulary scores than the young, but
smaller digit spans. In this study, the diarists recorded blocks for other
kinds of words as well as for names. As a result, Burke et al. were able to
confirm that the elderly and middle-aged experienced more blocks than
did the young, and that blocking occurred more often for proper names
than for other words. Some 68% of the 686 recorded blocks were for
proper names, and this predominance of proper name blocks was most
marked for the middle-aged and elderly. Most blocks, again, were for
familiar names of well-known acquaintances. Burke et al. also report that
the elderly diarists were less likely to recall any phonological features of
blocked names and less likely to recall nontarget candidates while search
ing for a target name than were the younger groups.
Burke et al. (1991) also note details of the strategies the participants
adopted when a word was blocked. From the point of view of communi
cation efficiency, the ways in which people manage their retrieval failures
are important. The elderly participants took longer to resolve their blocks
than did either the young or the middle-aged and, compared with the
young group, they were less likely to resolve blocks through conscious
search strategies and more likely to achieve "pop-up" resolution. Pop-up
resolutions are defined as occasions when a target comes spontaneously
to mind after conscious attempts to retrieve the missing name have been
discontinued. The target pops up into consciousness while the subject is
thinking about something quite different; this may occur minutes, hours,
or days later. Pop-up resolutions are thought to result from disinhibition
of the target, or from an augmentation of the level of activation from new
cues. Older people often report anecdotally that they find it counterpro
ductive to attempt to search for blocked words and more effective to think
about something else and wait for a pop-up to occur. However, employing
this strategy in conversation would entail a change of topic and would
necessarily disrupt the flow of conversation.
Two further findings from the Burke et al. (1991) study are of particular
interest. The researchers found blocked retrieval to be associated with less
frequent and less recent use of the target; this relationship was especially
marked in the older group. They also note that, whereas for the young
adults in their study blocks were associated with states of worry, fatigue,
or sickness, for the elderly adults retrieval failures were not associated
with unusual states. Young people in abnormal states performed similarly
to older adults in normal states. Like Cohen and Faulkner (1986), Burke
et al. interpret their findings in terms of level of activation, but they
develop a more detailed and more general model that links name retrieval
to mechanisms of speech production. They postulate a two-tiered network
with nodes in the semantic system linked to nodes in the phonological
system. In retrieval, activation spreads via these links from the semantic
node to the related phonological node. Linkage strength is affected by
recency and frequency of use and declines with age. To explain the effects
of age, Burke et al. put forward the transmission deficit hypothesis.
According to this hypothesis, retrieval failures are more common in the
elderly because insufficient activation reaches the phonological node,
especially if the target has not been activated often or recently. This
hypothesis is also consistent with the fact that the availability of phonological
features of the target and of nontarget candidates declines with age.
However, the claim that reduced linkage strength underlies retrieval
blocks in the elderly is questionable because it implies a permanent,
quasi-structural change, whereas performance appears to reflect tempo
rary fluctuations of state.
Diary studies of naturally occurring blocks depend on the willingness
and ability of subjects to monitor and report their own performance. It is
possible that the results may be biased if, for example, the elderly tend to
worry about the possibility of memory decline and are therefore sensitized
to errors that younger adults might ignore. To counter this criticism,
several researchers have conducted laboratory studies of experimentally
induced retrieval blocks. The complementary use of naturalistic and more
formal experimental techniques is increasingly recognized as a powerful
approach to the study of aging.
Experimental Studies
Burke and Laver (1990) carried out experiments in which retrieval
failures were induced in response to general knowledge questions (for
example, "What do you call the weapon used by the gauchos of South
America to entangle the legs of cattle and other animals?" [bola]). Maylor
(1990) induced blocks by presenting slides of famous faces and testing
respondents' abilities to name the faces. Both these studies confirmed that
older people have more difficulty in retrieving names. In addition, Maylor
carried out multiple regression analyses to discover how far performance
was influenced by a variety of factors, including measures of vocabulary
and IQ as well as age. She found that age was the single best predictor of
performance. The same results also emerged from a study by Crook and
West (1990) involving 1,205 healthy community-dwelling participants
ranging in age from 18 to 90 years. In addition to ages, genders, and
educational levels, the researchers recorded participants' scores on a
variety of cognitive tests. The participants were shown videotapes of indi
viduals introducing themselves and were then tested for both immediate
and delayed recall of the names. The number of names recalled declined
consistently with age. Following a set of six introductions, the 18 to
39-year-old group recalled on average 3.6 names; the 70 to 90-year-old
group recalled only 1.5 names. Crook and West employed multiple
regression analyses to assess the effects of demographic variables (age,
gender, and education) and performance variables (paired associate learn
ing and face recognition scores, vocabulary, and reaction times) on name
recall. Age was by far the strongest predictor, with much smaller amounts
of the variance being accounted for by vocabulary, reaction time, and
paired associate learning. It is particularly interesting to note that name
recall was unrelated to face recognition ability. Failure to recall names is
not caused by difficulty in remembering faces. The significant relation
ship between reaction times and name recall, however, is consistent with
the transmission deficit hypothesis, because slower mental speed can be
equated with weak or sluggish activation.
Is There a Selective Deficit for Proper Names?
Given that an age-related difficulty in the retrieval of proper names is

well established, is this part of a more general deficit in word finding?
The evidence here is not so clear-cut. In their diary study, Burke et al.
(1991) distinguished between retrieval blocks for proper names, object
(or common) names, and abstract words. For the elderly, the proportions
of blocks were 69%, 18%, and 13%, respectively. For the young group,
the corresponding proportions were 58%, 7%, and 35%. The elderly have
significantly more blocks for proper and common names, but fewer for
abstract words. However, it is clear that these percentages reflect relative
differences in the use of different kinds of words as well as possible
differences in retrieval difficulty. The young group was composed of
students, and the high proportion of blocks for abstract words in this group
probably results from the demands of their course work. It is also quite
possible that age groups vary in the use of proper names, but this question
has not been explored. Moreover, self-reports of the frequency of blocks
for common and abstract words are unlikely to be accurate. For many such
words the speaker or writer can easily substitute a synonym and might
therefore be unaware that a retrieval block had occurred. Blocks for proper
names cannot be bypassed in this way, because no synonyms exist. These
considerations suggest that more formal experimental methods are required
to estimate the relative incidence of blocks for different kinds of words.
In Burke and Laver's (1990) experimental study the elderly group

(mean age 71) had a higher number of blocks for proper names than did
the young group (mean age 20), but there was no age difference in
retrieval of other words. In vocabulary tests such as the WAIS, which tests
word comprehension, it is rare to find age-related impairments. Indeed, it is
common to find that elderly people have superior scores (see Salthouse,
1988, for a review). However, other tests have shown age-related deficits
in word production. For example, Bowles and Poon (1985) found that
elderly people had reduced accuracy and increased latency for naming
pictures and for producing words when given definitions. Tests of verbal
fluency in which subjects are asked to produce as many words as possible
starting with a specified letter within a fixed period of time usually show
that fluency declines with age. However, Light (1988) has suggested that
such differences might be attributable to a decline in speech rate rather
than in retrieval speed. The conclusion is that age deficits for retrieval of
common words are slight and, when they do occur, tend to result in slower
retrieval rather than in blocked retrieval. In contrast, the deficit for
retrieval of proper names is much more marked and often results in
retrieval failure.
Clinical studies support the view that memory for proper names is
functionally separate from memory for object names. Semenza and Zettin
(1989) describe a patient with a left frontotemporal lesion who scored
100% at naming real objects and 98% at naming pictured objects. In
contrast, his score for naming pictures of famous people was 8%. On
geographic names he scored 31%. A similar case is reported by Flude,
Ellis, and Kay (1989). These observations of a selective anomia for proper
names suggest that names are stored separately, or in a different way, from
other semantic information.
Models of Proper Name Retrieval
Just why proper names are harder to retrieve and more age sensitive
than other words is still a puzzle. However, it can be argued that names
are represented in memory in such a way that they receive less activation
and are therefore particularly affected by lowered levels of activation.
Bruce and Young (1986) propose a model in which names are stored
separately at the terminal node of a person recognition route and can be
accessed only after semantic information about person identity (at the
person identity node, or PIN) has been retrieved, as shown in Figure 3.1.
Figure 3.1. Successive Stages of Person Recognition: A Simplified Version

of the Bruce and Young Model
Thus activation may dissipate before reaching the terminal node. There
is considerable experimental and clinical support for this model. In particu
lar, this serial access model is consistent with the finding that, although
people are often able to remember person identity information when they
cannot remember a name (e.g., "He's an accountant, very tall, with glasses—I
can't remember his name"), the opposite pattern of remembering the name
but not remembering any other information about the person almost never
occurs. In addition, reaction time studies show reliably that the biographi
cal information can be retrieved faster than the proper name. These
findings confirm Bruce and Young's claim that recall of proper names
depends on, and occurs after, prior recall of biographical information.
In earlier work, I have suggested that the difficulty in retrieving names
arises because names are essentially meaningless and arbitrary (Cohen,
1990, 1992). They therefore lack the richly interconnected semantic
bakes bread
baker sells cakes
has a shop
Figure 3.2. Arbitrary Attributes of a Proper Name and Meaningful Attributes

of a Common Noun
associations that other words possess, so that instead of recruiting activa

tion from linked attributes, names receive relatively impoverished acti
vation. Of course, names do have attributes, as shown in Figure 3.2, but
these are arbitrary and accidental. It does not necessarily follow that
someone who is tall, plays tennis, and works in a bank will be called Mr.
Baker; nor does it follow that anyone who is called Mr. Baker will be tall,
play tennis, and work in a bank. The attributes will not serve as reliable
cues for recall of the proper name. Recall of the common noun baker, on
the other hand, can be facilitated through cues such as "bakes bread,"
"sells cakes," or "has a shop," because these are reliably and necessarily
associated with being a baker. The nature of the connections between a
common noun and its associates is quite different f r o m the nature of
connections between a proper name and its associates.
A different account of the difficulty of retrieving proper names has been

built into the architecture of a computational model of name retrieval
designed and implemented by Burton and Bruce (1992). In this model,
names and semantic information (SIVs) are stored together in semantic
information units, but name units have fewer connecting links and therefore
receive less activation. The architecture of the Burton and Bruce model,
shown in Figure 3.3, depends on the assumption that names are unique,
or at least highly distinctive. A semantic concept such as prime minister is
linked to several representations, whereas a name such as Margaret Thatcher
is linked to only one representation because it is unique. The model predicts
that highly distinctive names (such as Cedric or Felix) should be harder to
recall than common ones (such as John or Ann) because they will have
fewer links. Stanhope and Cohen (1993) tested this prediction experimen
tally and found, contrary to the Burton and Bruce (1992) model, that
highly distinctive names were easier to recall than common ones.
All the models of name retrieval described above are in agreement that
the deficit in name retrieval arises because insufficient activation reaches
the representation of the name in memory, and that this insufficiency results
from the pattern of connectivity. The differences among the models are not
fundamental. In Bruce and Young's (1986) serial access model, names
receive less activation because they are situated at a terminal node. Burke et
al. (1991) postulate structural connections such that, whereas semantic
activation converges on the lexical nodes for object names, it diverges from
the nodes for proper names. My own research suggests that proper names
receive less activation because, being meaningless and arbitrary, they lack
semantic connections (Cohen, 1992). Burton and Bruce's (1992) argument
is similar, in that they also claim that proper names have fewer connections,
although in their view this is because names are unique rather than because
they are meaningless. All these ideas are still in the process of being
modified and developed and, as yet, the cognitive mechanisms that underlie
the specific difficulty in recalling proper names are not fully understood.
Effects of Rettieval Blocks on Communication
How does the name retrieval deficit affect the ability of older adults to
communicate? The age-related deficit in memory for proper names is
asymmetrical. That is, people have difficulty in retrieving names f r o m
personal descriptions, but have no problem in recalling descriptions f r o m
names. The effects of retrieval blocks for proper names are therefore
confined to language production rather than language comprehension. So
far there has been no research on how name blocking affects communi
cation, but some consequences follow logically, and others can be iden
tified from everyday experience.
When speakers are unable to retrieve proper names, they often replace
the missing names with descriptions or with dummy tags such as "What's
her-name" that make their utterances imprecise and ambiguous. If a
speaker forgets a name when trying to introduce someone, or when
meeting someone he or she knows quite well, it is socially awkward and
embarrassing. If a speaker forgets a name when trying to refer to some
one, communication is disrupted. The outcome depends partly on the
way memory failures are managed and partly on the nature of the
conversation. The speaker may appeal to others to supply the name,
delay the conversation while carrying out a memory search, or give up
and change the topic. If the conversation consists of anecdotes about
people and places familiar to both speaker and hearer, reference can
usually be mutually established even if names are blocked. However, if
the speaker is trying to impart new information (for example, to recount
an item from a news bulletin, to recommend an author, or to list names of
roads and towns on a route), then a name retrieval deficit is a more serious
handicap.
Difficulty in retrieving common names has less obvious effects because

synonyms can usually be readily substituted. However, problems do arise
if blocking occurs for technical or specialized terms. For example, in the
Cohen and Faulkner (1986) study discussed above, elderly people reported
blocking on the botanical names of flowers. These are genus or species
names, not proper names, but because they have no synonyms, communica
tion is hampered when they cannot be retrieved. The fact that, for all kinds
of words, word finding is slower in old age is also likely to make communi
cation more effortful and less fluent for the elderly language user.
Perhaps more important, however, are the effects on hearers. Giles
(1991) has shown that young people tend to make ageist assumptions
about the language competence of older people and to denigrate older
speakers as "doddery," "vague," and "rambling," and these assumptions
influence their expectations and the ways they interact with elderly
people. Older adults tend to be stereotyped as less effective communica
tors (see, in this volume, Ryan, Kwong See, Meneer, & Trovato, Chapter
2; Hummert, Chapter 8). Such stereotypes are based on beliefs about
elderly people that are not necessarily true, but, as Rabbitt (1988) points
out, "a loss of working memory capacity which makes it difficult to hold
in mind the precise content of more than one or two sentences at a time
offers very marked obstacles to successful social interaction" (p. 506).
Thus older adults may be handicapped as communicators both by their
hearers' beliefs about their competence and by their own cognitive im
pairment. Name blocks and name confusions are likely to reinforce ageist
stereotypes and add to the difficulties of social interaction. When an
elderly speaker experiences a name block, the flow of conversation is
disrupted as the speaker struggles to retrieve the name or interrupts the
utterance to request help from the hearers. If the speaker elects to wait for
a pop-up retrieval, the communication is suspended until the pop-up
occurs. It seems obvious, therefore, that the increasing prevalence of
name blocks must make communication less effective and less enjoyable.
Can anything be done to avoid name blocks or to overcome them once
they occur? Some researchers have taught subjects to use imagery mne
monics to encode the face-name association (e.g., Morris, Jones, &
Hampson, 1978). People are told to identify a salient feature of the face
and link this to an image based on the name. For example, if a man named
Gordon has bushy eyebrows, they might image a bush in a garden. The
method has been shown to be effective, but it is cumbersome and effortful
to employ in everyday life, and some names and faces do not lend
themselves easily to this technique. Strategies for resolving name blocks,
such as running through the alphabet, are similarly laborious, and, as

already noted, older people usually prefer to think about something else
and wait for a pop-up resolution to occur.
Future Research
Arising out of this review, several issues can be identified that merit
further research, and these fall into two categories. The first type of
research needs to explore the pragmatic implications of name blocks by
analysis of natural discourse. Although diary studies have yielded subjec
tive self-reports giving some information about the contexts in which
name blocks occur, no objective analysis of the situational, social, and
linguistic contexts is yet available. In particular, diary studies have
concentrated on the preconditions for name blocks and have ignored the
consequences. Thus, although we can speculate about communicative
implications, the kind of discourse analysis that would reveal these is
lacking. We need to know more about how name blocking is handled in
conversation, how it affects communication, and how it affects the beliefs
of elderly people about their own competence in social interactions. We
need to devise better mnemonic strategies for encoding names effectively
and better strategies for overcoming blocks when they occur.
In addition, there is a further need for investigation of the cognitive
mechanisms underlying name blocks. Models of these mechanisms have
been proposed, but some issues are as yet unresolved. Why is memory for
names particularly vulnerable to aging, stress, and trauma? Are names and
other semantic information stored separately and accessed serially? Or
are they stored together, but with different patterns of connectivity? These
issues are currently attracting a great deal of attention, and substantial
progress has been made. Experimental studies, clinical observations, and
computational modeling are being used in complementary ways by groups
of researchers working cooperatively. Although these two kinds of research,
the sociolinguistic and the cognitive, are distinct, the problem of name
blocking is one that requires contributions from both approaches.
Conclusion
I began this chapter by noting that difficulty in remembering proper

names is reported, anecdotally, to be one of the most prevalent and
tiresome problems accompanying the process of normal aging. Research

has confirmed the fact that proper names are harder to recall than object
names and that there is an age-related deterioration in proper name
retrieval. The nature of retrieval blocks and some predisposing conditions
have been identified, and theoretical models of the representation of
proper names are being developed. Unfortunately for those who suffer
from name blocks, however, we are still unable to offer a solution to their
problem.
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1
The Effects of Alzheimer's Dementia

on Language and Communication
SUSAN KEMPER
KELLY LYONS
Among the earliest symptoms of dementia are impairments of language

and communication. Spouses and other caregivers note word-finding
problems, object-naming difficulties, and comprehension failures as
among the first indications of the onset of Alzheimer's disease (Bayles
& Tomoeda, 1991; Orange, 1991). Impairments of communication,
such as failure to take part in family conversations, failure to start and
sustain conversations, and lack of interest in newspapers, magazines,
and television, contribute significantly to caregiver stress (Rau, 1991)
and lead to feelings of frustration, loneliness, embarrassment, and
social isolation (Orange, 1991).
The magnitude of the impact of dementia on language and communi
cation is difficult to determine. Varying definitions and standards of
dementia contribute to wide-ranging estimates of its prevalence. Conser
vative estimates indicate that severe dementia may affect only 1.1% to
6.2% of those over 65 years of age, and mild and moderate dementia may
affect another 2.6% to 15.4% (Bayles & Kaszniak, 1987). Severe demen
tia increases from about 1% of the population over 40 years of age to 7%
of the population over 80 years of age (Schoenberg, Anderson, & Haerer,
1985). In contrast, in a widely publicized study, Evans, Funkenstein, and
Albert (1989) have reported that dementia affects 10.3% of the population
A U T H O R S ' NOTE: This research was supported by grants K 0 A G 0 0 4 3 and P 3 0 A G 1 0 1 8 2

f r o m the National Institute on Aging to Susan Kemper.
58
THE E F F E C T S O F A L Z H E I M E R ' S D E M E N T I A 59
aged 65, rising to 47.2% of the population aged 85 and over. Currently,
Alzheimer's disease is the fourth leading cause of death in the United States,
accounting for 150,000 deaths per year. By the year 2040, 14 million
Americans will be directly affected by this disease.
Alzheimer's disease is the most common form of dementia (Tomlinson,
Blessed, & Roth, 1970), accounting for approximately 50% of all forms
of dementia. Like many dementias, Alzheimer's disease is progressive,
with subtle indicators such as memory lapses and irritability leading to
end-state conditions such as mutism, rigidity, and incontinence. Survival aver
ages 8.5 years from initial diagnosis, although some individuals linger for
more than 20 years. Early-onset Alzheimer's, afflicting individuals 40 to
50 years of age, may have a different etiology from late-onset Alzhe
imer's. Genetic factors as well as environmental hazards have been
implicated in the etiology of Alzheimer's disease.
Alzheimer's disease is not the only cause of progressive dementia; a var
iety of other degenerative diseases also result in dementia, including Pick's
disease, Parkinson's disease, demyelinating diseases such as multiple sclerosis,
hydrocephalic conditions, and vascular infarcts (Tomlinson et al., 1970). Not
all forms of dementia are progressive; 10% to 15% may be reversible
dementias caused by depression, metabolic disorders, toxic factors, and drugs.
Alois Alzheimer first linked a specific pattern of neurological degen
eration with the symptoms of dementia in 1906 (Alexander & Selesnick,
1966). Now, Alzheimer's disease is diagnosed postmortem by the pres
ence of neurofibrillary tangles, protein filaments within neuronal cells
that twist together to form helixes, and neuritic plaques, clumps of
degenerating neurons surrounding a core of amyloid protein. These tan
gles and plaques contribute to neuronal loss, resulting in a 40% to 50%
loss of cortical volume in frontal, temporal, and parietal association areas
as well as in the subcortical limbic system, including the hippocampus
and amygdala; however, a critical aspect of Alzheimer's disease is that
the motor and sensory cortex is spared such neurological degeneration
(Chui, Teng, Henderson, & Moy, 1985).
In this chapter we will examine recent research on the effects of
Alzheimer's disease on selected aspects of language and communication.
We will review extensively the nature of semantic memory impairments,
and then present evidence for the preservation of grammatical abilities as
well as a discussion of how impairments of semantic memory coupled
with the preservation of grammar affect pragmatic aspects of communica
tion. The interested reader is referred to more extensive reviews of the effects
of Alzheimer's disease on cognition and language by Bayles and Kaszniak
(1987), Lubinski (1991), and Nebes (1992) for further information.
60 Interpersonal Communication in Older Adulthood
Semantic Memory Impairments
Although there is little disagreement regarding the presence of seman

tic deficits in Alzheimer's disease, the nature of this deficit has become
quite a controversial topic. Some researchers propose that the structure
and/or organization of the semantic network is changed in A l z h e i m e r ' s
patients. A second hypothesis is that the structure and organization of the
semantic network remain intact in individuals with Alzheimer's disease,
but access to the lexical representation (i.e., name or label) has been
interrupted or degraded.
Semantic memory refers to the linguistic form of a person's general
world knowledge. It is an organized system of concepts and their names,
meanings, attributes, and associations as well as the rules used to manipu
late this information. Although there are various models of semantic
memory, the model adopted by the majority of dementia researchers has
two separate but interconnected systems. The first is the semantic net
work, which is a hierarchical organization of concept knowledge. It
includes concept nodes that are connected to related nodes via labeled
and directed pathways denoting attributes, functions, and associations
(e.g., a cat is an animal, a bird has wings, a hammer is used for pounding,
a hand has five fingers). When a particular concept has been activated,
all related concepts are also activated through the process of spreading
activation. The second part of this system is the lexicon, which contains
the orthographic and phonemic information for each concept.
Two types of tasks have been used to study semantic memory: Elicita
tion of verbal responses to a variety of different prompts is commonly
used to examine semantic memory, and semantic priming tasks are often
used to examine the speed of lexical decisions and lexical naming under
different experimental manipulations. These two types of tasks have
tended to yield different results with regard to the nature of semantic
memory impairments resulting from Alzheimer's disease; prompted elici
tation tasks typically indicate that the semantic network is disorganized
or disrupted, whereas semantic priming studies typically suggest that
access to lexical representations is impaired.
Prompted Elicitation Tasks
Free Association
Free association tasks are often used to examine the organization of
semantic memory. There are basically two types of associations: syntag
THE E F F E C T S OF A L Z H E I M E R ' S D E M E N T I A 61
m a d e and paradigmatic. Syntagmatic associations represent words of

different grammatical classes that could appear together in a sentence
(e.g., soft-pillow, big-truck, man-work, go-home). Paradigmatic associa
tions represent words of the same grammatical class that often share
c o m m o n features and are commonly members of the same category (e.g.,
bus-truck, dog-cat, go-run, big-tall). If the organization of the semantic
network is changed with Alzheimer's disease, it would be expected that
Alzheimer's patients would produce differential patterns of syntagmatic
and paradigmatic responses relative to normal elderly adults.
In studies by Gewirth, Shindler, and Hier (1984) and Santo Pietro and
Goldfarb (1985), demented patients showed a significant decrease in
paradigmatic responses relative to normal elderly controls. However, the
frequency of syntagmatic responses was equivalent for the two groups.
The reduction of paradigmatic associations seems to indicate a loss of
semantic information owing to a change in the structure of the semantic
network, whereas the consistency in syntagmatic responses reflects a
preservation of syntactic knowledge.
Confrontation Naming
In a confrontation naming task, individuals are presented with line

drawings of objects and are asked to generate the names of the objects.
The most commonly used measure of confrontation naming is the Boston
Naming Test. Henderson, Mack, Freed, Kempler, and Anderson (1990)
suggest that this test is a good measure of semantic memory functioning
because in order to name the object successfully, the individual must
access both semantic information about the object and its lexical repre
sentation.
Kempler, Anderson, Hunt, and Henderson (1990) found vast individual
differences in Alzheimer's patients' performance on repeated confronta
tion naming tasks, rather than group responses. The researchers observed
qualitative differences in performance based on the consistency of re
sponding across tests; some patients produced consistent naming errors
across tests, suggesting they had experienced a loss of semantic informa
tion, whereas other patients had inconsistent errors across tests, suggest
ing intact semantic representations but deficits in lexical access. In an
attempt to find a cause of the lexical access problem, Kempler et al.
administered a series of attentional measures. Their results indicated that
inconsistent patients performed quite poorly relative to consistent pa
tients. Therefore, the researchers concluded that a deficit in attention was
partially responsible for the disruption in lexical access.
Category Knowledge
The supermarket test provides another way to examine the organization

of information in the semantic network. Patients taking this test are asked
to name as many objects as they can think of that are found in a super
market. Using this test, Troster, Salmon, McCullough, and Butters (1989)
found that persons diagnosed as having moderate Alzheimer's generated
significantly fewer correct responses than did normal elderly adults. They
were able to generate an equivalent number of category labels—such as
meats, fruit, vegetables—relative to normal elderly controls, but were
unable to generate category exemplars and specific category features. The
mild Alzheimer's patients produced the same pattern of responding, but
it was less pronounced. This pattern suggests that there is a bottom-up
breakdown (i.e., defining features are lost) in semantic knowledge that
becomes more severe with the progression of the disease.
Ober, Dronkers, Koss, Delis, and Friedland's (1986) results mirrored
those of Troster et al. (1989). Ober et al. also administered a verbal
fluency test in which patients had 90 seconds to produce as many words
as they could think of that began with the letter F, the letter A, and then
the letter S. Following this test they were given a semantic category test
in which they had 90 seconds to name as many animals as they could think
of and then 90 seconds to name exemplars of the category "fruits." For
both tasks, the mild Alzheimer's patients produced one half as many
responses as did the normal controls, and the performance of moderate
Alzheimer's patients was even worse. However, all patients produced
more responses for the semantic categories relative to the letter catego
ries, and no differences were found in the dominance or relative frequency
of the exemplars generated. The Alzheimer's patients did produce more
noncategory exemplars relative to normal controls. This implies that the
Alzheimer's patients were unable to sustain attention on a particular set
for 9 0 seconds. Based on the results of the three tasks, Ober et al.
concluded that the Alzheimer's patients had a progressive breakdown in
semantic memory functioning caused by a disorganization of information
in the semantic network that was especially apparent when sustained
attention was required.
The supermarket task and the verbal fluency tasks measure ability to
perform a self-directed search of semantic memory and to generate related
concepts. However, a more experimentally directed method is necessary
to determine whether the exemplars patients fail to mention are actually
lost from the semantic network. Huff, Corkin, and Growden (1986)
employed a category and name-recognition task to measure more directly
the contents of semantic memory in Alzheimer's patients. In the category-

recognition task, they presented patients with 20 items shown separately
in both word and picture form. At the time of presentation, patients were
asked, "Is this a type of _ ? " ; the blank was filled with the name of either
the correct or an incorrect category. There were no differences in perform
ance between Alzheimer's patients and the normal elderly controls, and
there was no different effect of pictures versus words. The name-recognition
task used the same picture stimuli, but at the time of presentation the
patient was asked, "Is this a ?"; the blank was filled with either the
correct name or an incorrect name from the same category. For correct
items, Alzheimer's patients and controls performed equivalently. In con
trast, the Alzheimer's patients were significantly less likely to name a
semantically related item as incorrect than were the controls. Thus the
Alzheimer's patients were not impaired in determining category member
ship, but detailed information necessary to discriminate between objects
within the same category was either lost or inaccessible to them.
Chertkow, Bub, and Seidenberg (1989) employed picture naming and
description tasks to examine category knowledge more closely. In the first
task, patients were shown pictures of five objects from different catego
ries and were asked to point to the picture representing a given object.
Alzheimer's patients performed equivalently to normal elderly controls.
This task was repeated, only this time the five objects in the picture were
from the same semantic category. Alzheimer's patients performed signifi
cantly worse than the controls on this task. Together, the results of these
tasks indicate that superordinate category knowledge is preserved in
Alzheimer's disease, however, there is a disruption or loss of specific
within-category knowledge.
Bayles, Tomoeda, and Trosset (1990) also examined categorical knowl
edge in persons with Alzheimer's disease. In their first task, they measured
the confrontation naming abilities of mild and moderate Alzheimer's
patients and normal elderly controls. Naming ability of all Alzheimer's
patients was significantly impaired relative to the controls. An error analysis
indicated that more than one-third of the mild patients provided object
attributes (e.g., long neck) rather than the object's name (e.g., ostrich). In
contrast, the majority of the moderate patients provided semantically
unrelated errors such as personal associations or idiosyncrasy responses.
In the second task, patients were asked to specify the category that
contained each of the confrontation naming objects. The performance of
both Alzheimer's groups was significantly inferior to that of the controls.
Both patient groups tended to respond with semantically unrelated associa
tions or gave no response, although they did provide semantically related

responses almost one third of the time. Finally, patients performed a
category-recognition task. Patients selected the category for each of the
confrontation naming objects from four possible choices. Both patient
groups committed significantly more errors than did the controls. How
ever, both Alzheimer's groups chose another item from the object's
category rather than the actual category name at least half of the time.
This study provides little evidence supporting the hypothesis that detailed
categorical information is lost in Alzheimer's patients. Although the
Alzheimer's patients showed a decline in performance for all three tasks
relative to the controls, the tendency to generate attributes of the objects
when asked for the names indicates that they retained at least some
semantic information. The major problem seems to be an inability to
access the appropriate names for objects presented.
Script Knowledge
Semantic memory also contains script information. A script is a tem

porally dependent list of events that occur in a certain situation (e.g.,
getting ready in the morning, eating at a restaurant, going to a movie).
Script knowledge is important to our everyday functioning because it
allows us to behave appropriately in various situations. Therefore, a
breakdown in script knowledge would greatly hinder our everyday per
formance and interactions with others. Consequently, it is critical to know
if this information remains intact in Alzheimer's victims, many of whom
are trying to function in society.
Grafman et al. (1991) found that Alzheimer's patients generated sig
nificantly fewer script events compared with normal controls when they
were asked to write down "all the things that you do when you get up in
the morning," but the first six events generated by both groups were
equivalent (e.g., take a shower, brush your teeth, put on your clothes). The
Alzheimer's patients generated significantly more events out of order
relative to controls, and many of their responses were inappropriate and
perseverative. When shown pairs of events from the preceding script and
asked if the events were in the appropriate order (e.g., putting on your
clothes and taking a shower), Alzheimer's patients were significantly less
accurate than the controls. Grafman et al. concluded that the A l z h e i m e r ' s
patients had breakdowns in script knowledge caused by either a structural
deterioration or a processing deficit.
Harrold, Anderson, Clancy, and Kempler (1990) gave three script
topics to Alzheimer's patients: a wedding, a surprise party, and restaurant
dining. Following each topic, the patients were given a list of events and
were asked to decide which events were appropriate to the given script.
Alzheimer's patients made significantly more errors than did normal
elderly. The majority of their errors had to do with the inclusion of
inappropriate events. In a second task, patients were given script pairs and
were asked to order the events. The pairs were controlled with respect to
temporal distance between the events given (e.g., temporally close versus
distant). The Alzheimer's patients performed better on this task compared
with the discrimination task, but their performance was still significantly
worse than that of the normal controls.
Together, the studies noted above indicate that script knowledge in
Alzheimer's victims is disrupted. The results are quite similar to those
reported in the category knowledge studies. Alzheimer's patients had diffi
culty recalling appropriate script information and, as the script events became
increasingly similar or related, the Alzheimer's patients experienced corre
spondingly greater difficulty in discriminating among the events.
Summary
Studies examining word associations, confrontation naming, and cate

gory knowledge have reached the general conclusion that information in
the semantic network is disorganized or lost in persons suffering from
Alzheimer's disease. The researchers who have conducted the majority
of these studies have based their conclusions on the fact that Alzheimer's
patients have had difficulty recalling semantic information or discrimi
nating between semantically related items. The decline in performance
may be the result of reduced ability to perform self-directed searches of
semantic memory and, subsequently, to access the appropriate lexical
representations. Flicker, Ferris, Crook, and Bartus (1987) and Huff et al.
(1986) have demonstrated that when the appropriate lexical information
is supplied, Alzheimer's patients can perform equivalently to controls in
terms of correct responses. In addition, the error analyses conducted by
Bayles et al. (1990), Huff et al. (1986), and Martin and Fedio (1983)
indicate that the majority of the errors committed were semantically
related to the correct answers, suggesting that the patients had difficulty
retrieving the appropriate lexical representation.
Semantic Priming
The semantic priming paradigm offers another way to examine seman

tic relations. In a semantic priming task, individuals are presented with a
prime that is semantically related, neutral, or semantically unrelated to

the following target. They are asked to respond to the target most com
monly by naming the target, making a word/nonword judgment or lexical
decision (e.g., deciding spirt is not a word), or responding to a yes/no
question about the target. In normal young adults, a target preceded by a
semantically related prime (e.g., rock-dirt) is responded to faster than a
target preceded by a semantically unrelated prime (e.g., table-dirt) (Meyer
& Schvaneveldt, 1971). The presentation of the prime is thought to
activate related concepts through spreading activation. Therefore, if the
prime and target are semantically related, spreading activation f r o m the
prime provides prior activation to the target, which in turn facilitates a
response. In contrast, a semantically unrelated prime activates concepts
inappropriate to the target, and activation must be redirected to the
appropriate concept, which takes additional time. The difference in re
sponse time between unrelated and related prime-target pairs is referred
to as the context effect.
Lexical Naming
Nebes, Martin, and Horn (1984) employed a naming task using a

semantic priming paradigm. Patients were presented with prime-target
pairs and were asked to name each word presented. Reaction times were
recorded only for the targets. One-half of the pairs were strongly related
associates, and the other half were unassociated. If the semantic network
is disorganized, patients should respond equivalently to associated and
unassociated pairs. However, if the basic structure and processes of
semantic memory remain intact, patients should respond to associated
pairs (e.g., bank-money) more quickly than to unassociated pairs (e.g.,
fish-money). Although Alzheimer's patients responded significantly more
slowly than the normal elderly controls, they responded to associated pairs
significantly faster than to unassociated pairs. This context effect (i.e., the
reaction time advantage for associated pairs) was equivalent for the two
groups. These results indicate that the associative structure of semantic
memory in Alzheimer's patients remains intact.
Lexical Decision
Albert and Milberg (1989) conducted a similar study using a lexical

decision task. Patients were presented with a prime followed by a target
to which they had to make a word/nonword judgment by pressing the
appropriate response key. Word targets were preceded by associatively
THE EFFECTS OF A L Z H E I M E R ' S D E M E N T I A 67
related or unrelated primes. Nonwords were preceded by word or non-

word primes. Response times were significantly slower for Alzheimer's
patients relative to controls. For both groups, related trials were re
sponded to faster than unrelated trials and context effects were equivalent.
However, an analysis of individual performance revealed quite different
results. Six Alzheimer's patients had context effects significantly greater
than the controls. In contrast, four Alzheimer's patients exhibited signifi
cant negative priming; that is, they responded more rapidly to unrelated
pairs than to related pairs.
Ober and Shenaut (1988) also demonstrated negative priming for
Alzheimer's patients. In their study, each patient was asked to make a
lexical decision for the prime followed by a one-second delay, after which
the patient was asked to make a lexical decision for the target. It should
be noted that in both this study and the Albert and Milberg (1989) study
an extremely long stimulus onset asynchrony (SOA, the amount of time
from the onset of the prime to the onset of the target) was used. It may be
the case that in Alzheimer's patients activation dissipates at a faster rate
than in normal controls. If this is the case, activation from the prime may
have worn off before the target was presented.
In order to test this hypothesis empirically, Ober and Shenaut (1989)
replicated their earlier study using a 750-millisecond reduction in SOA. In
the replication they obtained equivalent context effects for Alzheimer's
patients and normal controls. Thus it appears that the structure and organiza
tion of the semantic network remain intact with Alzheimer's disease, al
though the duration or persistence of spreading activation may be reduced.
Naming and lexical decision tasks require different processing opera
tions. The lexical decision task is thought to require a postaccess checking
process in order to make a word/nonword judgment that is not present in
the naming task. To verify that the results obtained in previous research
were not task specific, Nebes, Brady, and Huff (1989) examined the
performance of Alzheimer's patients using both naming and lexical deci
sion tasks. Although reaction times were slower for the lexical decision
task, equivalent patterns of performance were obtained. In both tasks,
Alzheimer's patients and controls responded faster to associated (e.g.,
dog-bone) than to unassociated prime-target pairs (e.g., cloud-bone).
Such context effects were much greater for Alzheimer's patients in both
experiments. Similar results were obtained by Nebes, Boiler, and Holland
(1986) using sentence primes. Both studies indicate that the semantic
structure of the Alzheimer's patients remained intact and that they ap
peared to benefit more from context than did the controls.
Context Effects
Stanovich and West (1983) have reported that poor readers demonstrate
much larger context effects than do normal readers. They conclude that
poor readers rely on contextual information in order to compensate for
deficient or lower-level reading skills. It may be the case that contextual
compensation also occurs for Alzheimer's patients. Context effects that
are substantially larger for Alzheimer's patients, relative to normal con
trols, are commonly reported (Albert & Milberg, 1989; Nebes et al., 1986,
1989).
Based on their speed and accuracy of responding in a naming task,
Hartman (1991) separated Alzheimer's patients into slow, inaccurate
responders and fast, accurate responders. The slow, inaccurate responders
had a substantially larger context effect relative to controls, whereas the
fast, accurate responders had a context effect that was equivalent to that
of the controls. Consequently, it appears that patients with naming deficits
may benefit more from context than do normal controls.
Summary
This review has highlighted the controversy surrounding the nature of

semantic memory declines in Alzheimer's patients. Researchers using
elicitation tasks typically conclude that there is a loss or disorganization
of information in the semantic memories of Alzheimer's patients. This
conclusion is based upon the patients' inability to recall particular words
or bits of semantic information. These studies do not measure the entire
contents of semantic memory; they only reflect how much information is
readily accessible as a result of a self-directed search of semantic memory.
It may be that Alzheimer's subjects are as capable of producing the
desired responses as normal elderly subjects when they are given the
appropriate retrieval cues.
Studies of semantic priming assess semantic memory functioning with
out requiring subjects' self-directed search of semantic memory; appro
priate retrieval cues are provided. The priming studies conducted to date
have consistently suggested that the semantic networks of A l z h e i m e r ' s
patients remain intact, indicating that performance deficits are caused by
disruption in lexical access. This conclusion is based upon the reports of
equivalent priming effects for Alzheimer's subjects and controls. The fact
that reaction times are significantly slower for Alzheimer's subjects is
seldom addressed. It is quite possible that this slowing is indicative of a
deterioration in the semantic network. That is, if there were three semantic
nodes connecting the words doctor and nurse, activation would have to
travel across these three nodes before a response could be made to doctor
given nurse as a prime. However, if one of these nodes had deteriorated,
then the activation would have to travel through a longer path of nodes
so that, perhaps, six nodes would have to be traveled before a connection
is made (Cerella, 1990). This rerouting of activation would most likely
lead to an increase in response time, although semantic priming effects
would still be obtained.
Regardless of the experimental methods adopted, most studies have
used a single task or a few very similar tasks. In order to evaluate semantic
memory functioning accurately, it may be necessary to incorporate a
number of tasks to include various levels of task difficulty and processing
demands. Hodges, Salmon, and Butters (1992) administered five tests of
semantic memory functioning to a group of Alzheimer's patients and
age-matched controls. The tasks included category fluency, picture nam
ing, item sorting (according to superordinate and subordinate categories),
within-category word-picture matching, and elicitation of verbal defini
tions. It is important to note that the same stimuli were used for all tasks.
A loss of information from semantic memory should be evidenced by the
same pattern of item-specific errors across tasks. However, if the semantic
network remains intact but access and retrieval problems arise, random
errors should occur across tasks. The Alzheimer's subjects had a signifi
cant decline in performance relative to the controls for all tasks, and their
performance was dramatically impaired for detailed category information
and low-frequency words. Finally, there was a direct item-to-item corre
spondence of errors across tasks. Therefore, Hodges et al. conclude that
declines in the semantic memory functioning of Alzheimer's patients are
caused by a loss or degradation of information in semantic memory. In
addition, they postulate that this loss of information proceeds in a pro
gressive fashion, such that category and detailed information is lost before
more general information is lost.
Bayles, Tomoeda, Kaszniak, and Trosset (1991) followed the same
logic and administered 11 different tasks to a group of Alzheimer's
subjects and controls. The tasks were confrontation naming, auditory
word-to-picture matching, dictation, reading comprehension, oral read
ing, definition generation, coordinate naming, superordinate naming,
superordinate matching, pantomime expression, and pantomime recogni
tion. The same stimuli were used for all tasks, and the series of tasks were
administered to the subjects in each of several successive years. A total
of 69 Alzheimer's patients were tested, and in no case was there evidence
for an item-specific loss of semantic information. Instead, p e r f o r m a n c e

was dependent upon the difficulty of the task, suggesting that the
ability to p e r f o r m complex semantic search and retrieval processes was
impaired.
Clearly, the nature of the deficits in the semantic memory functioning
of Alzheimer's subjects has yet to be resolved, although the weight of the
evidence seems to favor the hypothesis that semantic memory remains
intact in Alzheimer's disease, but access to this system is disrupted.
Preservation of Grammar
Unlike semantic aspects of language, grammar appears to be buffered

from the effects of Alzheimer's disease (Kempler, 1991). This dissocia
tion of the semantic and grammatical aspects of language is the reverse
of the typical aphasic pattern usually resulting from focal brain d a m a g e
(Caplan, 1987). Irigaray (1973) found that semantic impairments were
more prominent than phonological and grammatical ones among a group
of dementing patients. This observation has been confirmed in case
studies reported by Whitaker (1976) and Schwartz, Marin, and Saffran
(1979). Whitaker's patient was echolalic (i.e., repeated or echoed the
examiner's words) but nonetheless able to detect and correct phonologi
cal, morphological, and syntactic errors in test sentences, although she
ignored semantic anomalies. The patient studied by Schwartz et al. was
able to act out sentences using grammatical cues such as word order and
the passive verb morphology, despite severe semantic impairments.
Differential Diagnosis
Further evidence for the dissociation of grammatical and semantic

aspects of language comes from comparing the performance of Alzhe
i m e r ' s patients with that of patients with focal brain damage on a variety
of standardized diagnostic tests. Dementing adults are typically distin
guished from aphasic patients by their performance profiles. Table 4.1
summarizes the findings of Appell, Kertesz, and Fisman (1982) with
regard to the distribution of different aphasic syndromes among Alzhe
imer's patients and stroke victims. Note that agrammatism, or a disruption
of morphological and syntactic processes, is not characteristic of Alzhe
imer's disease but is a common characteristic of Broca's, transcortical,
and global types of aphasias.
Table 4.1 Frequency of Aphasic Syndromes Among Alzheimer's and

Stroke Patients (in percentages)
Syndrome Alzheimer's Stroke
B r o c a ' s (agrammatic, comprehension

deficits, nonfluent) 0 19
Wernicke's (impaired comprehension,
impaired naming, intact syntax, reading
and writing deficits) 28 11
Conduction (poor repetition, fluent,
good comprehension) 4 9
Transcortical sensory (preserved repetition,
poor comprehension, fluent) 16 9
Transcortical motor (preserved repetition,
agrammatic, good comprehension) 0 5
A n o m i c (impaired naming, good comprehension,
fluent but empty, circumlocutions) 20 30
Global (impaired expression,
impaired comprehension) 24 14
SOURCE: Adapted from Appell et al. (1982). Used by permission.
Syntactic Complexity
Two studies have explicitly examined the preservation of syntax in

Alzheimer's disease. Kempler, Curtiss, and Jackson (1987) compared the
use of different syntactic constructions in spontaneous speech by Alzhe
imer's patients and age-, gender-, and education-matched healthy adults.
Like the healthy controls, the Alzheimer's patients made f e w syntactic
errors such as omitting obligatory morphemes or subject-verb agreement
mismatches. Further, the Alzheimer's patients were as likely as the healthy
adults to produce complex sentence structures, such as passives, sentences
with relative clauses, and sentences with infinitive complements.
Kemper, LaBarge, et al. (1993) examined written sentences produced
by adults as part of a neurodiagnostic screening test. Only one sentence
per individual was analyzed, but sentences were collected f r o m 174
healthy adults, 75 adults with questionable or very mild dementia, 91
adults with mild dementia, and 28 adults with moderate dementia. Cog
nitive measures on a variety of different tests of mental ability were
available for each adult.
In the primary analysis, Kemper, LaBarge, et al. assigned a complexity

score to each sentence using Lee's (1974) Developmental Sentence Scor
ing (DSS). In addition, the researchers determined sentence lengths in
words and clauses, and scored each sentence for propositional complexity
by counting the number of basic ideas in each sentence. Although sen
tence length and propositional content declined with the degree of demen
tia, even the sentences produced by the mild and moderately demented
adults were grammatically well formed and complete.
Nonetheless, syntax does appear to be affected by the general cognitive
deficits associated with Alzheimer's disease in that DSS scores declined
with the degree of dementia. A loss of working memory capacity, as
measured by digit span tests, was associated with this decline in syntactic
complexity. The sentences produced by the demented adults, compared
with those produced by the nondemented adults, contained simpler verb
forms; fewer clause embeddings such as gerunds, relative clauses, and
infinitive complements; fewer subordinate clauses; and fewer conjunctions.
Thus a typical response of a moderately demented adult was "My name is
" or "I am at _ hospital," whereas a typical response of a nondemented adult
was "I walked in the park today before I came to the hospital."
Summary
According to modularity theory, these group comparisons and single-
case studies support the existence of an autonomous syntactic module that
may operate independent of an impaired semantic/lexical module. These
studies have also been interpreted as supporting a distinction between
automatic and controlled processes (Schneider & Shiffrin, 1977). Auto
matic processes (e.g., grammatical processes) operate without attentional
control and are acquired through extensive practice; automatic processes
are also fast, usually error free, and operate in an all-or-none fashion.
Controlled processes (e.g., semantic processes) require attentional control;
consequently, they are slow and error prone, and can be terminated prior to
completion. The semantic deficits of Alzheimer's patients have also been
attributed to underlying pathologies of visuospatial abilities (Becker, Huff,
Nebes, Holland, & Boiler, 1988; Martin, 1987; Mendez, Mendez, Martin,
Smyth, & Whitehouse, 1990) that are unrelated to grammatical processing.
Disruption of Communication
A variety of cognitive problems contribute to the disruption of commu

nication with Alzheimer's patients. Attention deficits, including the in
ability to focus or sustain attention on tasks, short-term or working

memory problems associated with the retention of information over short
intervals of time, and long-term memory deficits associated with semantic
memory as well as episodic memory all contribute to communication
problems. When combined with word-finding problems, these cognitive
deficits lead to a gradual curtailment of conversational skills and, even
tually, to withdrawal and mutism. In the early stages of dementia, these
communication problems may be masked by the patient's intact gram
matical system in that speech remains fluent and marked with speech
formulas such as familiar greetings and responses.
The earliest manifestations of communication impairments appear to
result from the breakdown of the semantic system. They include the
overuse of deitic terms such as here and there or it and this (Hier,
Hagenlocker, & Shindler, 1985; Hutchinson & Jensen, 1980; Nicholas,
Obler, Albert, & Helm-Estabrooks, 1985; Ulatowska, Allard, & Donnell,
1988). Empty or vague terms are frequently used by dementing adults,
including nonspecific references to things or stuff and pronouns without
traceable references (Nicholas et al., 1985). A loss of information is
evident in storytelling or picture-description tasks (Bayles, B o o n e ,
Tomoeda, Slauson, & Kaszniak, 1989; Ulatowska & Chapman, 1991), as
is increased repetition and redundancy (Hier et al., 1985). Compare, for
example, the descriptions of a Norman Rockwell picture given by a
healthy older adult, an adult with mild Alzheimer's disease, and an adult
with moderately severe Alzheimer's disease in Table 4.2.
The speech of Alzheimer's patients is unlike that of healthy older adults
in several regards. First, there is a marked dissociation between syntax
and semantic/discourse content. In the picture description given by the
healthy older adult, complex syntactic constructions appear to serve an
informative or semantic function; in picture-description tasks, syntactic
complexity is correlated with propositional content (Kemper, Anagnopoulos,
Lyons, & Heberlein, in press), at least for healthy older adults. This does not
appear to be the case for picture descriptions by Alzheimer's patients. The
Alzheimer's patient's description in Table 4.2 is syntactically well struc
tured, apart from the high incidence of sentence fragments owing to
word-finding problems, but semantically disorganized and vague.
Second, healthy older adults vary the form and content of their speech
in response to situational factors. Word choices, syntactic forms, sentence
cohesion, and so on typically vary according to different task demands
and assessments of the mutual knowledge and shared presuppositions of
speaker and listener. Unlike healthy older adults, Alzheimer's patients do
not appear to modify their speech to accommodate to situational factors
Table 4.2 Descriptions of a Norman Rockwell Drawing Provided by a

Healthy Older Adult, an Adult With Mild Alzheimer's Disease,
and an Adult With Moderately Severe Alzheimer's Disease
Healthy adult
T h e r e ' s probably a grandmother and a grandfather with their grandchild praying for
the . . .
. . . At the meal.
Perhaps it's dinner because they have one bowl there and their service and it looks like
it's in the olden times.
They have a checkered tablecloth.
She has an apron.
It looks like he has a suit on and the little boy has dark pants and a white shirt.
And, t h e y ' r e holding hands.
And, they have cane chairs.
The seats are cane.
I told you they were praying, didn't I?
T h e r e ' s a cupboard of some kind back here.
I d o n ' t know what that is.
Or, maybe it's a pillar.
I d o n ' t know.
And the floor?
Let's see.
M a y b e it's a wood floor.
1 think t h e y ' r e saying grace together.
I see one fork.
And they have napkins.
Mildly demented adult

Well, let's see.
I don't. . .
I don't. . .
Oh, well, it looks like a family's gonna eat some dinner.
Well, let's see.
Then . . .
There is something else.
Well, I ' d say that t h e y ' r e all . . .
But. . .
Well, t h e y ' r e bowing their heads.
. . . Before they eat or something like that.
(continued)
THE EFFECTS OF A L Z H E I M E R ' S D E M E N T I A 81
master this speech register? Which accommodations are necessary and

which are only incidental? How do task demands and contextual factors
affect the utility of such speech accommodations? Can speakers gauge the
appropriate level or degree of accommodation required as a function of
the cognitive status of their listeners? The available research base is far
f r o m adequate to answer these questions.
Conclusion
The tragedy of Alzheimer's disease provides a jigsaw puzzle model of

how different components of language interact. This pattern of semantic
memory impairments, preserved syntactic processes, and pragmatic dis
ruptions resulting in empty speech, discourse incoherence, and uninfor
mativeness may map onto a distinct pattern of neuropathology. Some
studies using computerized tomography, magnetic resonance imaging,
and positron emission tomography have linked neuropathology in the
frontal and temporoparietal association cortex to semantic memory defi
cits, neuropathology of subcortical limbic areas to attention and memory
disturbances, and intact neurological functioning in the motor and sensory
cortex to preserved grammatical abilities (Benson et al., 1983; Fox, Topel,
& Huckman, 1975; Kaszniak et al., 1978).
This pattern of neuropathology suggests that the linguistic and cogni
tive impairments associated with Alzheimer's disease are modular. This
term refers to a theory of the architecture of cognition, modularity theory,
advocated by Fodor (1982), that distinguishes among cognitive systems
on the basis of seven criteria:
1. Cognitiv e modules are domain specific and operate only on information

of the appropriate type.
2. Modules ' operation is mandatory and automatic.
3. Module s are opaque to central processes, hence their operation is not
influenced by, for example, desires or goals and their operation is not open
to introspection.
4. Module s are informationally encapsulated such that only the output of any
module, not the products of intermediate computational steps, is available
to other modules or the central system.
5. Module s are fast as a consequence of the previous criteria.
6. Th e outputs of modules are shallow because they are insensitive to context,
task demands, or background variation.
82
Interpersonal Communication in Older Adulthood
7 . M o d u l e s h a v e a fixed n e u r o l o g i c a l architecture, h e n c e t h e y a r e s u b j e c t t o
characteristic p a t t e r n s of n e u r o l o g i c a l p a t h o l o g y a n d o n t o l o g i c a l d e v e l o p m e n t .
Language disorders, particularly aphasia and dementia, provide strong

support for modularity theory. Aphasia is characterized by the impairment
of language comprehension and/or production, in one or more modalities,
without the concomitant impairment of cognition. Because aphasic dis
orders can be quite specific, these characteristic patterns of linguistic
breakdown suggest that there are separate phonological, syntactic, and
semantic submodules within the language module (Caplan, 1987;
Grodzinsky, 1990). Although Alzheimer's dementia involves the general
deterioration of some language functions served by association areas and
limbic structures, the neuropathology appears to spare other aspects of
language served by motor and sensory areas. Thus semantic memory
impairments and disruptions of pragmatic aspects of communication
coupled with preserved grammatical abilities are characteristic of Alzhe
imer's dementia and consistent with modular theories of cognition.
Speculations
Most research on Alzheimer's disease is grounded in a biomedical

model. The emphasis is on pathology, etiology, diagnosis, and treatment.
Caregivers are primarily viewed as "auxiliary medical personnel"; care
giver burden or stress is discussed as proportional to the stage or progres
sion of the disease (Lyman, 1989). It is not surprising, therefore, that
psychological and behavioral research on Alzheimer's disease has also
been grounded in this biomedical framework. The concern with mapping
out the correspondence between neuropathologies and linguistic patholo
gies is but one manifestation of the dominance of this framework. The
need for effective caregiver speech accommodations to "treat" commu
nication problems posed by Alzheimer's disease, analogous to the search
for effective pharmacological treatments, is another.
Dannefer (1984) has called for a "sociogenic" perspective on dementia.
This shift in perspective would de-emphasize the biomedical aspects of
dementia. A sociogenic perspective would emphasize interpersonal inter
actions within socially structured contexts. As a consequence, research
on neurolinguistic aspects of dementia would give way to research on
discourse interactions between cognitively impaired adults and others in
a variety of different relationships and social environments. To date,
Table 4.2 (continued)

And there's food on the table.
Let's see.
Did they say their prayers?
Moderately demented adult

There's a lady.
I guess that's something to eat.
There's . . .
. . . To e a t . . .
. . . Looks like . . .
There's a . . . a bed . . . no
I see there's a man.
This is the mother, I guess.
There's a young person there.
This one has . . .
The man has a . . .
It's a . . . a . . .
She has a . . .
. . . Something to hold him . . .
(Kemper, Anagnopoulos, et al., in press), perhaps, because they are no

longer sensitive to situational variations.
As a consequence of the breakdown of the semantic system, the substi
tution of deitic terms and vague terms for specific referents, the dissocia
tion of syntax and semantics, and the loss of discourse adjustments,
communicating with Alzheimer's patients poses many problems for
spouses and other caregivers. Alzheimer's patients themselves may be
come socially withdrawn, irritable, and physically agitated as their efforts
to communicate or to understand others fail. Self-help books and manuals
for caregivers are filled with recommendations aimed at helping them to
maintain communication and interpersonal relationships with Alzhe
imer's patients, such as "Avoid open-ended questions"; "Repeat, re
phrase, and restate"; and "Be direct." Research, however, has only
begun to assess the effectiveness of such communication management
techniques.
Recently, a special speech register, sometimes termed "elderspeak,"
has been described as an accommodation to the special challenges of
communicating with cognitively impaired older adults; elderspeak may
84
Interpersonal Communication in Older Adulthood
also be evoked by negative stereotypes of older adults and, hence, also

addressed to older adults who are presumed to be cognitively impaired
(Caporael, 1981; Caporael & Culbertson, 1986; Caporael, Lukaszewski,
& Culbertson, 1983; Ryan, Giles, Bartolucci, & Henwood, 1986; see also,
in this volume, Giles et al., Chapter 7; Hummert, Chapter 8). Elderspeak
has been characterized as involving a simplified speech register with
exaggerated pitch and intonation, simplified grammar, limited vocabu
lary, and slow rate of delivery. Kemper (1994) compared speech samples
collected from a variety of individuals directed to older adults, including
demented and nondemented nursing home residents, and compared them
with speech samples collected from the same individuals but directed to
young adults. These pairs of speech samples were carefully matched for
content and discourse style, so that any systematic differences between
the two sets of samples could be attributed to accommodations to the age
of the listeners. The speakers appeared to use a common elderspeak
register; they reduced sentence length and grammatical complexity, used
fewer connectives, avoided long words, and used more sentence frag
ments, lexical fillers (e.g., "you know"), and repetitions when talking to
older adults. However, these speech samples did not appear to vary with
the mental status of the listeners; the common eliciting cue seemed to
be the age of the listener. Pauses within and between sentences were
lengthened and diminutives (e.g., honey, dearie) were used more often
with dementing adults than with either institutionalized or community-
dwelling older adults, but otherwise speech addressed to dementing
adults by health aides, exercise leaders, and craft instructors did not
appear to be finely tuned to the communicative limitations of dementing
adults.
In contrast, spouses of Alzheimer's patients seem to be particularly
adept at adjusting their speech to facilitate communication with dement
ing adults (Kemper, Anagnopoulos, et al., in press). When confronted with
the challenge of describing a picture so that their spouses could pick it
out from among four thematically related pictures, spouses of Alzhe
imer's patients were able to reduce syntactic and semantic complexity
while restricting mentions to highly salient pictorial elements. These
speech adjustments appeared to aid comprehension, as correct picture
selections were associated with lower complexity scores and restricted
content.
Further research examining how spouses and other caregivers can learn
to accommodate to the challenges of communicating with Alzheimer's
patients is warranted. How much direct experience is required in order to
T H E E F F E C T S OF A L Z H E I M E R ' S D E M E N T I A 79
researchers have largely neglected the study of communication by and

with dementing adults from a sociogenic perspective.
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5
Presbycusis, Communication,
and Older Adults
W I L L I A M A. V I L L A U M E
MARY HELEN BROWN
RIEKO DARLING
N u m e r o u s stereotypes persist about how elderly adults c o m m u n i c a t e .

They may be seen as tending to withdraw, to repeat themselves, to
dominate conversations, to speak loudly, and/or to tell long stories (see
Ryan, K w o n g See, Meneer, & Trovato, Chapter 2, this volume). C o n
sequently, they may be considered less than competent and may be
spoken to as such. Although these stereotypes may have s o m e observa
tional basis in reality (see Gold, Arbuckle, & Andres, Chapter 6, this
volume), the communicative habits of elderly individuals d o not indi
cate that the elderly passively accept the negative effects of aging. In
fact, their communicative patterns often include proactive strategies for
coping with the stress imposed on communication by aging. In particu
lar, our research has documented the use of such strategies by older
adults coping with the normal hearing loss associated with aging
(Villaume, Brown, et al., 1993; Villaume, Darling, B r o w n , Richardson,
& Clark-Lewis, 1993; Villaume & Reid, 1990). This age-related hearing
loss was labeled presbycusis by Z w a a r d e m a k e r (cited in L o w e l l &
Paparella, 1977), who first described it in 1891.
In this chapter we explore the effects of presbycusis on communication.
We begin by reviewing the literature about presbycusis in the communi
cative experience of the elderly. We then reconceptualize presbycusis
along two dimensions and present qualitative data illustrating how elderly
83
persons cope conversationally with these two dimensions. We conclude

by outlining implications for communicating with elderly speakers.
Presbycusis and the Aging Process
Early conceptualizations of presbycusis focused primarily on the obvi

ous decrease in hearing sensitivity experienced by elderly persons. Cur
rent conceptualizations also focus on the reduced ability to understand
speech insofar as some hearing-impaired people experience abnormal
difficulty distinguishing among phonemes—the crucial sounds used in
language to mark the differences between words—and ultimately, there
fore, meanings (Gaeth, 1948). Further, as G'aeth (1948) points out, this
phenomenon occurs more frequently among persons over 50 years of age.
When compared with the entire population, elderly people are more
likely to have some degree of hearing impairment. The 1988 National
Health Interview Survey of 21.9 million persons revealed a 4.9% preva
lence rate of hearing impairment among persons aged 18 to 44 years, a
14.8% rate among those aged 45 to 64 years, a rate of 27.4% for persons
65 to 74, and a 38.1% prevalence rate for persons 75 years and older
(Shewan, 1990).
Presbycusis is insidious in onset,'and its course is one of progressive
and gradual deterioration. However, the exact mechanism of deterioration
cannot be specified (Lowell & Paparella, 1977). Investigators have long
tried to identify the pathological basis for this decline. Research examin
ing anatomical and physiological effects of aging on hearing has shown
that all portions of the auditory mechanism, from the outer ear to the
auditory cortex, can be affected (Konigsmark, 1969; Nerbonne, 1988;
Rosenwasser, 1964).
Aging affects the outer ear system primarily by changing the properties
of the cartilaginous structures, skin, and glands. Also, older persons
experience a loss of rebound and elasticity in the outer ear (Mahoney,
1987). Major age-related changes found in the middle ear include thin
ning of the tympanic membrane, atrophy of muscles and tendons, ossifi
cation of joints, and calcification of the auricular cartilage (Etholm &
Belal, 1974; Marshall, Martinez, & Schalman, 1983). Age-associated
changes in these outermost portions of the peripheral auditory system
typically impede the reception and conversion of sound waves into
vibrations of the tympanic membrane and the bones of the inner ear.
P R E S B Y C U S I S , C O M M U N I C A T I O N , AND O L D E R A D U L T S 85
However, these changes have minimal impact on clinical measures of

hearing (Anderson & Meyerhoff, 1982).
Inner ear manifestations of presbycusis usually are attributed to age-
related changes in the cochlea, where patterns of vibration are translated
into neural signals (Schuknecht, 1974). Recently, Soucek and Michaels
(1990) have claimed that age-related patterns of hair cell loss in the cochlea
account for the loss of hearing sensitivity involved with presbycusis.
Age-associated changes are also known to occur in the central auditory
system, including the nerves directed toward the brain from the inner ears,
various auditory neural pathways within the brain stem and the brain, and
the auditory cortex (Arnesen, 1982; Brizzee, 1985). The task of the central
auditory system is to interpret the patterns of nerve impulses as intelligi
ble speech. Neils, Newman, Hill, and Weiler (1991) report that "decreased
central auditory processing occurs independent of peripheral auditory
changes" (p. P74). Many elderly persons frequently complain that they
can hear but they cannot understand. In clinical settings this complaint
has been confirmed inasmuch as older persons show significantly poorer
speech discrimination skills when compared with younger persons with
the same degree of hearing sensitivity (Jerger, 1973). This phenomenon
has been labeled "central presbycusis" (Stach, Spretnjak, & Jerger, 1990;
Welsh, Welsh, & Healy, 1985).
The clinical assessment of auditory dysfunction begins with audiomet
ric measures using pure tone stimuli to determine the degree of hearing
sensitivity loss. This first stage is followed by audiometric measures using
speech stimuli in an attempt to determine the extent of difficulty in
discriminating and understanding speech (Jerger & Jerger, 1981). The
majority of speech discrimination procedures ask listeners to indicate how
well they perceive and understand speech by using a simple recognition-
type response. Accuracy is often scored as a percentage of the number of
items correctly identified out of the total number presented. Test items
may range from nonsense syllables to monosyllabic and multisyllabic
words, to real and synthetic sentences, to connected speech (Martin, 1989;
Olsen & Matkin, 1991). The purpose of the evaluation often determines
which speech stimuli are selected for use (Konkle & Rintlemann, 1983).
Presbycusic listeners typically experience greater hearing loss for high-
frequency than for low-frequency tones (Moscicki, Elkins, Baum, &
McNamara, 1985; Neils et al., 1991). Thus they have particular trouble
distinguishing consonants such as f , s, th, and k (Botwinick, 1984).
Although these sounds may carry little of the power of speech, they
contribute greatly to speech intelligibility (Gerber, 1974). Diminished

sensitivity for these higher-pitched sounds has significant implications
for how elderly persons may apprehend the content of speech by detect
ing, discriminating, and recognizing words, phrases, and sentences.
The effects of hearing loss on elderly persons are compounded by the
poor listening conditions often present in normal social settings (Nittrouer
& Boothroyd, 1990). Such conditions include simultaneous conversation,
environmental background noise (such as music, television, or general
noise), interrupted speech, and reverberation (Grady et al., 1984; Konkle,
Beasley, & Bess, 1977; Moller, 1981; Nabelek & Robinson, 1982; Ryan,
Giles, Bartolucci, & Henwood, 1986). Thus elderly persons may be at a
distinct communicative disadvantage in comparison with younger con
versational participants in many normal social settings.
The Communicative Impact of Presbycusis
As presbycusis decreases ability to process the content of speech, the

relational aspects of an elderly individual's life are adversely affected
(Carmichael, 1988; Herbst, 1983; Thompson & Nussbaum, 1988). For ex
ample, hearing losses may lead an elderly person to have reduced confi
dence in his or her ability to communicate, and may make it less likely
that he or she will initiate conversations or ask for clarification when
meaning is not clear (Nussbaum, Thompson, & Robinson, 1989). These
factors may reduce the chances for successful aging (Nussbaum, 1985).
Derbyshire (1984) notes that hearing-impaired individuals are likely to
suffer from anxiety, depression, and social isolation. Similarly, Herbst
(1983) reports that presbycusis decreases social engagement and enjoy
ment, even when general health and other physical disabilities are con
trolled for. When faced with the stress of hearing loss, some elderly
individuals may find it most expeditious simply to give up on communi
cation. As Tomb (1984) notes: "Presbycusis can drag a host of problems
in its wake. . . . If you can't hear, communication is difficult. . . . Talking
becomes hard work—it is simpler just to withdraw within y o u r s e l f '
(p. 23).
The situation may not be as bleak as Tomb suggests, however. Gener
ally, elderly individuals are capable of developing compensatory coping
strategies to deal with physical and mental challenges and to help them
move through the aging process successfully (Nussbaum et al., 1989).
Aid win (1991) maintains that during the aging process individuals are
PRESBYCUSIS, COMMUNICATION, AND OLDER ADULTS 87
exposed to a wide variety of stressors, including hearing loss, and test a

number of coping strategies to give them control over situations. She
contends that "a sense of control may be particularly important to well
being and even longevity in the elderly" (p. 174). Further, Aldwin asserts
that older individuals are not by nature passive copers. Rather than use
the escapist strategy described by Tomb (1984) in response to presbycusis,
they are likely to choose some more effective type of proactive strategy
for coping. For example, elderly individuals often employ lipreading to
apprehend phonemes that they can no longer discriminate aurally (Stephens
& Goldstein, 1983). In conjunction with lipreading, they may use infer
encing strategies to decipher or anticipate the content of an interlocutor's
utterances (Dancer, Pryor, & Rozema, 1989).
Such strategies may work well as long as the loss of information within
an utterance has not become too great. Inferring the content of a whole
utterance is a riskier strategy when the individual has heard only a few of
the words in the utterance. Thus strategies used to cope with relatively
early stages of presbycusis may become dysfunctional in later stages.
Reconceptualizing Presbycusis
Recognition of the communicative impact of presbycusis is dependent

upon the nature of one's model of communication (see Coupland, Giles,
& Wiemann, 1991). As individuals become unable to distinguish the
phonemes of a language, they suffer losses in apprehending and under
standing words, phrases, clauses, and sentences. When language is as
sumed to function as the basis for a conduit or transmission model of
communication (Reddy, 1979), presbycusis is viewed primarily as an
obstacle to the linear transfer of verbal information.
Dynamic models of communication transcend this linear approach to
emphasize the relational aspects of communication (Brown & Rogers,
1991). From this perspective, speech cannot be adequately modeled
solely as language because speech simultaneously utilizes nonverbal
codes. How something is said nonverbally provides extensive relational
information about the flow of conversation, the nature of the interaction,
the purpose of the current utterance, and how the speaker regards the
interlocutor. Thus communication theorists have stressed that the mean
ing of a message results from the interaction between the content and
relational dimensions (Watzlawick, Beavin, & Jackson, 1967), or the
message and the metamessage (Tannen, 1986).
The Relational Dimension

of Presbycusis: Paralanguage
Paralinguistic nonverbal cues include such features as tone of voice,

pitch, stress, rhythm, volume, intonation, and rate of speech. These
features comment metacomtnunicatively on how the words are to be
interpreted. Usually, paralanguage is tacit. We become explicitly aware
of it only under problematic situations. For example, the delivery of a
memorized speech is often marked by faulty paralinguistic patterns that
no longer facilitate, but actively impede, interpretation of the words.
Paralinguistic cues function in several ways to support and supplement
the content dimension of conversation. Communicative functions accom
plished paralinguistically in speech are (a) linguistic preprocessing func
tions, (b) discourse integration functions, (c) personal affect functions,
and (d) interpersonal relational functions.
In the first function, paralinguistic cues serve as linguistic preproces
sors that facilitate the literal interpretation of the words in an utterance.
For example, intonation, rate, and pausing are often used to indicate the
boundaries of phrases and clauses because syntactic rules can judge these
boundaries only in retrospect. The paralinguistic marking of syntactic
boundaries provides additional cues to break up an utterance into its key
constituents and facilitate its interpretation (Bollinger, 1989).
Second, paralanguage often facilitates the integration of the current
utterance into the ongoing interpretation of a conversation. The most
widely known form of this function is the use of stress and intonation to
mark the difference between given and new information (Levelt, 1989).
The third function of paralanguage is to exhibit personal affect in the
voice. Mehrabian and Ferris (1967) estimate that speakers express 38%
of their attitudes through paralanguage. Frick (1985) has reviewed studies
showing that specific emotions (e.g., happiness, sadness, anger, fear) can
be reliably discriminated from one another on the basis of tone, intona
tion, rhythm, pitch, volume, and other features of the voice. This expression
of emotion is particularly important as a form of feedback in conversation.
Finally, paralanguage performs interpersonal relational functions during
conversation. Duncan and Fiske (1985) have noted the paralinguistic
features in the code regulating the turn-taking system of conversation.
Other participants in conversation read these paralinguistic markers and
know when they may assume the role of current speaker.
Speech accommodation also relies upon paralinguistic features (Giles
& Smith, 1979). If the speakers in a conversation identify with each other,
their use of paralinguistic features becomes more similar. For example,

their rates of speech and pausing will tend to converge until they share
roughly the same rates. Conversely, speakers who are repulsed by each other
exhibit a divergence in the use of these features. Such patterns help to
establish and regulate the relationship of the participants in conversation.
Research on the
Relational Dimension of Presbycusis
Cognitive psychologists have reported that elderly persons exhibit

increased reliance on paralinguistic cues to comprehend and recall speech
in response to age-related declines in working memory capacity. For
instance, Wingfield, Lahar, and Stine (1989) have shown that a lack of
prosody or intonation has a greater negative impact upon content recall
for older adults than for younger adults. In a related study, Wingfield,
Wayland, and Stine (1992) determined that when prosody and syntax
conflict, elderly individuals are likely to reconstruct sentences to be
consistent with the prosody. Finally, Cohen and Faulkner (1986) found
that increased paralinguistic stress on focal elements significantly as
sisted the elderly in apprehending and remembering the content of spoken
messages.
At the same time, a number of studies have found that elderly persons
exhibit decreased ability to process the paralinguistic cues that are so
important to their comprehension of speech. Neils et al. (1991) describe
losses in the ability to process and recall sequences of tones. According
to Hooyman and Kiyak (1988), presbycusis interferes with the apprehen
sion of emotions that are conveyed paralinguistically. Likewise, Lieberman,
Rigo, and Campain (1988) report that elderly females are worse at
decoding paralanguage than are college-age females.
Intriguing evidence that presbycusis also involves auditory losses along
the relational dimension of communication comes from two recent studies
by a research team at Auburn University (Villaume, Brown, et al., 1993;
Villaume, Darling, et al., 1993). Both studies utilized a pool of 28
participants across four age groups (7 young adults, 20-30 years old; 6
middle-aged adults, 40-50 years old; 8 young-old adults, 60-71 years old;
and 7 old-old adults, 77-89 years old). Each group included a range of
normal and hearing-impaired persons. Participants took a series of audiomet
ric and speech discrimination tests as well as the Watson-Barker Listening
Test, Form A (Watson & Barker, 1983). Subjects were then paired to
participate in 10-minute unstructured conversations. The initial audio

metric examinations were conducted to determine appropriate presenta
tion levels for stimuli in the speech discrimination tests. The Watson-
Barker Listening Test is composed of 50 multiple-choice items following
a series of recorded stimulus texts. Five subscales measure five types of
listening ability, differentiated by type of content presented, type of
interpretation required, and length of retention. The tests and conversa
tions all took place in an acoustic booth normally used for audiological
examinations. Thus the acoustic environment was at an optimal level, free
from reverberation.
Villaume, Darling, et al. (1993) report that a factor analysis of the three
speech discrimination scores and two subscores of the Watson-Barker
Listening Test yielded a two-factor solution. The first factor, accounting
for 38.5% of the variance, represented the ability to apprehend the
relational dimension of communication. Loading on this dimension was
one subsection of the listening test in which the participants used paralin
guistic cues to apprehend indirect emotional meanings of either positive
or negative valence. Also loading on this dimension was one of the speech
discrimination tests in which paralinguistic features such as intonation
and rhythm are an important basis for differentiating simultaneously
presented utterances. The second factor accounted for 26.8% of the
variance and represented the traditional conception of presbycusis as loss
in the ability to discriminate among phonemes and the ability to under
stand the verbal content of messages.
The most important finding was that the two dimensions of presbycusis
exhibited different patterns of aging. Although this conclusion is tenta
tive, because it is based on cross-sectional rather than longitudinal data,
it is nevertheless heuristic because it accounts for some noted gaps in the
theoretical description of presbycusis. The traditional content dimension
exhibited a linear relationship to age. Small initial losses were observed
in those in their 20s. Further losses appeared gradually and consistently
in individuals in their 30s, 40s, and 50s. The continuing losses experi
enced by individuals in their 60s, 70s, and 80s were often severe. On the
relational dimension, however, individuals aged 20 through late 60s
showed little decline, but those in their late 70s and 80s had great losses.
These data suggest a relatively late decline in relational listening ability
that matches Nerbonne's (1988) observation that some significant aspects
of presbycusis do not appear until the mid-70s. Similarly, Neils et al.
(1991) contend that significant changes in central auditory processing
occur in the late 70s and early 80s.
P R E S B Y C U S I S , COMMUNICATION, AND OLDER ADULTS 91
Villaume, Darling, et al.'s (1993) results establish that the experience

of presbycusis is more difficult for the old-old than for the young-old. The
young-old participants had fairly severe losses on the content dimension
of listening but relatively little loss on the relational dimension. In
contrast, the old-old participants exhibited major losses on both the
content and relational dimensions. If paying attention to paralinguistic
cues is a coping strategy employed by older persons (Stine & Wingfield,
1987), then the old-old are considerably more handicapped in employing
this strategy than are the young-old.
A subsequent study by Villaume, Brown, et al. (1993) examined whether
patterns of conversational behavior were predicted by the interaction of the
content and relational dimensions of presbycusis. It was assumed that
adjustments to the loss of content are a matter of relational concern.
Frequent requests for repetition and clarification can become bothersome
and annoying; the presbycusic individual must gauge the interlocutor's
response to such requests in order to coordinate the conversation smoothly
and happily with the interlocutor.
If presbycusic individuals past their mid-70s have problems hearing the
relational cues in the interlocutor's voice, adjusting to the interlocutor
may become an uncertain and risky process. Villaume, Brown, et al.
(1993) liken the process to "shooting blindfolded at a moving target"
(p. 6). They assessed the pattern of conversational adjustment for presby
cusic individuals by coding three sets of conversational features: aligning
actions, relational control patterns, and verbal immediacy.
Aligning actions are explicit verbal forms of metacommunication used
to manage problematic conversational situations (Ragan, 1983; Stokes &
Hewitt, 1976). Among the forms of aligning actions coded were confir
mations/back channels (e.g., "uh huh"; "right"; "Isn't that the case?"),
remediators/clarifiers (e.g., "Well, not exactly . . . "; "I mean . . . "), and
intensifies (e.g., "a lot o f ' ; "without a doubt"). Villaume and Reid (1990)
found the use of aligning actions to be curvilinearly related to age, with their
use increasing in middle age and falling off considerably in the late 70s.
Relational control patterns (Millar, Rogers, & Courtright, 1979) are
useful in assessing whether in any given utterance a speaker claims
control of the relationship (a one-up move), shares control (a one-across
move), or abdicates control (a one-down move). Three derivative meas
ures are computed. Transactional redundancy measures the relative vari
ability of control moves. The more a speaker relies upon one particular
type of control move, the greater the transactional redundancy. Relational
intensity reflects the strength of each control move and thereby differentiates
strong control moves from weak ones. Relational distance measures how
closely the intensity of a speaker's control move matches the relational
intensity of the interlocutor's previous control move.
Verbal immediacy is an indicator of a speaker's use of lexical choices
to indicate identification or involvement with the topic or interaction
(Wiener & Meharabian, 1968).
A factor analysis of the coded conversational features yielded a three-
factor solution. The first factor accounted for 39.3% of the variance and
represented relational dynamism marked by low transactional redun
dancy, high relational intensity, high relational distance, and f e w confir
mations/back channels. The second factor accounted for 19.0% of the
variance and represented distancing in conversation as indicated by low
verbal immediacy and few confirmations/back channels. The third factor
accounted for 16.0% of the variance and represented high use of reme
diators/clarifiers and intensifiers.
Using multivariate multiple regression, the researchers found that
content and relational listening ability and their interaction accounted for
57.2% of the variance in the three conversational factors. Relational
dynamism in conversation was significantly predicted by relational lis
tening ability and by the interaction of the two dimensions of presbycusis,
but not by content listening ability itself. Low verbal immediacy in
conversation was significantly predicted only by content listening ability.
Neither listening ability significantly predicted the third conversational
dimension (use of remediators/clarifiers and intensifiers).
These results indicate that how elderly speakers participate in conver
sation depends upon the relative configuration of the hearing loss they
experience on the content and relational dimensions of presbycusis. T h e
content dimension of presbycusis has no direct connection to the flexible
use of various relational moves in conversation, but leads only to de
creased immediacy in vocabulary choice. However, losses on the rela
tional dimension of presbycusis are linked with a decreased variety of
relational moves in conversation. Villaume, Brown, et al. (1993) conclude:
"As long as elderly individuals maintain their relational listening ability, they
maintain their relational dynamism in conversation while adapting to severe
losses on the content dimension of presbycusis" (p. 17).
Conversation of the Young-Old and Old-Old
In order to assess further how the young-old (60-71 years old) and
old-old (77-89 years old) adjust conversationally to differences in pres
bycusis, we conducted a qualitative post hoc study of the transcripts used

in Villaume, Brown, et al. (1993). We matched two young-old and two
old-old dyads for content listening ability. However, the four young-old
participants had significantly better relational listening abilities than did
the four old-old participants. In each age group, one dyad was composed
of strangers and one of social acquaintances.
The first pattern evident in the transcripts was that all four dyads talked
extensively about both their past and their present experiences. Topics
included work experiences, church and community experiences, vaca-
tions, retirement activities, volunteer activities, and, finally, the status and
activities of children, grandchildren, and acquaintances. No systematic
differences in topics were evident between the young-old and the old-old
dyads.
The major difference between the young-old and the old-old dyads lay
in the strategies employed by the interactants to create and maintain their
topics of conversation. The young-old speakers developed and main-
tained topics in a dynamic fashion, with utterance-by-utterance negotia-
tion of the direction their talk would take. Instead of abrupt topic shifts,
they tended to use topic shading, whereby one topic would slowly evolve
into another.
A topic introduced by one speaker would often turn into a shared topic.
When responding to the comments of a speaker about his or her topic,
young-old interlocutors would use confirmations or continuers, typically
followed by clarifying questions or sensitive extensions. Thus the inter-
locutor exhibited considerable influence on how the speaker further
developed the topic, as is evident in the following excerpt of conversation
from a young-old dyad (A is a 62-year-old male; Β a 62-year-old female).
They have been discussing their Christmas plans. A, his wife, and his son
Blair (a college student home for the holidays) are going to visit A's sister
and her family. Β has just asked whether A will go hunting while he's
down there.
1 A: We g o n n a see what the weather's like and, m y brother-in-law

2 is n o t a b l e t o w a l k l i k e h e u s e d t o . H e h a s s o m e , s o m e
3 a r t h r i t i s , s o m e s p u r s o n h i s h i p — h i p a n d s p i n e a n d s o it
4 h u r t s h i m t o w a l k a lot. B u t w e m i g h t try t o s c a r e u p
5 something.
6 B: M m m m m , Well d o e s Blair like to hunt as well as y o u d o ?
7 A: N o o o . H e d o e s n ' t , h e d o e s n ' t l i k e it t o o m u c h .
8 B: Uh huh
9 A: He . . . in fact he'll, he not even gonna get a license. He'll

10 just go and visit for a while. He'd rather sleep in rather
11 than get up and go.
Here, in line 6 speaker Β confirms and acknowledges A's observation

with " M m m m m " and then asks a question to clarify whether A's son
Blair might be available as a hunting partner. Interactants A and Β then
begin a discussion of Blair and his situation that extends well beyond
this excerpt. Thus, by bringing Blair into the conversation, speaker Β
has substantively affected the conversation's direction.
The mutual engagement of the young-old speakers was also evident in
collaborative completions whereby one speaker finished the utterance of
the other speaker. Members of these dyads seemed to have a good sense
of the flow of the conversation. In fact, several times it happened that
young-old dyads would smoothly double back to pick up earlier topics.
For example, two 66-year-old female interactants were attempting to
determine how they might know one another. The following exchange
took place (from lines 90-97, as numbered in the original transcript):
90 C: I can go back, yes. I now keep active with my church and

91 D: Uh huh
92 C: that was my husband and my mother and my church and my home
93 was about enough
94 D: Uh huh. Well, now, you're a member of the Methodist church
95
96 C: Village Christian
The strong phrasing of line 94 seems to imply that D is a member of the

Methodist church or at least well acquainted with the Methodist church.
Much later (line 317), when the current topic has been exhausted,
speaker C uses a definite reference to reintroduce the Methodist church
into the conversation and to ask for confirmation that D is a member of
that church. Even though there has been no intervening reference to any
church, C seems to prefer checking out a previous assumption from
earlier in the conversation to introducing an entirely new topic. And D
seems to find this move entirely appropriate.
317 C: Sure. You go to the Methodist church?

318 D: Yes
319 C: Uh huh
320 D: Our back door neighbors, the Driscolls, go.

321 C: Oh ya. His first wife was a real close friend of mine.
Thus C has kept the conversation going by reinvoking a prior entity in

the conversation that D can be presumed to be involved with and
capable of discussing.
Finally, the young-old speakers seemed aware of the work required to
save face not only for themselves but also for their interlocutors. They
were able to exert influence on topic development in a polite and sensitive
fashion, using variable patterns of relational control. Thus they were able
to engage in talk with sensitivity to their interlocutor and the evolving
interaction. Most of these characteristics are evident in another tran
scribed segment of conversation by the two young-old females.
1 D: Well, I uh didn't join, rejoin the women's club . . . when my

2 husband went away, we went away for him to get a Ph.D. and
3 when we came back I just didn't rejoin. I started doing
4 other things, and then started working pretty soon after that
5 so . . .
6 C: Ya, ya
7 D: So, just didn't have time to go into that or I guess I would
8 have met up with her again.
9 C: Well, I did the unheard of. I resigned from Auburn Women's
10 Club hahaha
11 D: (big laugh) When was this?
12 C: Well my husband retired, and then he had open heart surgery
13 and then my mother was so ill and I just had to concentrate
14 one day at a time, and 11 just couldn't.
15 D: Couldn't be a member of everything could you?
In this conversational excerpt the speakers move smoothly through a

conversation describing mutual acquaintances and experiences. They
both point out that they've left the women's club, but for different
reasons that are confirmed by the conversational partner. In lines 9-10,
speaker C admits to resigning from the club. This admission is con
firmed in line 11 by speaker D's laughter and clarifying question,
"When was this?" Speaker C then describes the various problems that
led to this action. In line 15, speaker D indicates her sensitivity toward
C ' s position by completing C's last independent clause in line 14.
In contrast, the old-old dyads did not exhibit the mutuality of topic
development evident in the young-old dyads. Confirmations and con
tinuers often stood starkly without additional clarification or extension.
As a speaker developed his or her topic, the interlocutor relied on short
passing moves that exerted minimal influence on the direction of topic
development. Speakers were relatively free to develop their topics in the
directions they chose. These topics, however, never developed the shared
mutual perspective evident in the talk of the young-old dyads. Such a
pattern is evident in the following conversation in which W (a 78-year-old
female) and X (a 79-year-old female) are discussing trips that they and
their friends have taken.
1 W: . . . and I looked at those. Now Dorrin mother and her daddy

2 went on one of those last February, uh, a Mediterranean
3 cruise and just they said it was the most wonderful thing.
4 They wanted the wholllle family to go. But, and then they
5 went to Alaska in the summertime, but they had a nephew there
6 and they could stay with him ...
7 X: Ya Mmmmhmmm
8 W: . . . and he could direct em. And if they were tired and
9 didn't feel like going, they didn't have to go. But with a
10 group, so many of the trips I went on, I had to room by
11 myself because I didn't want to get with someone that smoked
12 ((laughter)) and somebody that drank and so if you don't know
13 who you're getting with . . .
14 X: You sure don't know.
15 W: And so I said "OK Billie I'm just gonna pay the extra and
16 just be by myself. So that's what I did for the last several
.17 trips I wou—Martha Moore was my roommate . . .
In this excerpt, Speaker W conducts a monologue on her experiences

with traveling. Speaker X limits herself to brief supportive utterances
in lines 7 and 14 that are neither acknowledged nor acted upon by
speaker W, who simply continues her discourse as though X ' s responses
never occurred.
Essentially, the old-old speakers seemed to agree implicitly that one
speaker would speak as long as he or she wanted, while the other speaker
offered passive support. In one old-old dyad the same speaker maintained
dominance through most of the 10-minute conversation. The other old-old
dyad (speakers X and W in the last excerpt) also had one dominant speaker
at any given moment. However, speakers X and W took turns being the
dominant speaker, as is evident in the following excerpt regarding how
their travel has been restricted because of changes in health.
1 X: I didn't go to the meetings and all

2 W: Uh huh ya
3 X: because you know she . . .
4 W: I know Bess was . . .
5 X: . . . (mumble) for seven, well, six years, oh six years in the
6 nursing home.
7 W: Yes, I know . . .
8 X: and then, I don't know how many years before . . .
9 W: mmmmmhm
10 X: . . . she started 'cause I retired a little early because . . .
11 W: because of her health.
12 X: mmhmmmm It's something to go through.
13 W: Well, you know, my husband was not sick too long . . .
14 X: Uh huh
15 W: . . . we knew that he had, when he retired when he was eighty,
16 we knew that there was something wrong but we didn't know
17 what it was and it was a form of leukemia then but it went
18 into uh recession
19 X: Uh huh
20 W: and uh, uh course it didn't come back then for five years so
21 we didn't know what it was, but uh mmm it was just that uh we
22 and five good years together.
23 X: Ya. mmhmmm
24 W: . . . where he was not working . . . (W continues with a long utterance
and the pattern continues)
In lines 1-12, speaker W provides brief acknowledgments, confirma

tions, and continuers (lines 2, 4, 7, 9) that support speaker X's discussion
of how Bess's being in a nursing home limited X's activities. In line 11,
speaker W provides a cooperative completion of X ' s incomplete utter
ance in line 10. When X confirms this completion with " m m h m m m m "
and provides a formulation that summarizes and concludes the segment
(line 12), W is able to introduce in line 13 the related topic of how her
"husband was not sick too long." As speaker W launches into an
extended discussion of her husband's illness, speaker X reverts to the

supportive role, with brief confirmations in lines 19 and 23.
Finally, there were occasions when an old-old participant would step
out of the supportive interlocutor role and confront the dominant speaker
in the midst of that person's developing a topic. Usually this move was
to question a fact or detail. However, the most significant aspect of such a
move was that it often involved a serious issue of impression management
(Goffman, 1959) for the dominant speaker. In fact, as in the following excerpt,
the confrontation could become quite intense. Y, an 84-year-old female, and Z,
an 80-year-old female, are discussing Y's grandson. (The onset of simultane-
ous talk in this excerpt is indicated by brackets across utterances.)
1 Y: Well, he's uh one more year at the University of Michigan,

2 and he came down, he's in Botany, and he talked to Ron
3 Roberts
4 Z: Mmhm
5 Y: And then he went over and Ron gave him the names of several
6 of the professors. He's interested in doing his graduate
7 work in Auburn.
8 Ζ In what now, did you say?
9 Y Botany
10 Ζ Botany?
11 Y And I thought it was so interesting for him to choose
12 Ζ . Well that's not
13 what Ron Roberts is
14 Y Yes, he's a botanist.
15 Ζ Is he a botanist? I didn't know he was a botanist.
16 Y .Mmhm, yes, Mmhm
17 Ζ 1 thought he was in Engineering
18 Y No, no
19 Ζ Well, why did they call him back after he retired?
20 I thought they retired him.
21 Y .Well, he's L He does, he does some, I don't
22 know whether he's still continuing some research, I never
23 have asked him what he does, but he he goes back over there.
24 Most of them usually go back and do
25 Ζ: I don't know why I thought it was Engineering, I guess
26 because after that
27 Y: No, Dean Bickle was head of Engineering

28 Ζ: I know he was Dean of Engineering, but I was thinking Ron was
29 in Engineering.
30 Y: Mmhm
31 Z: But he's a botanist. Well, I didn't know that.
Until this point, speaker Ζ has played the passive interlocutor sup-
porting speaker Y's talk about her grandson. Two details in lines 2-3
cause speaker Ζ some difficulty in interpretation. After an initial ac-
knowledgment in line 4, Ζ requests clarification in line 8 that the field
is botany and then confirms the clarification in line 10 by repeating,
"Botany." Finally, in lines 12-13, Ζ rejects Y's implication that Ron
Roberts is in botany. When Y affirms in line 14 that "he's a botanist,"
Ζ softens her stance in line 15 by again requesting confirmation and
then by a disclaimer. But in lines 15 and 17, Ζ reverts to stronger
challenges of Y's repeated contention that Roberts is in botany. In line
27, Y tries to provide a cooperative explanation of Z's misunderstanding
by suggesting that Ζ has confused Ron Roberts and Dean Bickle, only
to have Ζ reject that explanation in lines 28-29.
At this point the relationship between the speakers is in peril. Ζ has
pushed the issue to the point that one speaker must be wrong. Finally, in
line 31, Ζ accepts that Ron Roberts is a botanist and admits to not having
known that. The problems involved in this interaction could have been
avoided if Ζ had stopped after making the same point in line 15. The
confrontation in this episode has imparted a much more energetic tone
that carries on in the conversation for another 20 utterances. After that,
however, the pattern of one dominant speaker and one passive interlocutor
resumes for the remainder of the conversation.
Conclusions
The study presented above explicates a major difference in the conver-

sational styles of young-old and old-old speakers that seems to be asso-
ciated with the onset of a second dimension of presbycusis in the old-old
speakers. Dyads consisting of young-old speakers exhibited a dynamic
development of topics in which both speakers exerted influence on the
direction of their talk on an utterance-by-utterance basis. Members of
young-old dyads were flexible in how they responded to each other and
sensitive to the flow of their interaction. The young-old speakers talked
about events and concerns appropriate to their age, but their interactional
patterns were marked by vitality, flexibility, and dynamism. In contrast,
members of the old-old dyads relied on a restricted conversational style.
While one speaker dominated the conversation, the other played a passive
supporting role and exerted little influence on further development of the
current topic. The old-old speakers were more rigid and less mutual in
their conversations than were the young-old speakers.
This difference in conversational styles seems to be associated with the
onset of the second dimension of presbycusis. The young-old and old-old
dyads in this study had equivalent losses on the first dimension of
presbycusis and therefore had equal difficulty in hearing the content of
their interlocutor's comments. They differed only insofar as the old-old
participants had significantly greater losses on the relational dimension
of presbycusis. The restricted conversational style of the old-old partici
pants may be a rational response to a situation of heightened uncertainty
brought about by their added inability to discern their interlocutors'
paralinguistic cues. Focusing on the concerns of one speaker or the other
lessened their need for a fine-grained reading of relational feedback. This
restricted pattern seems to be functional given an understanding of the
constraints imposed on old-old persons by severe hearing losses on both
dimensions of presbycusis.
The programmatic research of Wingfield and his associates has spelled
out how older adults may compensate for decreases in working memory
during conversation by increased attention to the paralinguistic cues
involved in prosody (Stine & Wingfield, 1987; Wingfield et al., 1989,
1992). In effect, then, the onset of the second dimension of presbycusis
is especially troubling for old-old persons because it deprives them of a
primary adaptive strategy that they may have relied upon during their
young-old years. As long as the participants had not suffered severe losses
on the second dimension of presbycusis, prosody and other paralinguistic
cues helped to fill in gaps in the interpretation of content. However, when
old-old individuals lost their ability to hear and discern paralanguage,
they seemed to switch to a restricted conversational style as an adaptation
to a severely constrained communicative situation.
Much additional research is needed to determine the precise nature of
the auditory losses involved in the second dimension of presbycusis. Do
hearing losses occur across all aspects of paralanguage or only on certain
forms of paralanguage? What are the physiological and neurological
changes that account for the onset of the second dimension of presby
cusis? Are these changes located in the peripheral auditory system or in

the central auditory system?
When the second dimension of presbycusis has been described in
sufficient detail, it may be possible to determine whether hearing aids can
be redesigned to counteract losses on the second dimension of presby
cusis. The results of this study indicate that mechanical assistance is
probably more important for the second dimension of presbycusis than
for the first dimension.
Additional research is needed to determine whether some old-old
speakers have developed dynamic strategies for coping with major losses
on both dimensions of presbycusis. Perhaps presbycusic old-old speakers
can be trained to retain relational dynamism in their conversations and to
resist adopting a strategy of only one dominant speaker at a time. If such
training is not possible, perhaps teaching old-old individuals about the
second dimension of presbycusis and its communicative effects can
relieve some of the stress they experience in social situations.
Reactions to Restricted Conversational Style
The restricted conversational pattern of old-old presbycusic individuals

may trigger some extremely negative stereotypes of the old-old among
younger people. It may appear that old-old speakers want to talk only
about topics of interest to themselves and withdraw f r o m topics intro
duced by other speakers. Although the behavioral pattern reflected in this
stereotype is somewhat accurate, the stereotyped attribution of increas
ingly egotistical motivation is unjustifiably damning.
The most immediate pragmatic impact of this study may be in helping
younger people to adapt their expectations of conversation with the
old-old. With training, younger people may be able to think of their
conversations with presbycusic old-old people more along the lines of
story swapping. Under this format, mutuality is judged not so much by
how each utterance accommodates to the immediately prior utterance, but
more by how longer conversational segments relate to prior segments.
Whereas younger participants may be able to j u d g e rather quickly how
involved or engaged a younger interlocutor is by assessing patterns of
relevance within one short conversational segment, such judgments would
be premature for older adult interlocutors. Their involvement may be
manifested only by how they interconnect several longer successive
segments of conversation. Asking younger adults to assess the conversa
tional involvement of older adults on a segment-by-segment rather than
an utterance-by-utterance basis involves asking them to make consider

able adjustment to normal conversational procedures. Research is needed
to determine whether younger speakers may be trained to make such a
counterintuitive adaptation.
Training may also help younger people to appreciate the magnitude of
the communicative hurdles faced by old-old speakers with presbycusis.
Feelings of exasperation and frustration normally occurring in reaction to
preoccupied, inattentive, or uninterested people are not appropriate in
reaction to elderly speakers. Older speakers who persistently seek repe
tition or clarification from their interlocutors are striving to remain
engaged and involved in the conversation. They should not be discour
aged by overt exasperation.
Finally, research is needed to determine appropriate speech adaptations
for professionals who deal with the elderly. For example, the heightened
paralanguage associated with elderspeak may assist some older individu
als in dealing with the loss of relational listening ability, but care must be
taken to avoid the demeaning word choices and patronizing tone often
associated with such a style of speaking to the elderly (Ryan, Bourhis, &
Knops, 1991; see also Hummert, Chapter 8, this volume). Another helpful
strategy might be to describe explicitly one's emotional reactions in
words when conversing with old-old individuals. Such explicit lexicali
zation of emotional reactions is not a normal pattern, and must be learned.
Psychological counselors are trained to lexicalize emotions; geriatric
professionals might benefit from the same type of training.
In summary, in this chapter we have explicated how old-old individuals
suffering from the onset of the second dimension of presbycusis utilize a
restricted conversational style. Their inability to hear paralinguistic cues
in speech and thereby to apprehend relational feedback from their inter
locutors impedes their flexible and dynamic involvement in conversation.
Clearly, it is heuristic to differentiate the communicative impacts of the
two dimensions of auditory loss involved in presbycusis. Research is
needed to define the exact nature of the loss in relational listening ability
and to determine which communicative adaptations are feasible and
helpful for older adults with both dimensions of presbycusis. In the
meanwhile, awareness of the second dimension of presbycusis may help
younger adults to appreciate the communicative difficulties faced by
presbycusic old-old individuals and to eliminate the negative stereotypes
they may attach to these old-old speakers.
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5
Verbosity in Older Adults
DOLORES PUSHKAR GOLD

T A N N I S Y. A R B U C K L E
DAVID ANDRES
W h e n we first began working with older adults, w e were vividly

impressed by how often we encountered extremely verbose elderly
people, a p h e n o m e n o n we had never experienced in research with
children and only very infrequently observed in younger adults. S o m e
people produced such extreme amounts of irrelevant speech that we
were curious about how they functioned in their daily lives, how other
p e o p l e responded to them, and the processes underlying such speech
behavior. Consequently, we developed a research program to investi
gate this type of speech in older adults, which we labeled off-target
verbosity, or O T V (Gold, Andres, Arbuckle, & Schwartzman, 1988).
Abundance and lack of focus are two salient characteristics of off-target
verbosity (Gold et al., 1988). Although typically prompted by a specific
external conversational stimulus, OTV quickly becomes a series of loosely
associated verbalizations that stray more and more f r o m the original topic.
Conversations with individuals who produce high levels of O T V quickly
lose their interactive nature as the talk becomes a monologue. The content
that is inserted consists of material associated with but irrelevant to the
nominal topic of conversation. It typically consists of reminiscences
A U T H O R S ' N O T E : The research reported in this chapter was f u n d e d by grants f r o m the

Social Sciences and Humanities Research Council of Canada, le Conseil Q u e b e c o i s de la
Recherche Sociale, the Natural Science and Engineering Research Council of C a n a d a ,
and the Canadian Aging Research Network.
107
about the speaker's past, presented not as a coherent reflection on the past,
but rather as a disjointed series of narrations of past life events. The
characteristics of both copiousness and lack of coherence must be present
for speech to be characterized as OTV. Abundance of speech in itself is
not sufficient to constitute OTV, as prolonged speech can remain focused
in presenting either a logically and/or temporally related narrative se
quence or an organized enrichment and development of a topic.
A typical example of OTV occurred during an answer to a structured
interview question given by a 74-year-old female respondent (Gold,
Andres, Arbuckle, & Zieren, 1993). The following verbatim excerpt taken
from the research transcript of this interview illustrates the copiousness
of the speech and the difficulty in maintaining focus that result in dis
jointed and irrelevant one-way talk:
Interviewer: How often do you see your daughter?

1 Respondent: I've gone down there twice, she's only been there three
2 years. It's only an hour and 23 minutes by plane, but she said, "What the
3 poop are you coming down for?" Because it was the Royal Commonwealth
4 Conference and since they were preparing for Prince Edward and so she
5 said, "Are you coming?" And so I phoned up Air Canada and I said I wanted
6 a ticket. So I went the next day and it was my birthday and since it was my
7 birthday and I had 12 little roses from my garden in a wata ase. And I
8 went back and I said, "Don't us poor senior citizens get a bitak?" and she
9 said, "Why yes, dear," she said and took $90.00 off my bill, but I wasn't a
10 delegate to the conference so I couldn't go to that, so my daughter phoned
11 Judge _ and the judge said, "No, its only for delegates," and I said,
12 "You mean I came all this way for nothing?" Anyway, we went to a dance
13 and my daughter was clapping and snapping with all these people from
14 Newfoundland, Oh my God, and she told all these people that it was her
15 mother's birthday and she made them all sing Happy Birthday and they gave
16 me a long-playing record. . . .
This participant contined to speak abundantly for many more minutes.

Clearly, this woman's reply took her far afield from the original topic of
how often she saw her daughter to events that were only distantly related,
if at all, to the original question.
Our research program on OTV has two important objectives. The first
is to develop reliable and valid measures for sampling OTV. The second
objective is to develop and test hypotheses regarding the psychological
processes underlying the production of OTV. A series of cross-sectional
V E R B O S I T Y IN OLDER A D U L T S 109
and short-term longitudinal studies of elderly people examining the cor

relates of and changes in OTV have addressed these objectives. In this
chapter we summarize our research on OTV, evaluating the significance
of the phenomenon for the cognitive and social functioning of elderly
people. In the following section we review evidence concerning the
reliability and validity of the OTV measures. We then present a discussion
of the theoretical issues involved in explaining OTV. In subsequent
sections we focus on the demographic, psychosocial, stress, and cognitive
correlates of OTV. We conclude the chapter with a summary of the current
state of the OTV research program and offer suggestions for further
research in the area of interpersonal communication and OTV. To aid the
reader, we provide a summary of the OTV studies discussed in Table 6.1,
at the end of the chapter.
Reliability and
Validity of Measures of OTV
Initial attempts to sample OTV resulted in a global classification scheme

that interviewers applied after conducting life-history interviews with elderly
community-based volunteers (Gold et al., 1988, Exp. I). The life-history
interview was chosen as a means of obtaining samples of OTV because the
interview format requires the production of past life events, which make up
the typical content of OTV. Furthermore, interviews require active participa
tion from the respondent and provide an opportunity for OTV to appear.
The interviewers independently classified respondents into one of three
categories of speech based on their responses to the interviews. The
category of Extreme Talker was used for people who were very verbose,
whose speech was a series of sequences of loosely related topics, who
provided much extraneous information, and who did so continuously.
Controlled Talkers were very chatty throughout, provided extraneous
information, but were guided more or less by the questions. Non-talkers
responded appropriately to the questions asked and made few extraneous
comments. Of 346 elderly people, with a mean age of 72.6 years, 21.4%
were classified as Extreme Talkers, 33.5% were classified as Controlled
Talkers, and 45% were classified as Non-talkers. However, interrater
agreement between the interviewers' initial classifications and classifica
tions made by an independent interviewer after conducting follow-up
interviews by telephone one year later was only 50%. This marginal level
of retest agreement was felt to be primarily a function of the methodology
employed, which required a sometimes difficult categorical judgment on
the part of the interviewers.
To obtain more reliable data, Gold et al. (1988, Exp. II) developed
quantitative Item OTV and Extent OTV measures. Item OTV was com
puted as the number of life-history items on which the respondent gave
extraneous information. For each item on which the respondent produced
off-target material, the interviewer also rated the sheer amount of extraneous
speech on a Likert-type scale, giving a measure of Extent OTV. These two
scores were tabulated separately in order to provide two distinct measures of
OTV: one for frequency and one for extent of OTV speech.
Gold et al. (1988, Exp. II) used these new measures, as well as the
global classification system, to analyze speech samples of 203 male army
veterans with a mean age of 65.3 years (for more information about this
second data set, see Gold et al., 1988, Exp. II). Interrater reliability
coefficients of .76 and .70 for Item and Extent OTV were obtained for the
interviewer and a second rater who listened to audiotapes of the inter
views for 98 men. Correlation coefficients for Item and Extent scores
obtained during the relatively unconstrained interview portion of the
session, as well as those obtained in a more constrained portion of the
session when the respondent was completing a questionnaire, were all
significant and ranged from .38 to .46. Item and Extent scores were highly
correlated with each other in both the constrained questionnaire and
unconstrained interview portions of the session, with coefficients of .87
and .89 for the two situations, respectively. OTV as indexed by Item and
Extent measures also corresponded to OTV as measured by global clas
sification. Using the classification method, 18% of the veterans were
classified as Extreme Talkers, 46% were classified as Controlled Talkers,
and 35% were classified as Non-talkers. Non-talkers were significantly
lower on all measures of Item and Extent OTV and took less time to
complete the session than did the other two groups. Extreme Talkers had
higher Extent scores in the interviews and took more time to complete
their sessions than did Controlled Talkers.
Later studies also obtained good levels of interrater agreement on Item
and Extent OTV scores. Gold et al. (1993) found interrater reliability
coefficients of .84 and .92 for Item and Extent OTV scores obtained
during interviews with a sample of 125 people (mean age = 74.2) living
independently in the community. Arbuckle and Gold (1993) achieved
interrater reliability coefficients of .91 and .82 for Item and Extent OTV
scores based on interviews with 205 people (mean age = 73.1).
Longitudinal data support the stability of the OTV measures (Gold,
Arbuckle, & Andres, 1992). Follow-up reclassification for 61 people from
Gold et al. (1988, Exp. I), obtained 6.5 years after initial classification,
V E R B O S I T Y IN O L D E R A D U L T S 111
demonstrated significant continuity in classification, with the majority of

individuals falling into the same categories as in the original study.
Furthermore, individuals who had been classified originally as Extreme
Talkers had significantly higher Extent OTV scores 6.5 years later than
did individuals who had been classified originally as Non-talkers. Simi
larly, other data (Gold et al., 1992) indicate highly significant continuity
of reclassification for 179 participants (87.3%) from the Arbuckle and
Gold (1993) study after a one-year period. Test-retest coefficients were
.51 and .64 for Item and Extent scores, respectively, indicating significant
continuity of classification after a one-year interval.
Other data support the validity of these measures of OTV, indicating
that they identify a generalized speech pattern that extends beyond the
interview situation. As part of the Gold et al. (1993) study, peers and
professional workers (ministers, community group workers, and so on)
who were well acquainted with the elderly interviewees rated the extent
to which the interviewees participated in various activities. Three items
embedded in the activity ratings sampled everyday talkativeness: the
extent to which the individual (a) participated in conversations, (b) talked
about the past, and (c) talked in general. These ratings were combined to
give a talkativeness score. Analysis showed that everyday talkativeness
as rated by peers and professionals correlated significantly with Item
(r = .39 and r = .32) and Extent OTV (r = .42 and r = .37) scores, although
confirmatory factor analysis supported a model in which everyday talka
tiveness and OTV were best represented as two latent correlated, but
largely independent, factors.
In sum, these studies demonstrate that the methods developed to sample
OTV are reliable and valid. These measures tap a speech style that,
although showing some situational specificity, is consistently used by
individuals over time and is related to their behavior outside the research
laboratory.
Theoretical Issues
There is a broad issue guiding our study of possible explanations of

OTV. Such speech can be conceptualized in two very different ways. It
can be considered as a normal, perhaps somewhat extreme, variation in
the range of individual differences among conversational behavior. Alterna
tively, OTV can be considered a sign of atypical aging and a harbinger of
declining function, probably of the cognitive processes underlying speech.
If OTV is best explained as falling within the range of normal social

behavior, then it may not be age related, but is probably a long-standing
individual adult characteristic best explained on the basis of psychosocial
variables, such as personality, social functioning, and stress. In particular,
OTV may be associated with the personality trait of extraversion. Extra
verts are socially active, at ease in social situations, and like interacting
with people (Costa & McCrae, 1986; Eysenck, 1973). Thus it is highly
probable that extraverted people talk more in social situations and may
be prone to displaying OTV.
However, OTV is communication that undoubtedly affects social rela
tions. The flow of words that a person with high rates of OTV produces
continues without pausing for the listener to respond. Frequently, the only
way the listener can break the flow is to interrupt, overlapping the speech.
Extreme OTV undoubtedly makes a strong impression upon a listener,
especially one unfamiliar with the speaker, and probably has some dys
functional effects on social relations. Furthermore, speakers who have
extremely high rates of OTV appear preoccupied with themselves, unin
terested in other people, and egocentric—that is, indifferent to other
people's perspectives. It has been suggested that lower amounts of social
contact and increased isolation can result in impaired communication
skills (Norris & Rubin, 1984). However, any correlation between social
activity and OTV is more likely the result of a causal effect in the other
direction. That is, high levels of OTV cause contact with the speaker to
be somewhat aversive for others, resulting in lower levels of social
support and less satisfaction with social support for such individuals.
In addition, older age is linked to normative age-related social and
economic losses, such as retirement from work, decreasing health, and
death of close friends and family members. It is possible that these
psychosocial stress-related factors can influence the appearance of OTV.
The loss of many of one's previous roles or their diminishment in impor
tance (Blythe, 1980) could stimulate a need to reinforce the concept of
self at this stage of life. The process of self-affirmation could, in turn,
further contribute to self-preoccupation. This type of self-affirmation is
more likely to be verbalized to others by more extraverted people. In
summary, it can be argued that a combination of extraversion, self-
preoccupation, and stress would produce higher levels of OTV; that a less
extensive and less satisfactory social context would be associated with
higher OTV; and, although these processes may be related to age, that
OTV would not indicate any underlying neuropsychopathology.
The alternative hypothesis is that OTV is an atypical process, presum

ably caused by underlying changes in the brain that come with age.
According to this view, variation in OTV across individuals would reflect
primarily individual differences in the extent or locus of age-related
changes in the brain, although the expression of OTV in language behav
ior might depend also on psychosocial factors. For example, any age-
linked deterioration in brain functions might be more evident in times of
stress and more apparent and measurable in socially outgoing, talkative
individuals than in those who are more retiring and reserved.
The hypothesis that OTV reflects some type of age-linked process of
deterioration means that OTV is necessarily related to age. However, if
correct, this hypothesis raises two additional issues about the nature of
OTV: first, whether the underlying problem is language specific or the
reflection of a more general cognitive deficit, and second, whether the
problem is attributable to a general deterioration of brain functions or
specific deterioration in a particular area of the brain. Attempts to evaluate
the adequacy of these two alternative hypotheses require study of the
demographic, psychosocial, linguistic, and cognitive correlates of OTV.
We review the research on these correlates of OTV in the following
sections.
Demographic Correlates of OTV
The only demographic characteristic that relates consistently to OTV

is age. In the OTV studies cited earlier (Arbuckle & Gold, 1993; Gold et
al., 1988, Exps. I and II; Gold et al., 1993), age was either significantly
different across OTV classifications or correlated significantly with Item
and Extent OTV scores. For example, in the study of 346 community-
based volunteers (Gold et al., 1988, Exp. I), Non-talkers had an average
age of 71.4, whereas Extreme Talkers had an average age of 73.0. In the
study of army veterans (Gold et al., 1988, Exp. II), Non-talkers had a
mean age of 64.2 and Extreme Talkers had a mean age of 66.9. Age and
Item and Extent OTV scores correlated at .20 and .24, respectively.
Similar, though slightly higher, correlations between age and Item and
Extent OTV scores are reported in Gold et al. (1993) and Arbuckle and
Gold (1993). In the former study, Item and Extent OTV scores correlated
at .32 and .38, respectively, with age. In the latter, Item and Extent OTV
scores correlated at .28 and .24, respectively, with age. Age has also been
found to correlate significantly with Item and Extent OTV scores among
somewhat younger participants. In an ongoing study of university gradu
ates (Gold & Arbuckle, 1993), age correlated with Item and Extent OTV
scores at .16 and .15 (p < .05), respectively, for a sample of 243 men and
women with a mean age of 55. The results, therefore, consistently indicate
that in cross-sectional samples of older individuals, there is a significant,
positive association between age and OTV, albeit at a low level of
magnitude, ranging from a low o f . 15 for people in their mid-50s to a high
of .38 for people in their mid-70s.
Despite this positive relationship between age and the incidence of
OTV, the results of two longitudinal studies generally do not support the
hypothesis that individual levels of OTV increase with time. In one
short-term longitudinal study (Gold et al., 1992), 179 participants from
the Arbuckle and Gold (1993) study were reinterviewed after a one-year
interval. Comparisons of percentage Item and Extent OTV scores indi
cated only a slight increase in mean percentage of items on which
participants gave OTV responses, resulting in a trend for participants to
respond with off-target material more often at follow-up than at initial
assessment. Extent OTV scores did not differ significantly across time.
Examination of the three-group OTV classifications for these participants
indicated that the percentage of participants who were classified as
Extreme Talkers did not differ at the initial and follow-up assessments:
17.2% and 16.9%, respectively. The majority (56.6%) of the participants
were rated in the same classifications on the two occasions, whereas
19.5% were rated in a more verbose direction and 23.9% were rated in a
less verbose direction. In the second longitudinal study of OTV, members
of a subsample of participants from the Gold et al. (1988) study were
independently reclassified into OTV categories after 6.5 years (Gold et
al., 1992). There was significant continuity of classification, with no
consistent shift in classification when changes did occur. Thus, over the
relatively brief period of one year, older individuals did not show any
consistent trend toward greater OTV. Likewise, no trend toward increased
OTV occurred over a longer period of time for a small sample, but this
may have been caused by selective attrition. Further longitudinal research
is required before we can draw any conclusions about the effects of aging
on OTV levels.
The relations between other demographic characteristics and OTV are
consistent across the OTV studies (Arbuckle & Gold, 1993; Gold et al.,
1988, 1993). OTV did not correlate with education, socioeconomic status
as measured by occupational prestige on the Blishen Scale (Blishen &
McRoberts, 1976), gender, or marital or employment status. Although

education did not have significant univariate correlation coefficients with
OTV, education did enter in the regression equations predicting Item and
Extent OTV in one study (Arbuckle & Gold, 1993). Education appeared
to function as a suppressor variable in the regression equations, possibly
through its shared variance with verbal fluency scores, increasing the
predictive efficacy of a variable set that included age, psychosocial, and
neuropsychological variables.
OTV in Relation to Psychosocial Variables
Extraversion and Other Personality Variables
In the three studies that examined the relationship between extraversion

and O T V (Arbuckle & Gold, 1993; Gold et al., 1988, Exps. I and II), a
significant positive association emerged between OTV and introversion/
extraversion as measured by the Eysenck Personality Inventory (Eysenck
& Eysenck, 1968). In Experiment I of the Gold et al. (1988) study, Extreme
Talkers scored higher on extraversion than did Non-talkers. Extraversion was
also one of the significant predictors of both Item and Extent OTV scores in
the Gold et al. (1988, Exp. II) study of army veterans, with unique effects of
.14 and .11 on Item and Extent OTV, respectively. In addition, extraversion
was a positive predictor in the regression equations for Item and Extent OTV
scores, with unique effects of .11 and .09, respectively, in the Arbuckle and
Gold (1993) study.
Longitudinal data (Arbuckle, Chaikelson, & Gold, 1993) confirmed the
association between extraversion and OTV for both these samples. A
sample of 143 veterans was retested on a variety of measures approxi
mately five years later. The follow-up data indicated that veterans who
had been classified originally as Non-talkers had significantly lower
current extraversion scores than did the veterans who had been classified
originally as Talkers. One year later, participants f r o m the Arbuckle and
Gold (1993) study were independently reclassified into the three-group
OTV categorization. Participants who were classified as Non-talkers were
significantly more likely to have obtained lower scores on extraversion
in the initial assessment than did the two Talker groups.
Lower concern with self-presentation is also associated with OTV,
although the association is not as consistent as that between extraversion
and OTV. For example, Extreme Talkers scored significantly lower than
Non-talkers on desire to present the self in a socially desirable fashion
(Gold et al., 1988, Exp. I), as measured by "Lie" scale scores on the
Eysenck Personality Inventory (Eysenck & Eysenck, 1968). Similarly,
lesser concern with the impression the self made on others was found to
predict significantly the OTV Item and Extent scores in the army veterans'
data set, with unique effects o f . 18 for both OTV scores (Gold et al., 1988,
Exp. II). One other finding is of relevance to the issue of self-presentation.
The sample of 125 elderly individuals in the Goldet al. (1993) study rated
themselves on everyday talkativeness, and their ratings were compared
with those made by friends and professional workers well acquainted with
them. The ratings made by peers and professionals correlated signifi
cantly and positively, at a moderate level, with Item and Extent OTV
scores. Self-ratings of talkativeness, however, correlated only with Item
OTV scores, and at a much lower level. These results support the hypothe
sis that individuals who score high on OTV do not realize how excessive
their speech is, although those well acquainted with them do, suggesting
that egocentricity is involved with the production of high levels of OTV.
Initial studies of the personality correlates of OTV also tested the
hypothesis that personal adjustment might be linked to OTV levels. This
hypothesis was based on the assumption that, given that the content of
OTV speech is reminiscence, such speech might represent a therapeutic
process of resolving past conflicts or, alternatively, might indicate unsat
isfactory resolution of earlier developmental issues (McMahon & Rudich,
1967). This hypothesis was not supported. Personal adjustment, as meas
ured by the Neuroticism scale on the Eysenck Personality Inventory or
self-ratings on the TriScale (Schonfeld & Hooper, 1973), was not associ
ated with OTV in any of the studies (Arbuckle & Gold, 1993; Gold et al.,
1988, Exps. l a n d II).
Furthermore, well-being as measured by the Memorial University of
Newfoundland Scale of Happiness (Kozma & Stones, 1993) has been
found to be significantly associated with OTV levels in only one study
(Arbuckle & Gold, 1993). In that study, well-being, although having an
insignificant univariate correlation with Item and Extent OTV (.07 and
.03, respectively), emerged as a significant predictor in the regression
equations, with unique effects of .21 and .16, respectively. Higher levels
of well-being predicted higher levels of OTV. This was an unexpected
finding; it appears likely that it was caused by well-being's acting as a
suppressor variable through its correlations with age and illness. That is,
given that well-being had very low zero-order correlations with OTV
scores, it is likely that for this sample well-being scores acted to suppress
irrelevant variance in age and illness in the regression equation, thus

clarifying their influence on OTV.
Stress
Results of the studies indicate that stress-related factors are related to

higher levels of OTV. In both Experiments I and II, Gold et al. (1988)
found that measures of specific types of stressors (e.g., self-ratings of less
adequate financial resources and greater difficulty with transportation)
and a greater negative impact of life events in general predicted OTV.
Similarly, Arbuckle and Gold (1993) found that poorer health predicted
Item and Extent OTV scores with unique effects of .16 and .18, respec-
tively. When 186 of the individuals participating in the Arbuckle and Gold
study were retested a year later, a composite score indicating negative
change on a combination of health, finances, family contact, residential,
and marital bereavement measures predicted higher levels for both Item
and Extent OTV scores (Gold et al., 1992).
Social Relations
Measures of· social relations show a consistent relationship to OTV.

Although social support did not enter as a significant predictor of army
veterans' OTV scores in the regression equations, the size of the social
support network of family members and friends was negatively correlated
with Extent O T V (r = - . 1 5 , ρ < .05). For the subsample of 143 veterans
who were reassessed 5 years later, those veterans who had been originally
classified as Extreme Talkers had significantly fewer family members
they could count upon to provide social support. Similar results were
obtained in the Gold et al. (1993) study, with Item OTV scores correlating
at - . 1 9 (p < .05) with the size of the social support network.
Satisfaction with social support also appears to be associated with OTV.
Item and Extent OTV were predicted by lower levels of satisfaction with
social support received, with unique effects of .19 and .20, respectively.
In addition, although it did not enter into the regression equations predict-
ing OTV scores, size of social support network correlated negatively with
Item and Extent OTV scores at - . 1 5 and - . 1 7 (Arbuckle & Gold, 1993).
Further, telephone contact with and visits f r o m family members were
significantly and negatively correlated with OTV scores with coefficients
ranging in the low .20s. When this sample was followed up one year later,
those individuals classified as Extreme Talkers were significantly less
satisfied with the social support they received from family and friends
than were the Controlled Talkers or Non-talkers.
Two other findings indicate associations between OTV and social
functioning. Extreme Talkers in the first and second data set were signifi
cantly lower on a measure of desire for independence in their activities,
presumably indicating a willingness to depend on others (Gold et al., 1988).
In addition, in the second data set, higher activity levels predicted Item and
Extent OTV scores, with unique effects o f . 15 and . 16, respectively.
Summary of Psychosocial Factors
The results of the analyses of the OTV studies provide consistent

evidence that higher levels of extraversion, higher levels of stress, and
lower levels of social support are associated with higher levels of OTV.
In addition, there is some evidence suggesting that individuals with higher
levels of OTV are less concerned with how they are perceived by others
and are less aware of their own propensity to talk abundantly than are
individuals with lower levels of OTV.
OTV in Relation to Cognitive Factors
Although OTV research indicates that the incidence of OTV is higher

at older age levels (Arbuckle & Gold, 1993; Gold et al., 1988), recent
research on speech production has found no evidence for a generalized
age-related increase in speech. Older adults do not differ f r o m younger
ones on measures of speech quantity such as number and length of
utterances and number of words per clause (Cooper, 1990; Kemper,
Kynette, Rash, Sprott, & O'Brien, 1989; Walker, Roberts, & Hedrick,
1988). Thus OTV appears to be an atypical process causing qualitative
changes in spoken language, rather than simply the upper end of a normal
distribution of talkativeness.
As can be seen from the example of OTV quoted early in this chapter,
what defines OTV, as opposed to general talkativeness, is lack of focus.
Verbal information that is irrelevant to the conversational context is
repeatedly intruded into speech. This phenomenon of an increase with age
in the intrusion of irrelevant information has been noted by other re
searchers studying speech patterns of the elderly. For example, Obler and
Albert (1981) found that older speakers used more evaluative and modi
ficatory terms, verbal output not directly relevant to the basic message.
Similarly, Glosser and Deser (1992) found that, whereas the speech of
older adults in their study did not differ f r o m that of young adults on
microlinguistic measures such as syntactic complexity, syntactic and
lexical production errors, and the use of lexical cohesive ties, the older
adults' speech showed much less global thematic coherence. The coher
ence measure was based on the extent to which subjects' verbalizations
provided substantive information that was directly related to the topic;
thus the older adults were off topic proportionately more than were the
younger adults. Glosser and Deser further note that this particular pattern
of age-related deficits in discourse production differed f r o m the one that
they had previously observed in fluent aphasia patients. For this reason
they conclude that age changes in spoken language probably do not result
f r o m disruptions in language-specific systems.
Findings f r o m OTV research by Arbuckle, Gold, Frank, and Motard
(1989) lead to the same conclusion. In that study, subjects classified as
either High OTV or Low O T V were asked to describe the Cookie T h e f t
picture f r o m the Boston Aphasia examination. Their productions were
scored in terms of the 12 categories of empty speech used by Nicholas,
Obler, Albert, and Helm-Estabrooks (1985) in a study of the Cookie T h e f t
descriptions given by aphasic and early dementia patients and by normal
elderly. As defined by Nicholas et al., empty speech refers to verbal output
that does not contribute to the description of the picture, including
repetitions, use of indefinite terms of reference, value j u d g m e n t s and
comments, and various types of paraphasia. The characteristics of the
speech samples for the High OTV group were very different f r o m those
reported by Nicholas et al. for their aphasia and dementia patients and not
significantly different f r o m those of the Low OTV group. These findings,
together with further work in our laboratory (Rainford, 1991) that has
failed to show any significant association between OTV and the microl
inguistic characteristics of speech, suggest that OTV, like the age changes
in spoken language studied by Glosser and Deser (1992), probably does
not result from disruptions in language-specific systems.
An alternative possibility is that the continued intrusion of irrelevant
information that is characteristic of OTV reflects an age-related decre
ment in attentional processes, specifically in the ability to inhibit irrele
vant information. Recent research on cognitive aging has provided strong
evidence that there is an age decline in the ability to inhibit task-irrelevant
thoughts. Studies by Hasher, Zacks, and their colleagues, using a number
of different learning and retention paradigms, have shown that older
adults are less able than younger ones to ignore or suppress irrelevant
information (Connelly, Hasher, & Zacks, 1991; Gerard, Zacks, Hasher, &
Radvansky, 1991; Hartman & Hasher, 1991; Hasher, Stoltzfus, Zacks, &
Rypma, 1991). At least at a conceptual level, the interference effects
described in this research literature appear similar to the speech intrusions
associated with OTV. As Gerard et al. (1991) point out, the increased rates
of irrelevant intrusions that characterize OTV can be readily interpreted
in Hasher and Zacks's (1988) terms as a reduced ability of older adults to
inhibit competing or irrelevant thoughts.
To examine further this cognitive explanation of OTV, Chaikelson,
Berkovic, Arbuckle, and Gold (1992) compared two groups of elderly
subjects previously rated as showing high OTV and low OTV, respec
tively, on Gerard et al.'s (1991) measure of retrieval interference in
recognition memory. In the Gerard et al. paradigm, subjects must recognize
items (targets) that are identical to ones that they studied previously and reject
items (foils) that are new combinations of previously studied items. Be
cause both targets and foils are made up of previously studied informa
tion, participants who have greater difficulty in inhibiting task-irrelevant
thoughts are likely to experience high levels of interference on the
recognition task, resulting in less accurate recognition and longer re
sponse latencies. Chaikelson et al. found that, although the two OTV
groups did not differ in accuracy of recognition of targets or foils,
response latencies were longer for the high-OTV group, particularly in
the case of foil items. The finding that the more verbose subjects were
more affected by the interference manipulation is consistent with Gerard
et al.'s report that older subjects in their study likewise showed larger
interference effects. Further, the finding of a stronger effect of OTV for
the foils is consistent with the hypothesis that, because a more extensive
search of memory is required to reject foils than to accept targets, more
interference would be generated with the foil items (Gerard et al., 1991).
In the cognitive aging literature as well as in studies of the speech of
older adults, this apparent difficulty in inhibiting irrelevant information
has been attributed to a decline in frontal lobe functions (Moscovitch &
Winocur, 1983; Obler & Albert, 1981). For example, Obler and Albert
(1981) speculate that what they term the "loquaciousness" of older adults
might be "related to a general tendency to disinhibition due to age-dependent
changes in the frontolimbic system" (p. 111). Moscovitch and Winocur
(1983) found that institutionalized elderly subjects resembled patients
with frontal lobe impairments in that they continued to show proactive
interference from previously presented stimuli even after a shift in task
demands that, in younger subjects, would be sufficient to dissipate the
interference.
The known functions of the frontal lobes include two that appear
particularly relevant to OTV. Patients with frontal lesions have difficulty
in making mental shifts, tending instead to perseverate responses that
were previously relevant. They also have difficulty in "holding back a
wrong or unwanted response particularly when it may have either a strong
association value or be part of an already ongoing response chain" (Lezak,
1983, p. 81). Consequently, as part of a continuing attempt to understand
the nature of OTV, Arbuckle and Gold (1993) examined the relationship
between OTV and a number of measures that were supposedly sen-
sitive to these functions. They hypothesized that measures that were
sensitive to these particular aspects of frontal lobe functioning would
prove to be significant predictors of OTV.
To evaluate this hypothesis, Arbuckle and Gold (1993) used Moscovitch
and Winocur's (1983) proactive interference measure and three stand-
ardized neuropsychological tests. Perseverative errors on the Wisconsin
Card-Sorting Task (WCST; Milner, 1964) provided a measure of degree
of difficulty experienced in inhibiting a previously relevant response.
Number of words produced when asked to give as many words as possible
beginning with the same letter (Controlled Word Association test; Benton
& Hamsher, 1976) provided a measure of the ability to inhibit the
interference from previously generated responses and strong semantic
associates. Finally, Arbuckle and Gold indexed difficulty in inhibiting the
next response in a sequence taking the difference between the time taken
to complete Form Β of the Trailmaking Test (Reitan & Davison, 1974),
which requires subjects to alternate between two highly overlearned
sequences (the alphabet and numbers from 1 onward), and the time taken
to complete Form A, which does not require such alternation. If OTV is
associated with problems in the particular aspects of frontal lobe func-
tioning assessed by these various measures, high OTV should be predicted
by greater difficulty in dissipating proactive interference, a greater num-
ber of perseverative errors on the WCST, fewer words produced on the
Controlled Word Association test, and more time taken to perform Form
Β relative to Form A of the Trailmaking Test.
To control for the possibility that OTV was not specifically related to
a decline in frontal lobe functioning but reflected a more general cognitive
decline, Arbuckle and Gold also included a set of neuropsychological tests
of verbal and visual memory. These were the Digit Span and Logical
Memory subtests of the Wechsler Memory Scale (WMS; Wechsler, 1945)
and a measure of the ability to copy and recall the parts of a complex
design (Sequential Geometric Design Test; Read, 1987). These tests are
considered to be relatively specific measures of temporal lobe and hippo

campal functioning.
Arbuckle and Gold found that decreased ability to inhibit irrelevant
information, as indexed by scores on the neuropsychological measures of
frontal lobe functioning, and decreased dissipation of proactive interfer
ence on the Moscovitch and Winocur task were both significantly asso
ciated with higher levels of OTV. In contrast, the measures of verbal and
visual memory were unrelated to OTV. These findings thus support the
hypothesized relation between OTV and frontal lobe functioning. Arbuckle
and Gold found further that the frontal lobe measures shared considerable
variance with age, so that, if they were entered before age in regression
analyses, they accounted for much of the variance in OTV that would
otherwise be attributed to an age effect. Thus it appears that the tendency
of OTV to increase with age that was observed by Gold et al. (1988) can
be at least in part attributed to an age-related decline in frontal lobe
functioning.
Conclusions
The research findings discussed above provide some explanation of the

factors underlying the production of high levels of OTV. First, despite the
need for further longitudinal research, it does appear that OTV is more
common among the elderly. However, the percentages of subjects classi
fied as Extreme Talkers have generally varied within a narrow margin,
ranging from 16.9% (Gold et al., 1992) to 21.4% (Gold et al., 1988,
Exp. I). Thus, although OTV is associated with age, only a minority of
elderly participants can be classified as extremely high on OTV. Further
more, it appears that the effects of age on OTV levels are associated with
declining frontal lobe performance.
The psychosocial variables of social relations, stress, extraversion, and
possibly egocentrism are associated with OTV but appear to be inde
pendent of age. The psychosocial variables in this combination can be
associated with OTV in different ways and are less likely to have straight
forward causal effects on OTV. Although older individuals with high rates
of OTV live in less extensive social support contexts, they do not appear
to be isolated or to have lower well-being than do more taciturn individu
als. Therefore, it is likely that any impairment of social functioning is
caused by the high levels of OTV rather than the opposite. Highly verbose
individuals make great demands upon the attention and patience of their
listeners, but are unlikely to recognize that they are doing so and to
reciprocate when others want their share of the conversational action.
Consequently, such individuals are at risk for losing people from their
support networks and eventually to become less satisfied with the atten
tion and support they receive from others. It should be pointed out,
however, that speech that is extremely low on OTV probably also has
dysfunctional effects on social relations. Just as everyday social conver
sations contain and require redundancy, so do they require some extension
of verbal response beyond the immediate eliciting stimuli. People who
respond only to what is immediately asked probably appear to others as
brusque, unfriendly, shy, or uninterested in maintaining the social rela
tionship. Therefore, a certain amount of OTV probably is an advantage
in social relations, especially with unfamiliar others.
It can be argued, from the viewpoint of individuals who produce high
levels of OTV, that it is the researchers' interview questions that are off
target to subjects' main objective of reviewing their pasts. Although it is
true that there may be somewhat different, even conflicting, agendas and
objectives between researchers and participants in the interview sessions
of the studies discussed above, the same is true of all situations involving
more than one actor. To establish adequate communication, a process of
mutual accommodation is required that has been called the "cooperative
principle" (Grice, 1975). Such a process, involving both participants in
the conversation, determines what is communicated and what is inhibited
(Hasher & Zacks, 1988). The OTV data suggest that individuals produc
ing high levels of OTV have more difficulty making the accommodations
necessary for successful communication. Hutchinson and Jensen (1980)
found a similar violation of the cooperative principle in the speech of
dementia patients who abruptly introduced unrelated themes in their
speech. They too characterized the intrusion of unrelated content into
speech as egocentric, attributing the cause of the egocentrism to declining
cognitive function.
The stress associated with OTV may be explained as caused in part by
the more dysfunctional social behavior of high-OTV people or their less
competent performance in situations requiring careful attention and con
trol. Alternatively, the higher stress levels may be caused by events
unrelated to OTV, but individuals who produce more OTV may respond
with even more irrelevant talk when experiencing higher levels of arousal
and need for self-affirmation caused by the stressors.
The most important psychosocial correlate of OTV is the personality
variable of extraversion. Extraversion may be related to OTV in a variety
I
Table 6.1 Summary of OTV Studies
Data Set Sample Cliuructeristics Measures of OTV Correlates of OTV Follow-up Findings
Gold, Andres, N = 346 males & interviewer classification lower desire for N = 61: follow-up reclassifications
Arbuckle. females; age range (Extreme Talker, reinforcement; lower obtained 6.5 yrs. after initial
& Schwartzman 65-93 yrs. (mean = Controlled Talker, self-rated adequacy of classification: majority fell in same
(1988). 72.6 yrs.); educational Non-talker) financing; older age; categories as in original study; those
Experiment I level mean = 1I .O yrs. more extroverted; lower originally classified as Extreme Talkers
social desirability set had significantly higher Extent OTV
scores; more difficulty scores than did those originally classified
with transportation as Non-talkers
~~
Gold, Andres, World War I1 Canadian Item OTV (number of lower social desirability N = 143;follow-up examination 5 years
Arbuckle, & army veterans: N = 203 interview items on which set scores; more after iniual interviews: veterans
Schwartzman males: age range 60-81 subject went off target); extroverted; greater originally classified as Non-talkers had
(19881, yrs. (mean = 65.3yrs.): Extent OTV (5-point social activity: higher lower current extroversion scores; those
Experiment I1 Blishen socioeconomic Likert scale ratings of levels of stress; originally classified as Extreme Talkers
prestige scores (mean = extent of speech); global combination of higher had less social support from family
46.5;upper working rating (Extreme Talker, young adult levels of
and lower middle class) Controlled Talker, nonverbal intellectual
Non-talker) performance with poorer
current scores
~
Gold. Andres. N = 125 males & Item O T V Extent OTV, duration of session; age:
Arbuckle, and females; age range talkativeness (self-rating, self, peer, and
Zieren (1993) 65-92yrs. (mean = peer rating, professional professional ratings of
74.2 yrs.); educational rating) talkativeness
level mean = 9.0yrs.
Arbuckle & N = 205 males & Item OTV; Extent OTV older; more extroverted; N = 179; reinterviewed after one-year
Gold (1993) females; age range less satisfied with social interval; slight increase in mean
61-91 yrs. (mean = support; poorer health; percentage of items on which OTV
73.4yrs.); educational slower Trailmaking Test responses given; extent O W did not differ
level mean = 13.2 yrs. performance; more across time; percentage of participants
perseverative errors; classified as Extreme Talkers did not differ
poorer word fluency; less at initial and follow-up assessments (17.2%
release from proactive and 16.9%, respectively); test-retest
inhibition coefficients .51 and .64for Item and Extent
OTV scores, respectively; higher Item and
Extent OTV scores predicted by higher
scores on negative life change measures;
participants initially classified as
Non-talkers had current lower extroversion
scores; participants originally classified
as Extreme Talkers less satisfied with
social support
of ways. It is possible that frontal lobe deficits are more apparent in

extraverted, more talkative individuals. The unverbalized thoughts of
more introverted elderly people could have the same lack of coherence
that more extraverted individuals express verbally. This, however, is an
untestable hypothesis. It is also possible that more extraverted individuals
are more likely to develop frontal lobe impairments than are less extra
verted individuals. Supporting this hypothesis is the evidence that more
introverted individuals retain higher levels of cognitive and intellectual
performance in old age (Gold & Arbuckle, 1991). However, no pattern of
significant correlation between specific measures of frontal lobe perform
ance and extraversion has been documented (Arbuckle & Gold, 1993).
Alternatively, the nature of extraversion per se may contribute to the
production of OTV independent of age-linked neuropsychological defi
cits. Extraversion, as conceptualized and operationalized by Eysenck
(1973; Eysenck & Eysenck, 1968), includes not only sociability but also
spontaneity and impulsivity. Such personality predispositions toward
exercising lower amounts of control and inhibition could combine with
frontal lobe deficits to increase OTV levels. Constructs and measures of
extraversion differ somewhat according to theoretical orientation. Costa
and McCrae (1985, 1986), for example, emphasize sociability and posi
tive affect as dimensions of extraversion, in contrast to the views of
Eysenck. It remains to be seen if extraversion, measured in such a way as
to exclude impulsivity but to include sociability, will also predict OTV.
Finally, it must be emphasized that these factors still explain only
approximately 20% to 25% of the variance in OTV frequency and extent.
The variability of OTV scores accounted for by age and frontal lobe
performance ranges between 1% and 12%, depending upon their order of
entry in regression equations (Arbuckle & Gold, 1993). The role of
psychosocial factors appears independent of age and frontal lobe perform
ance and explains approximately 10% of the variance in OTV. Obviously,
further research is required to examine other predictors of OTV, including
measures more directly sampling the functioning of individuals at a
physiological level. As the data do suggest that OTV is an atypical
process, with involvement of declining neuropsychological performance,
it is highly likely that other neurological and health-related variables also
play causal roles in its production. Another research priority is for the
carrying out of prospective, long-term, large-scale longitudinal research
examining the psychological, neurological, and health outcomes for peo
ple with different levels of OTV. Finally, in addition to examining the
correlates and possible consequences of OTV, research is also necessary
to examine and specify more precise patterns of OTV. If different patterns

of OTV can be reliably established, then it is quite possible that different
combinations of causal agents may be found to underlie and help explain
specific patterns of OTV.
OTV is a phenomenon that is of interest in itself and for its potential
explanatory value concerning the neuropsychological processes underly-
inq speech. However, OTV is also a social phenomenon occurring in
social contexts and having repercussions on social functioning. Research
has not yet examined the types of situations that produce different amounts
of OTV. Thus a study of the generality and specificity of OTV responses
across different types of situations could be of value in helping us to
understand the phenomenon. Further, as discussed above and in Gold et
al. (1993), the daily social functioning of elderly people with high levels
of OTV can be negatively affected, primarily owing to the reactions their
disjointed talk can elicit in listeners. In addition to possible reactions of
boredom and irritation resulting in burnout among members of the social
support network of the elderly person, the loss of cohesion that is mani-
fested in OTV can create doubts about the competence of the older person.
Consequently, the study of OTV is of interest to researchers examining
discourse in the elderly and the psychology of interpersonal relations as
well as the neuropsychology of aging.
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7
Talking Age and Aging Talk

Communicating Through the Life Span
HOWARD GILES
SUSAN FOX
JAKE HARWOOD
ANGIE WILLIAMS
Language, as manifested in emotional and informational support, can

be crucial to psychological well-being, especially if recipients of sup
portive language feel they can reciprocate somehow in the f u t u r e
(Revenson, 1990). That said, people can sometimes be particularly
inept at expressing support or communicating their need for it ( L e h m a n ,
Ellard, & Wortman, 1986). Furthermore, certain negatively tinted, but
positively managed, interactions can be superior to their positive coun
terparts in promoting good health outcomes (Rook, 1984), perhaps
because self-esteem, internal locus of control, and social resilience
result as a consequence of coping with difficult interpersonal encoun
ters. In this chapter we steer a different course from the research
mentioned above by arguing that although the "right" language patterns
can promote health, some commonly used language patterns can also
accelerate personal demise; what is more, this can be accomplished
slowly and methodically throughout the life span. Everyday use of
A U T H O R S ' N O T E : W e are most grateful to the editors of this volume for their thoughtful
and valuable feedback on earlier drafts of this chapter.
130
T A L K I N G A G E A N D A G I N G TALK 131
language, then, can have hitherto unrealized potency in matters of

longevity and the quality of life.
In what follows, we provide an overview of studies f r o m our research
program concerning young adults' beliefs about the elderly and their
communication, the nature of elder talk, forms and social consequences
of patronizing language, and a developmental perspective on intergenera
tional communication. All of these issues we believe to be fundamental
in understanding interpersonal communication in older adulthood (for a
more detailed overview of the material covered in the first two sections,
see Giles, Coupland, Coupland, Williams, & Nussbaum, 1992). These
diverse lines of research enable us to locate socially significant interac
tional misattributions and miscommunications arising between the gen
erations (see also Coupland, Nussbaum, & Coupland, 1991). We will
argue that important sociolinguistic problems facing older people can
have their origins much earlier in the life span—here we highlight the
communication and adaptation issues surrounding midlife in particular.
In addition, younger people can collude in their own ultimate psychologi
cal and physical decrement and are also required to manage ageist com
munications themselves. In an expansive epilogue, we will argue that if
we are to develop a more unified theory in this important area, then we
need to understand societal representations of people as well as the
interculturing mechanisms involved in adapting to aging throughout the
life span.
Young Adults' Beliefs About

the Elderly and Their Communication
In their age-conscious culture, Westerners nurture a plethora of beliefs

and naive theories about aging, most of which are negative and many of
which exist because of mistaken associations (Branco & Williamson,
1982). These beliefs range f r o m popular notions of intergenerational
conflict characterized by the "generation g a p " to those that assume the
inevitability of developmentally staged decline. Much existing research
on age stereotyping suggests that elderly people in Western societies are
viewed negatively (see Kite & Johnson, 1988, for meta-analysis; see
however, Hummert, 1990, and Chapter 8, this volume). For example, as
a group, older people are viewed as feeble, egocentric, incompetent, and
abrasive. This decline is also manifested communicatively such that older
people's communicative practices are seen as less efficient and less
socially skilled than those of their younger counterparts (see Nussbaum,

Thompson, & Robinson, 1989). Furthermore, depictions of negative
aspects of aging in television comedy programs and cartoons (e.g., young
people groaning or yawning as an older person appears, egocentrically,
to "ramble on" about his or her aches and pains) are rather familiar images
to consumers of Western media (e.g., Dail, 1988).
Our research, to be described in this chapter, indicates that older people
are also heard to sound frail and vulnerable and are considered overly
self-disclosive and controlling in intergenerational encounters. Initial
studies in this field originated as a result of the first author's long-standing
interest in the social evaluation of accented speech (e.g., Ryan & Giles,
1982). One of the main findings arising from studies conducted in this
so-called language attitudes or language effects tradition can be summa
rized as follows. Prestige-accented speakers are upgraded on traits indi
cating competence, such as perceived intelligence and confidence, yet are
often downgraded on traits indicating solidarity, such as perceived friend
liness and trustworthiness. This evaluative profile is "ageist" to the extent
that usually the listener-judges, and almost always the speakers, are young
adults. The issue here is not to score obvious gerontological points, but
rather to suggest that this could be theoretically crucial. As our chapter
title is meant to imply, we need to be talking age more. It is possible that
the judgmental pattern noted above would become virtually irrelevant
when considered vis-a-vis much older speakers, given pervasive negative
stereotypes associated with the elderly's competence in the West. Alter
natively, possessing a standard accent and also a fast speech rate (given
that slower rates are also associated with a lack of competence and
agedness; see Stewart & Ryan, 1982) could assume even more importance
in older years, as it could stave off some of the negative connotations of
being elderly. These then were the initial, competing, hypotheses.
Two studies were conducted to assess the relative merits of these two
competing positions. The earlier of these employed a factorial ( 3 x 2 x 2 )
independent samples design (fast versus medium versus slow speech rate;
standard [British] versus nonstandard [northwest English] accent; elderly
versus young guise) (Giles, Coupland, Henwood, Harriman, & Coupland,
1990). Therefore, the speaker produced 12 versions of the same (neutral)
320-word passage, in which he was heard talking about his car, suppos
edly during an interview. In this and the follow-up study, the speaker was
a male actor (aged mid-30s) whose professional viability depended on his
ability to produce different authentic age- and class-related guises, an
accomplishment he achieved many times on national television. A total
of 12 groups of young adult listener-judges f r o m South Wales rated 1 of

these 12 target speakers on traits derived from relevant literatures. Ma
nipulation checks substantiated that the speaker's guises were perceived
as intended, and that when "elderly," he was judged to be 62 years old.
Predictably, the guises using standard accents were upgraded on status
and downgraded on benevolence and integrity. The older guises were
considered more aged (i.e., evaluated along the dimensions of frail,
old-fashioned) and more vulnerable (i.e., weak, insecure), with the most
vulnerable voice being the slow, nonstandard, older voice. Although the
use of fast speech and a standard accent by an older speaker reduced
perceived vulnerability, he was nonetheless seen as asocial and egocen
tric. Moreover, this guise was rated as the least benevolent of the older
age variants.
Unlike most others working in this domain, the researchers also gath
ered open-ended qualitative information by asking participants to give
reasons for their particular ratings of the speaker(s), as well as by asking
them to explain why the speaker had made certain statements. This
provided some interesting findings. The combination of old age and
nonstandard speech produced responses that drew heavily on assumptions
about both old age and relative disadvantage. The researchers found that
listeners interpreted extracts from the text, such as the speaker saying, "I
didn't know what to think," differently depending on the speaker's age.
Hence this statement was more likely to be attributed to the speaker's
being "confused" if elderly (and recall he was perceived as only in his
early 60s!), but to his "wishing to withhold judgment given the complex
ity of issues at hand" if he was young. In other words, listeners were
interpreting the same utterances in schema-consistent fashion. W h e n
asked why they rated the speaker as they had, despite the fact that he said
exactly the same thing in each condition, listeners described the young
standard speaker as "arrogant and pompous"; the nonstandard young
speaker as "trying to impress" or "using the words of others"; the standard
elderly speaker as "egocentric, living in the past, and talking of trivia";
and the nonstandard elderly speaker as "stupid and losing his grip." When
invited to substantiate these accounts by recourse to pinpointing textual
information, respondents very often highlighted exactly the same utter
ances to justify their very disparate claims. The open-ended data clearly
indicate that respondents were actively interpreting what they had heard,
tailoring information to fit schemas prompted by age and class variables.
Building on this foundation, a follow-up study employed the same
independent variables, but with different message content (Giles, Henwood,
Coupland, Harriman, & Coupland, 1992). Again, the speaker was talking
about his car, but this time in the context of an interview following a car
crash (no personal injury involved). The speaker's competence was held
in question and the responsibility for the crash was kept uncertain. In
addition, respondents were given a questionnaire asking them, among
other things, to list their thoughts and feelings when the speaker was
talking. Other measures included textual interpretation items (e.g., items
such as "Was the speaker aware of damage?"; "Was the speaker to
blame?") and a passage recognition questionnaire administered two days
later. Results of listener-judges' interpretations of the text revealed potent
age effects in that younger speakers were perceived to be more aware of
the damage caused by the accident than were older speakers. Older
speakers were denigrated as doddery, vague, and rambling, seen as more
upset and weak, and were commented upon less than younger speakers,
who were seen as stronger. A couple of days later, information spoken by
younger speakers was more accurately remembered than the same infor
mation spoken by older speakers.
Returning to our initial competing hypotheses, we find that neither
hypothesis was fully supported, although elements of each were. Accent
effects appear, under these experimental conditions anyway, to be evalu
atively consistent across the life span for young judges. Having a fast rate
of speech and standard accent as an older person does appear to have some
modest social value on competence-related dimensions. Far more impor
tant in the present context is the notion that age markers in speech can act
as sociolinguistic triggers activating schemas for decoding processes.
Such biasing, in turn, leads to labeling and attributional processes and
also interferes with subsequent recall. In sum, then, older people's sociol
inguistic behaviors are negatively evaluated, actively processed in a
stereotypical manner, and recalled less effectively than are the sociolin
guistic behaviors of younger people (see also Ryan & Johnston, 1987).
If stereotypical inferences are drawn from the speech of older people
as indicated above, then talk to older speakers may also be mediated by
beliefs about the ways in which the latter communicate—it is the nature
of this that is explored next (see Ryan, Kwong See, Meneer, & Trovato,
1992). It stands to reason that if respondents are using schema-driven
processing in interpreting the behavior of others, then they would also use
such strategies when seeking information from others. Carver and de la
Garza (1984) had two groups of students read the same brief five-line
description of an automobile accident involving either an older (84-year
old) or a younger (22-year-old) male driver-protagonist—the impetus, as
T A L K I N G A G E AND A G I N G TALK 135
it happens, for the stimulus messages in the studies described above.

Respondents were presented with a list of nine empirically derived ques
tions that could be posed to the protagonist. These questions were to be
rank ordered by the respondent in terms of their perceived importance in
assigning responsibility for the accident. As predicted, age labels induced
stereotypical information seeking. Specifically, the elderly label (refer
ring to a person aged 84) led to differential patterns of information seeking
concerning the physical, mental, and sensory inadequacies of the driver;
the young label (age 22) led to questions concerning speeding and alcohol
consumption.
A later study conducted in Britain extended this design to include 77-,
66-, and 54-year-olds as well as the original 84- and 22-year-old targets
(Franklyn-Stokes, Harriman, Giles, & Coupland, 1988). As age of target
increased, the importance of questions about health, physical condition,
quickness of reaction, and mental competence also increased in a linear
fashion. The reverse pattern occurred for questions concerning alcohol
consumption, in that these were more frequently asked of young targets
and tailed off linearly as the targets' ages increased. In a follow-up study
conducted in New Zealand (Ng, Moody, & Giles, 1991), the target ages
were extended to cover the life span from 16 to 91 years (in 10-year age
bands). Again, health and competence information was more frequently
sought from older speakers, whereas speeding and alcohol information
was perceived as more relevant for younger targets. However, rather than
a steady linear trend, as in the previous study, the importance of health
and competence information seeking was observed to increase most
sharply at 31 and 81 years. As in the previous study, information seeking
based on speeding and alcohol showed a negative linear trend. In this case,
therefore, not only was information seeking ageist, but information seek
ing that seemed to rely on a decrement perception of growing older was
present for middle-age targets, increasing dramatically with a target
around 31 years of age. Of course, the attributions of criminal behavior
(in this case, drunken driving) to the young person can also be seen as
ageist. This does not refute our more general claim of ageist information
seeking, which affects all age categories (see also the section below on
patronizing speech).
That young (and older) adults have beliefs that allow them to formulate
what to say to each other has been amply demonstrated by an experimental
examination of how young adults might address older people when
requesting different kinds of assistance (Dillard, Henwood, Giles, Coupland,
& Coupland, 1990). This research tapped into the prodigious area of
inquiry known as compliance-gaining (see Miller, 1983). Working from

the premise that older adults are stereotyped as less effective communi
cators than their younger counterparts, this study attempted to tease apart
two potentially stereotypical views of older communication (see Brewer,
Dull, & Lui, 1981). One view proposes that older people are labeled as
"weak and feeble," and thus their influence strategies would tend to be
characterized as gentle and polite, whereas the opposing view of "ego
centric" and "abrasive" older people suggests stronger, more directly
assertive strategies. Dillard et al. (1990) examined these two views while
manipulating the legitimacy of the request made.
Young adults completed a questionnaire designed to investigate how
people set about persuading someone else to do something for them. They
were asked to imagine themselves as either a "typical 20-year-old" or a
"typical 70-year-old" and to ask a particular favor of either a 20-year-old
or a 70-year-old. In addition, participants were told that they should either
feel justified (legitimate request) or unjustified (illegitimate request) in
asking the favor, because they had or had not granted a similar favor about
a week before. Respondents were first asked to write down what they
would say and then to check off from a list which strategies they thought
they might use.
Although the results did not succinctly confirm either stereotype,
young respondents believed that older actors in general were willing to
exert more pressure than were their younger counterparts. They construed
older people to be more direct with young targets than with their peers
and as more forceful and aggressive in their compliance-gaining attempts.
This could reflect construals of older persons as authority figures who
may use age status alone as justification for exerting pressure to comply.
The respondents in this study were hypothesizing about strategies that
might be used in a way that allowed access to young people's perceptions
of older persons' strategies. Obviously, these kinds of studies need to be
replicated in an interactional context from both generations' perspectives
(as do the language attitude studies discussed above) before any hard-and
fast conclusions can be extracted. Nevertheless, the fact that age had an
effect on the type of strategy used in the study indicates some profitable
directions for future research in this area and underscores the vital role
stereotypes can often play in mediating actual communication.
Whatever the strategies used in compliance-gaining, they are sure to
be influenced by interactants' beliefs about what may be the most effec
tive forms of talk. The last study to be introduced in this section concerns
young and older people's beliefs about talk (Giles, Coupland, & Wiemann,
T A L K I N G AGE A N D A G I N G TALK 137
1992). A Welsh sample of young (average age 19) and older persons
(average age 70) completed a version of a "beliefs about talk" question
naire (developed by John Wiemann and associates in the mid-1980s)
modified to include items aimed at assessing own-age peers as well as
eliciting attributions about other age cohorts' beliefs about talk. Results
of a factor analysis of the questionnaire study suggested that older people
construed talk more positively than did their younger counterparts. In
addition, young people rated their peers as likely to use talk for affiliative
reasons. Older people considered their peers to have more communication
problems than themselves individually. That young people have a nega
tive view of older people's beliefs about talk is indicated by their percep
tion of older persons as assertive and valuing small talk without these
factors being apparent in the young people's views of their own-age peers.
There was a recreational element of talk common to older people's ratings
of both themselves and their peers; in contrast, they viewed young people
as skeptical about the value of talk but in favor of "chitchat." As both
groups construed each other (but not their own groups) as valuing "small
talk" and "chitchat," there seems considerable potential for intergenera
tional miscommunication with both young and old engaging in overac
commodative small talk together.
In sum, young people will solicit information and compliance from
older people in ways different from those they would employ with
individuals of their own age. Moreover, the assumptions underlying these
different and anticipated strategies seem to be based on, and allied to,
negative beliefs about the ways in which older people communicate and
talk. In the next section we describe some of the dynamics of older
communication in intergenerational settings, and how such communica
tion relates to younger talk driven by the beliefs described above.
The Nature of Elder Talk
Not surprisingly, our long-standing aim has been to examine how older
people actually talk and are talked to by younger people—an issue that
has received very little empirical attention across the disciplines, espe
cially as it relates to the nowinstitutionalized elderly (see Coupland &
Coupland, 1990). A pioneering study of older people's talk was conducted
in South Wales in the mid-1980s (for a review, see Coupland, Coupland,
& Giles, 1991). The research team collected 40 videotaped interactions
in which pairs of volunteers aged 70 to 87 and 30 to 40 years were asked
"to get to know one another." Participants were given no further instruc
tions and were left alone, knowing they were being videotaped, for 8
minutes. The elderly women, who were members of two adult day centers,
were mostly from upper-working-class backgrounds, lived alone, and
were widowed. Characteristic of this society, women constitute more than
80% of day center participants and the (arguably biased) focus on women
in these studies is a result of this structural constraint. The younger women
were mostly lower-middle-class and married, and were recruited through
an advertisement in a local newspaper. Of the dyads taped, 20 were
intergenerational (young-old), 10 were peer-young, and 10 peer-elderly.
Following a Latin square design, the researchers had each informant
participate in two interactions, one within generation and one across
generations.
The initial goals of the project were to determine whether the younger
women overaccommodated to their elderly partners, and to document
what this looked like verbally, paralinguistically, and nonverbally. Data
are available (mainly from caring and nursing contexts) that suggest that
many young people overaccommodate to the elderly irrespective of the
elderly p e r s o n s ' i n d i v i d u a l f u n c t i o n a l a u t o n o m y (e.g., C a p o r a e l &
Culbertson, 1986; see however, Hummert, Chapter 8, this volume). In
other words, some young people linguistically depersonalize their elder
interlocutors by becoming overly polite and warm, slower in rate, louder
in volume, exaggerated in intonation, higher in pitch, and grammatically
and/or ideationally simple in the presence of older people. This might be
mediated by stereotypes of either elderly incompetence (as above) or
sensory decrements, and could also be encoded as a means of establishing
social control (see Ryan, Giles, Bartolucci, & Henwood, 1986). Overac
commodation to elderly people can occur even when avoidance of such
tactics has been vigorously and normatively prescribed—for example, in
the training regimens of home-care assistants (Atkinson & Coupland,
1988). In addition, it has been shown that younger people may deflect and
downplay some of the seriously expressed concerns, thoughts, and feel
ings of the elderly (Grainger, Atkinson, & Coupland, 1990). All of this
can, of course, cause irritation, anger, and frustration on the part of the
elderly—as we shall see in the next section. It can, despite the often
nurturing intentions of the your.g, lead to severed communication, espe
cially among cognitively alert and socially active elderly (see Ryan &
Cole, 1990), who were the type of persons constituting the older, nonin
stitutionalized sample in this study.
Findings revealed distinct evidence of overaccommodation occurring

from the young participants (e.g., initial and profuse nodding of the head
placed at a tilt by the young, many of whom were seemingly "interview
ing" the elderly). For all intents and purposes, however, this sample
seemed positively disposed toward, and experienced in, conversing with
older people. Yet the research team's attention was struck by, and energies
diverted toward, examining quite another sociolinguistic phenomenon, which
they labeled "painful self-disclosure" (PSD) (see Coupland, Coupland, Giles,
& Wiemann, 1988). In this, admittedly limited, data set, they found that
the elderly people spent about one sixth of their time in initial intergen
erational encounters disclosing personally painful information (e.g., ac
cidents they had suffered, family bereavements, ongoing medical problems),
whereas the young spent negligible time (less than 2%) doing so. More
specifically, the team found that of the 20 intergenerational dyads, 16
manifested instances of elderly PSD, with only one young person recip
rocating. In the 10 peer-elderly dyads, there were 9 instances of recipro
cated PSD, whereas in the 10 peer-young dyads, there were only 4
instances of the phenomenon (only one of which was reciprocated).
However, the researchers were not so much interested in the content and
quantity of these revelations—a predilection of the extant literature here
(Holtgraves, 1990)—as much as in the process of self-disclosure: how
PSDs were introduced into discourse, responded to, and curtailed.
Space constraints preclude any real examination here of the rather
complex taxonomies of the PSD process that ensued (see Coupland,
Coupland, & Giles, 1991). However, the majority of elderly P S D s in
intergenerational contexts can be characterized as initiated by the elderly
themselves, wherein the backgrounds, consequences of, and emotional
responses to the painful events are detailed. Moreover, an initial PSD
often leads to the chaining of further substantively different PSDs. Elderly
PSDs were textually managed quite well by a few young interlocutors, at
least in procedural terms, and sometimes even solicited by them in the
first place. Yet many young people found themselves uncomfortable and
in a so-called accommodative dilemma, as almost every follow-up move
is a dispreferred one. For instance, they could switch topics and discour
age further disclosure, but this represents an aggressive or dismissive
stance; they could express empathy, but this risks their being seen as
overaccommodative; and they could signal interest and involvement, but
this could lead to an escalation or maintenance of disclosive talk. Often
the response was minimal ( " M m m " ) , one of surprise ("Good heavens"),
or sympathetic ("Oh dear"). These appeared, to all concerned, as commu

nicatively bland (in this context, anyway). Such unnerving experiences
on a day-to-day basis could possibly deter younger people from wishing
to engage in future intergenerational contact (see Notarius & Herrick,
1988).
Interestingly, 75% of the older people in these conversations (but
hardly any of the young) spontaneously divulged their age in years (see
Coupland, Coupland, & Giles, 1989), and virtually all older persons in
the sample (and in other databases too) disclosed their ages in some form
or other. Indeed, there are many ways to tell others one's age without
mentioning chronological years (see Coupland, Coupland, Giles, &
Henwood, 1991), and such expressions tend to be linked to health issues.
Nevertheless, most young people responded to the disclosure of elderly age
with a seeming intergenerational conversational routine—for example:
"Why, 87, good heavens, you don't.look 87!" This was often linked to a
statement such as, "I hope I look like you when I'm 87," and in almost
every case with the evaluative exclamation, "Marvelous!" There was a
rich variety of ways in which PSDs were creatively terminated (e.g.,
commenting on a positive by-product of the unfortunate event and shift
ing topic), cither by the discloser herself or by the recipient.
There was, of course, interindividual variability in the ways in which
older people managed their PSDs as well as in the ways young people
reacted to and discussed them. In a follow-up study, Coupland, Henwood,
Coupland, and Giles (1990) invited a complementary sample of young
people to listen to, and comment upon, audiotaped extracts of PSDs (and
non-PSDs) in group discussion format. A few young people denied PSD
as a problem, with one informant labeling it "lovely," but most found it
"sad," and some even strategic. For instance, one informant claimed,
"They [note the intergroup pronoun] play for sympathy, they're very
much . . . like young children, they want to be the center of attention for
as long as possible." Yet, more often than not, it was described and
evaluated by young people in ways that we would interpret as underac
commodative. By this we mean that older people were seen to be egocen
trically hogging the floor and talking more of their own problems rather
than sensitively inquiring after the dispositions and interests of their
younger partners. Relatedly, PSD flies in the face of three out of the nine
rules for self-disclosure in initial encounters with unfamiliar others pro
posed by Berger and Bradac (1982); that is, never disclose personal,
negative information, let alone excessively. Interestingly, the individuals
from whom these rules have been culled have invariably been young
adults. Nonetheless, the accounts provided by young observers all too

often reflect a decremental model of older communication and talk (see
Coupland & Coupland, 1990).
Data from a complementary American self-report study by Williams
(1992) suggest that young interlocutors find elder underaccommodation
to be a pervasive feature of dissatisfying intergenerational communica
tion. Again, it is considered to be very communicatively demanding for
young recipients to manage underaccommodation. In part following the
procedures of Hecht, Ribeau, and Alberts (1989) in their study of in
terethnic satisfaction, Williams asked a large sample of California stu
dents to recall, describe, and rate encounters with elderly adults that they
had found both satisfying and dissatisfying. One of the four factors found
to differentiate significantly between such encounters (which were sig
nificantly associated with reported happiness and relaxation in the pre
dictable directions) was so-called "old underaccommodation negativity."
Items loading highly on this factor included "The older person talked
excessively and exclusively about his/her own problems" and "I didn't
know what to say in return to the older person's complaints," the latter
item reflecting much of the notion of accommodative dilemmas intro
duced above. Furthermore, those respondents who viewed their dissatis
fying encounters more in terms of an awareness of self as young and the
elder as old claimed to have endured more of this negative underaccom
modation than those scoring lower on such dimensions.
Yet there may be functional significance in this apparent lack of elder
accommodation because it (a) may translate into their garnering social
control over the conversation and thereby assists in reducing or avoiding
potentially negative intergenerational comparisons; (b) may elicit out
wardly sympathetic, supportive, and flattering responses from the young,
as we have just seen; (c) can be a form of self-handicapping (Arkin &
Baumgardner, 1985); and (d) is often a rational, poignant reflection of life
circumstances and events (very often painful) the elderly have so clearly
endured (see Coupland, Coupland, Giles, Henwood, & Wiemann, 1988,
for further discussion).
Therefore, in intergenerational communication, both younger and older
people collude in talking age and aging talk, with a questionable amount
of satisfaction on either interlocutor's part. This may be, in part, the result
of a lack of intergenerational contact experiences, or of more peripheral
causes, such as inaccurate or negative societal representations of either
party. Regardless, these factors are worthy of further study to determine
how communication contributes to intergenerational situations.
Forms and Social Consequences

of Patronizing Language
We have conducted a series of experimental studies that are aimed at

teasing apart some of the processes of one particular element of intergen
erational talk we did not investigate systematically in our naturalistic
data: patronizing or overaccommodating talk to the elderly. Although
patronizing talk is not limited to the intergenerational context (and is
apparent in other intergroup contexts, such as in talk to persons with
disabilities; see, e.g., Strenta & Kleck, 1985), we saw it as a feature
worthy of considerable attention for a number of reasons. First, it is
interesting in that it can potentially occur "bidirectionally": Young people
can patronize the elderly, and the elderly can patronize the young. This is
less the case with phenomena such as PSDs, which mostly occur from old
to young, or advice giving/receiving, in which, again, the roles are
somewhat age restricted. Second, patronizing talk seems to carry with it
considerable implications for the power relations of the individuals (and
groups) involved. In other words, it is a type of talk that we feel may
reflect, more immediately than others, the societal relations underlying
the minutiae of interaction (see Ng & Bradac, 1993). In addition, because
these modifications are not necessarily based on realistic needs of the
individual—although sometimes such talk is helpful (Kemper, 1994) and
appreciated (Ryan & Cole, 1990)—many socially and cognitively active
elders view such acts as communicating a lack of respect that undermines
their self-esteem and dignity. Third, we have also observed that when
negative images associated with age are made salient to older individuals
(e.g., by overaccommodating to them or by making visible a magazine
attending to age decrements), they will, compared with controls, look,
move, sound, think, talk, and account "older"—a self-stereotyping phe
nomenon (see Turner et al., 1987) that we have termed "instant aging."
Hence, as attributional principles would attest, hearing different people
in various contexts inform you (indirectly by overaccommodations or
through societal images, discussed below) that you are "over the hill" will
ultimately induce many a recipient to accept this as reality. To refer to the
second notion in our chapter title, this is "aging talk."
Following the procedures of Ryan, Bourhis, and Knops (1991) by using
a vignette of a middle-aged nurse talking with an elderly nursing-home
resident, Giles, Fox, and Smith (1993) found uniformly more negative
evaluations of a nurse when she used patronizing talk (such as " B e a good
girl"; "Poor dear") compared with when she used a more neutral style.
For example, she was perceived as less respectful, considerate, compe

tent, and benevolent in the former condition. The resident herself was
perceived as more frustrated and helpless in the patronizing condition.
We also found that elderly respondents were likely to be very sensitive to
the characteristics of the individual receiving the patronization. When the
nurse spoke patronizingly, older (but not younger) respondents rated the
resident as less competent, more weak, and less alert. At one level, this
implies that older adults incorporate contextual cues in their evaluations
of particular episodes of talk, whereas younger individuals appear less
inclined to do so. However, it also suggests that elderly persons may be
more willing to denigrate their peers on dimensions of competence as a
result of the particular kinds of talk directed toward them. The results of
a follow-up investigation with our elderly respondents (reported in the
same study) indicated that many of them claimed to have been patronized
themselves (albeit, interestingly, to a lesser extent than they believe others
of their own age to be patronized), and that it made them extremely
irritated.
Patronization may, however, not be the one-way street it seems to be
depicted as in the literature. Giles and Williams (1994) conducted a series
of studies examining young people's reactions to patronizing talk from
older to younger adults. Undergraduates reported that they, too, were the
recipients of patronizing speech, and that this annoyed them. They were
asked to describe how older people patronized them and, from a content
analysis of these data, eight categories emerged. In a second study,
undergraduates were presented with two examples of each of these cate
gories and were asked to make similarity judgments of each combination.
Analyses showed that they cognitively represented the different kinds of
patronizing speech on three dimensions: nonlistening (e.g., "The elderly
don't listen to what I have to say"), disapproving (e.g., "You're all party
animals!"), and overparenting (e.g., "When you get older you will see this
was best"). In a third study, these three different kinds of patronizing
forms were utilized for social evaluation in a vignette study alongside a
nonpatronizing (control) variety. Patronizing of any of the types by a
70-year-old or by a 40-year-old was seen very negatively by young adults,
but a hierarchy of judgments did emerge depending on the question posed.
Stereotypical disapproving was considered by judges to convey the most
negative intent, but nonlistening was considered the most difficult to
manage communicatively, with overparenting considered the least offen
sive of the three. Different causal attributions were afforded patronizing
targets when they were middle-aged rather than elderly (e.g., age envy
was, interestingly enough, associated far more with the 40-year-old than
with the 70-year-old). Returning to the Williams (1992) study, it is
informative to note that intergenerational conversations reported as sat
isfying by her young informants were characterized as ones in which the
elder participant accommodated to his or her interlocutor, defied the usual
self-centered stereotype, and admired and validated young behavior.
The parallels between young-to-elder patronization and elder-to-young
patronization may extend beyond the labels. Some form of wide-ranging
accommodative practices may be operating such that a form of discrimi
natory talk in one direction is matched by a similar (although not identi
cal) type of talk in the other direction. This form of competitive, yet
complementary, counterattuning could reflect matching or mirroring strate
gies by which individuals of different age groups express dissatisfaction
with their interlocutors through use of strategies similar to those that
annoy them. Indeed, it would be interesting to see if those who experi
enced being patronized most as children and young adults are precisely
those who model this behavior later in life and overaccommodate to the
young. Furthermore, certain parents and adults make explicit intergroup
boundaries in their talk to children (e.g., "It's grown-ups' time now";
"That's an adult word") and, again, maybe those who are socialized early
into seeing the life span predominantly in these terms could, in cyclical
fashion, be those who later linguistically discriminate against the young.
Harwood, Giles, Fox, Ryan, and Williams (1993) extended this re
search in two ways. First, we examined patronizing talk from the young
to the elderly and from the elderly to the young within a single design.
Second, we were interested in various response strategies to patronizing
talk, not least with a view to formulating recommendations for appropri
ate strategies to ward off unwanted patronization. Previous work in this
domain has portrayed the elderly target as a (behaviorally) passive recipi
ent of patronization, and hence possibly as colluding with the patronizing
behavior (see also Edwards & Noller, 1993; Ryan, Meredith, & Shantz,
1994). We wished to confront the dilemmas and management problems
associated with accommodating to patronization, and our design included
conditions in which the recipient of it was either "accepting" or "asser
tive." Results showed that pairunizing the elderly was viewed as negatively
as patronizing the young and, predictably, intergenerational communication
was judged as far more satisfactory when patronizing talk was not present.
Assertive responses from the patronized person led to evaluations of her
as higher status, more controlling, and less nurturing than when she
provided a neutral response. An interesting aside for future work: Patron
izing individuals who were the recipients of this response mode were
evaluated as less satisfied and less in control than when they received an
accepting response.
Besides examining who patronizes, when and why, and what specific
effects occur with whom, we are investigating the following issues. We
have very strong evidence suggesting that despite passive responses from
those patronized, judges infer that their thoughts in this situation are
actually quite assertive. Moreover, although the patronized response in
the previous study was depicted as "individualistic" (i.e., " / can man
age"), more "group-oriented" reactions are feasible (e.g., "Do you
always talk to older people like this?"). And it is exactly these kinds of
intergroup stances that are being inferred by judges in recipients' thought
patterns. Hence we shall be varying passive versus assertive (both indi
vidualistic- and group-oriented) responses to patronizing talk in sub
sequent studies, and also varying the ethnicity of the recipient. It could
well be that unfavorable reactions to patronizer and patronized are particu
larly evident when there is incongruence between passivity of thoughts and
verbal actions. It is also likely that older foreign immigrants who react
verbally in a group-oriented assertive manner will be responded to more
negatively—with their assertiveness perhaps attributed to be a function
of their ethnic, rather than their age group, membership. Clearly, the social
meanings attached to the particular ethnic group membership here will be
pertinent.
We are also extending this work to other cultural contexts in which
views of aging are purportedly different and more respectful (see, for
example, Cheung, 1989). A data set collected from students in Southern
California and Hong Kong (with Herbert Pierson and Richard C16ment)
indicates that there are important similarities and differences in stereo
types of age groups across cultures. Specifically, we find that the dimen
sions used by young people to evaluate other young people are similar
across the two cultures. Although the content of the stereotype is not the
same, there is some evidence that the underlying evaluative basis is
similar. This does not appear to be the case for the middle-aged and the
elderly; they are evaluated along different dimensions between the cul
tures, although the middle-aged and the elderly appear to be evaluated
along similar dimensions within the cultures. A further point of interest
that emerges is that the stereotypically positive view of the elderly in
Asian cultures does not emerge from our data (see also Harwood, Giles,
Pierson, Clement, & Fox, in press; Tien-Hyatt, 1987). Rather, we find a
fairly negative portrayal that does not feature the classic elements of
wisdom, knowledge, and the like. These elements are actually more
prominent in young Americans' evaluations of their elders.
We are sensitive, of course, to the fact that a positive regard for the
elderly may exist in the culture under consideration, and that particular
items in our North American-originated survey may not have provided
access to the particular dimensions on which such positive evaluations
are made. Naturally, such research is crucial for understanding commu
nication issues that are currently dominated by a limited intracultural
perspective. In this vein, and with Herbert Pierson, we are currently
examining replicative data on evaluations of patronizing talk in Hong
Kong as a first step toward a programmatic, cross-cultural consideration
of the issues presented in this chapter. Early indications, from the data set
we are analyzing, reveal that Hong Kong students do not appear to attach
the same social meanings to patronizing talk as do students in Southern
California. Hence we are intent on examining intergenerational commu
nication patterns in this as well as other Asian Pacific cultures, with the
intention of determining the, undoubtedly, different forms it takes there.
A Developmental Perspective
on Intergenerational Communication
The problems apparent in intergenerational communication, such as the

phenomenon of patronization, exist because of communication between
regions in the life span. Despite the gross categorizations engaged in by
both laypersons and the scientific community, we would argue for an
approach to the life span that considers aging as a continuing process
rather than as a series of stages of "being" a member of a particular group.
Thus what is unique about intergenerational communication as a special
case of intergroup communication is that we all pass through the group
memberships along the continuum. Although at particular points we may
identify primarily with one group or another, there is a good chance that
we will identify with other groups as well. Dependent teenagers seeking
adult independence and elderly bungee jumpers are both groups that
inspire interest and/or humor (often, we would argue, ageistly) because
of their apparently conflicting group memberships. If it makes sense to
split the life span into chunks, then these people are "in two places at one
time." Also, although at certain stages in the life span we might be
identified and identifiable as "members" of an age category, our knowl
edge of certain other age categories will be qualitatively different from,
for instance, our knowledge of other cultural categories. In an age-based

intergroup encounter, the older participant can often have somewhat of
an "insider's" understanding of the out-group (albeit sometimes naive
because of different generational, and hence cultural, experiences; see
this chapter's epilogue). This can seldom be said of an intergroup encoun
ter based on, for example, ethnicity or gender.
In addition to the problems outlined above, failure to adopt a holistic
view of the life span has resulted in a lack of attention to particular places
in the life span—particularly middle age. In an attempt to rectify this
situation, and in concert with growing U.S. media attention to midlife
issues (see, for example, the December 7, 1992, issue of Newsweek), we
have started to look at relationships between middle age and communi
cation (as alluded to in the studies of information seeking and patroniza
tion described above). Although the middle-aged have been the focus of
some research in psychological (e.g., Hunter & Sundel, 1989) and psy
choanalytic (e.g., Oldham & Liebert, 1989) veins, as well as the subjects
of much lay theorizing (e.g., Fried, 1976), the communicative phenomena
central to middle age remain something of a mystery.
Our research examined college students' evaluations of the middle-
aged compared with younger persons (Harwood & Giles, 1993). In
general, we found that younger people perceive themselves as more
liberal and happy than the middle-aged, with the elderly rated as most
conservative and least happy (see also Boyd & Dowd, 1988). Young
people perceived differences between themselves and the middle-aged
(usually employers and/or parents) in terms of the control the latter exert
over them. In addition, they often registered social-distinctiveness con
cerns, such as dissatisfaction when middle-aged individuals "act y o u n g . "
Perhaps most important here was the finding from open-ended responses
that advice giving and advice requesting were perceived as consuming a
considerable amount of time in middle-aged-to-young talk. This m o d e of
interaction was seen as crucial not only in delimiting age roles for both
generations of participants, but also in terms of delimiting future oppor
tunities. For young individuals, exchanges of advice will concern their
plans and goals for the future. For the middle-aged, such exchanges may
well serve to limit their perceptions of a useful and productive future for
themselves. Their conversational role has changed to that of the "sage,"
a role generally reserved for those of more advanced years, and it should
be noted that these interactions are often described as mutually satisfying
and pleasant. Hence what could be perceived as sensitive attuning to the
age-based dynamics of the conversation by both participants (Coupland,
Coupland, Giles, & Henwood, 1988) may result in a hardening of age bounda
ries and a growth in age stereotyping of self and others (see Levin, 1988).
A hierarchical regression analysis on these data was performed with
respect to what factors young people perceived as leading to communi
cation differences between themselves and middle-aged people. In gen
eral, the perception of such differences was seen to be a function of the
degree to which young individuals (a) categorize those somewhat older
as "middle-aged," (b) have a high level of contact with middle-aged
people, (c) perceive power differentials in the middle-aged's favor, and
(d) seek positive distinctiveness over middle-aged people (especially
those who were construed as overaccommodating youthful ideals and
habits). From a social constructionist perspective, the hardening of these
intergenerational boundaries might usefully be examined in terms of the
socialization of individuals into received views of the life span (Kearl &
Hoag, 1984). It is important to bear in mind that many of the problems of
intergenerational communication reside within socially constructed im
ages and stereotypes of individuals, and that these originate in the activi
ties of categorizing and assigning meaning to categories. The processes
by which these categories are developed and viewed as useful and impor
tant should not be subordinated to the study of the consequences of
categorization. Indeed, v/e should remain sensitive to the position that in
studying age categories we are, ourselves, furthering the legitimacy of
those categories (see Potter & Wetherell, 1987; van Dijk, 1987). Such
delimited roles may underlie the phenomenon of younger-to-elder pa
tronization as described earlier. The roles constructed for individuals as
they age may play an important part in determining practices such as
patronization of the elderly. At least one author has suggested that the
limitations that are placed on roles that are appropriate for different age
groups may play a part in determining psychological health at different
stages (Rader, 1981). Obviously, the redefinition of middle-aged roles in
a more positive direction—assuming that one's context can provide
institutional support for it—can reap significant psychosocial rewards
(Kerns & Brown, 1992).
From an intergroup perspective (Giles & Coupland, 1992; see also
Hogg & Abrams, 1988), our work on middle age is important. First, it
indicates that we should consider multiple levels of group relationships
in the aging sphere. Gross categorizations of young and old are less and
less useful to us in understanding the multiple age groupings that people
may construct for themselves and others. Indeed, we have found perceptions/
T A L K I N G AGE AND A G I N G TALK 149
understandings of middle age to be diffuse and highly variable. In addi

tion, we have found an interesting confound in terms of family relation
ships. In assessing the nature of middle age and the middle-aged, our
informants were clearly (as indicated by their open-ended comments)
often considering their parents (see Montepare, Steinberg, & Rosenberg,
1992). Hence while we, as researchers, may be trying to understand
conceptions of groups in society, we may be coming closer to under
standing relationships in the family. We would want to consider in the
future how to assess younger individuals' perceptions of middle-aged
people beyond their family experience; in itself, differences between this
and "family-based" evaluations would be interesting (as would compari
sons of views of "the elderly" in general and particular individuals' aging
parents/grandparents).
Furthermore, we should be aware of just how limited intergenerational
contact is for a large number of people in society. For many of our
college-age respondents (and possibly for many in the population as a
whole), contact with those outside of their immediate generational group
is restricted to certain clearly delimited role relationships (family, student-
teacher, employee-employer). Such relationships may not be ideal con
texts for developing intergenerational understanding because of the role
discrepancies associated with the different age groupings. As before,
building equal-status "personal" relationships is a crucial ingredient of
felt satisfaction for younger people (Williams, 1992).
Finally, we would argue that our discussion illustrates in a life-span
context how particular linguistic choices and conventions (in our exam
ple, advice giving) can be agreed upon between the generations as
appropriate (if not enjoyed) "scripts," for "what to d o " when interacting
with someone of a given generational group. (And we might point to PSD
as a parallel example from young-elderly interactions.) These activities
become a default that may serve to compensate for a lack of particular
intergenerational skills (see above), but may be harmful in terms of
broader attitudinal/communicative concerns. In the case of the middle-
aged, such features are seen as a tool that both "sides" employ and, in doing
so (whether consciously or not), engage in building barriers and creating
distance between the generations. Such behaviors do little to emphasize
commonalities between individuals, and do a great deal to delimit per
missible "age-role-appropriate" behaviors in the future. Relatedly, a re
cent issue of Spin (April 1993), a music magazine targeted at the young,
published an article drawing the following intergenerational distinctions:
What your birthdate does provide you with is a common ground, a shared
vocabulary. . . . there is a lexicon that develops among the members of a
generation, a secret language that's so pervasive it's taken for granted. Asking
a 40-year-old to comprehend a conversation between two 24-year-olds is as
fruitless an exercise of code breaking as reading the daily racing form. (p. 38)
Activities that begin early in life may well be adopted as normative

intergenerational processes, and applied wholesale as individuals become
identifiably elderly. Indeed, these may be processes that occur with many
interactions in which age differences are present and salient, for example,
among adolescents in familial or age-diverse contexts (Kubey & Larson,
1990; Petronio, in press; see also Montepare et al., 1992). Consider, for
instance, interactions between younger and older siblings in which age is
often salient (Zukow, 1989), as it often is between first- and later-born
twins (Malmstrom & Silva, 1986). Indeed, we know that intergroup
differentiation is developed quite early in childhood (Vaughan, 1978). It
would be interesting to look at the sorts of talk that characterize older-to
younger child interactions and see if there are any parallels with other
kinds of intergenerational communications. Certainly, some forms of
advice giving are common between siblings, as are quite sophisticated
forms of interpersonal accommodation (and perhaps even patronization)
apparent when even 4-year-olds talk to those younger than them (Shatz
& Gelman, 1973). To this extent, the phenomena identified as charac
teristic of young-old interactions may be characteristic of intergenera
tional talk across the life span, although such phenomena in talk with the
elderly might present particularly difficult problems for both the elderly
themselves and their interlocutors. Some examination of individuals with
and without siblings in terms of their evaluations of, for instance, patron
izing talk might indicate whether such factors are important determinants
of later intergenerational communication style.
Epilogue
To return full circle to the start of this chapter, attitudes toward lan
guage varieties of different age groups can influence young people's
conceptions of the elderly's interpretive and cognitive competencies. In
addition, such attitudes also mediate the middle-aged and the elderly's
construals of their own capacities (see Ryan, Kwong See, Meneer, &
Trovato, Chapter 2, this volume). Younger people's communication may
include overaccommodation, the sociolinguistic meanings of which can
f u e l elderly helplessness, negative personal and social identity, and per

ceived, actual, and "instant aging" (see also Paltnerino, Langer, & McGillis,
1984). In these cases, and in the spontaneous evocation of elderly painful
self-disclosure, sociolinguistic stereotypes are a potent force not only in
miscommunication, but in the construction and acceleration of aging.
Being told that " y o u ' r e past it" implicitly constrains communicative
potential and ultimately disposes people to self-stereotype as middle-aged
or old, and with a decidedly negative taint. One might predict that
uncrafted verbal balking against this (e.g., as in group-oriented assertive
responses to patronization) may nonetheless result in ageist stereotypes
of an older person as grouchy and irritable.
Applied implications emerge from our discussion of intergenerational
communication, and indeed the topic is one that has already begun to
receive social policy attention (e.g., American Board of Family Practice,
1991; see also Williams & Giles, 1991). However, we would suggest that
further research attention is warranted on a number of levels. First, work
has emerged examining the nature of contact with the elderly, both in
"interpersonal" and mediated contexts (see below). This research indi
cates that contact between the elderly and younger groups is limited, and
is frequently dissatisfying for the young (Williams, 1992). A first issue is that
there would be merit in instituting broad-based, communication-oriented
curricula of the life span (along with manipulated intergenerational con
tact) for children, beginning at relatively young ages. Negative societal
representations, individual ignorance, and uncertainty could be chal
lenged with such information. In addition, if sensitively established, such
programs could act as supplements for the small degree of "real" contact
that occurs. An additional point is that current "adopt-a-grandparent"
schemes and the like would benefit from systematic multidisciplinary
evaluations, to assess the potential good and harm that might emerge f r o m
such schemes. Despite the increasingly accepted assumption that "mere
contact per se is not e n o u g h " (Hewstone & Brown, 1986), such largely
atheoretical, short-term schemes with an overemphasis on attitude (rather
than communication) change continue, and continue to be construed as
positive (for a critique of intergenerational contact programs and studies,
see Fox & Giles, 1993).
Another area we feel is important in understanding the connections
among intergenerational attitudes, beliefs, and communication is that of
mediated contact situations. We have been concerned with the role that
mediated contact might play in the formation/change of attitudes regard
ing the elderly. As alluded to earlier, data collected indicate that, at least
for a sample of college students, the mediated contact they have with the
characters of the TV show The Golden Girls far exceeds the level of
"interpersonal" contact they have with older adults in general (Harwood,
1992). At least one major study has demonstrated that television portray
als have direct correlates in the beliefs of heavy television viewers, who
have a tendency to view elderly individuals as less healthy, less sexually
active, and in worse financial situations than do light TV viewers (Gerbner,
Gross, Signorelli, & Morgan, 1980; see, however, Wober & Gunther,
1982). Furthermore, television portrayals of interpersonal interactions
between younger and older people can be modeled by younger people in
intergenerational interactions who, given a lack of experience, view these
interactions as appropriate and acceptable (Huston et al., 1992). There
fore, given younger people's lack of experience with real-life intergen
erational situations and the effects the media can have on attitudes and
beliefs about the elderly and the aging process, it is vital that we examine
how these mediated contacts translate into communication in person-to
person intergenerational situations.
Analyses of literature, humor, magazine fiction, and television drama
and commercials show that there is no shortage of societal cues, beyond
interactional ones, to make age salient for elderly people in Western
societies (see, e.g., Berman & Sobkowska-Ashcroft, 1986). Examples
range from elderly road-crossing signs showing unflattering elderly sil
houettes to the British Medical Association's talk of the elderly heath
."disaster." Although not meant to be outwardly ageist, these types of
representations can perpetuate negative beliefs about older people and
growing older. Even cownierstereotypical representations, exemplified by
such headlines as "At 85, Still Provocative" and " L i f e ' s Still a Spree at
93," can be thought of as exceptions to the elderly population in general
(or else why would these people be newsworthy?), causing a reinforce
ment of negative iittitudes and a discounting of these exceptions as having
zero relevance to the general category "older people" (see Hewstone,
1989). Television's negative representation and underrepresentation (Bishop
& Krause, 1984; Davis & Kubey, 1982; Robinson, 1989) of the elderly
conveys a message of marginalization to both younger and older people.
Even media supposedly crafted to enhance the image of elderly people
(e.g., the Senior Olympics) can be interpreted as actually reproducing and
sustaining ageist views that so readily interfere with face-to-face inter-
generational encounters. Therefore, these portrayals can invariably affect
how we think about aging and subsequently how we communicate these
beliefs both to ourselves and to others interpersonally.
An exception to the negative portrayals of the elderly has been the show
The Golden Girls (see Bell, 1992), a sitcom featuring an all-elderly cast
of women who are physically and sexually active and engaged in society.
Harwood and Giles (1992) examined the show's "text" and found that
themes of age are inextricably tied up with the humorous interpersonal
dynamics on which the show's popularity is based. However, the inces
santly humorous tone of comments about (often serious) problems that
face the elderly can be seen as having a discounting and trivializing effect
on any suggestion that these are problems that should be taken seriously
(Nahemow, McCluskey-Fawcett, & McGhee, 1986). Therefore, although
the mediated intergroup contact exemplified by shows such as The Golden
Girls is qualitatively different from face-to-face interpersonal contact, w e
would, nonetheless, claim that such contact is important to attend to and
have sensitivity toward. We would include such proactive behaviors as
conducting controlled effects-style studies on both ageist humor and
elderly representations in the media that could aid in future policy recom
mendations attempting to make talking age and aging talk a less negative
experience for those currently involved in it and those moving toward
their later years.
We also need to acknowledge the cultural distinctiveness of different
generation groups, and that aging is development, not inevitable decline.
We feel it is a valid perspective to view different age groups as different
cultural groups, given their different life experiences, social norms, and
communicative patterns (see Coupland & Nussbaum, 1993). Not only d o
elderly people inhabit different historical eras, often associated with
different values and predispositions (communicative as well as noncommu
nicative), they also have different problems (some existential) to which they
must adjust, both somatically and life historically. Although we are only
beginning to appreciate the complexity of the matter, it is important to
investigate and theorize about how people ease along the age continuum
from young adulthood to middle age to elderliness (to name but a few
junctures), and how they are eased along it (sometimes resistantly) by the
way others communicate with them. Developmental adaptation, and ulti
mately a positive personal identity, is likely to be achieved through being
exposed to more enlightened values and interactional stances by younger
people (see Taylor, 1992). An acknowledgment of multiculturalism should
put us on the path toward effective "multilingualism." We must learn f r o m
the history of other research traditions involving language and social
categories (such as social class and gender), moving swiftly beyond the
documentation of intercategory language and communicative differences
toward an analysis of the communicative processes of ageism and its

relationships to sexism, classism, and racism. Moreover, and in line with
our interests in cross-cultural issues, theory and research into intercultural
communication and immigrant acculturation (e.g., Kim, 1988) may well
point to important and hitherto unacknowledged processes inherent in
aging as intercultural development.
Notions of adaptation, we would argue, have been underplayed in
considerations of movement through the life span. The intercultural
communication literature is rich in both data and theoretical concepts that
shed light on individual responses to entering novel cultural milieu. As
we have argued a number of times before, one of the central elements of
aging involves the new ways in which one is treated, and expected to
behave, and the constantly shifting cultural norms that we face as we
transit through the phases of the life span (see, e.g., Giles, 1991; Giles &
Coupland, 1991; Giles, Coupland, Coupland, et al., 1992). Thus we argue
for a wholesale conceptual borrowing from literatures on cross-cultural
psychology and communication that relate to the ways in which we
choose (and choose not) to adapt to new surroundings. Kim's (1988)
stress-adaptation-growth model presents a number of concepts that might
be of use in such an integration. In particular, we are interested in the
notion of an "intercultural" person, and whether such a concept might be
extended to consideration of an intergenerational person: One who is
particularly effective at adapting to new generational contexts (in terms
of both his or her own development and that of others) and possibly who
is a particularly effective communicator in intergenerational encounters.
The experiential determinants of becoming such a person should be
theoretically powerful, as well as offering grounded positions from which
to argue for interventions of various sorts. Moreover, the application of
intercultural communication models might, in a reflexive fashion, un
cover limitations in the models offered thus far. Life-span adaptation
requires a continual process of updating previous adaptations. This pro
cess is never finished, and growth is never complete in a way that is
implied in certain intercultural models. In addition, the aging process
requires that we adapt not only to our current, ephemeral, chronological
point, but also to infinite future points and, given certain exigencies, to
the end of our being. These are considerations that will stretch, and
ultimately improve, current culture-based understandings of adaptation.
Herein, we have had to gloss over many complex matters, including
the tremendous heterogeneity (loneliness, contextual and psychological
ages, and so on) that represents the communicative experiences of younger
and older people (see Barbato & Perse, 1992; Hoffstetter, Schultze,
Mahoney, & Buss, 1993; Mares & Cantor, 1992) and the fact that self-
definitions of age are extremely diverse (see Deaux, 1993) and socially
situated (Ward, 1984; see also C16ment & Noels, 1992). Indeed, our
observations of "instant aging" exemplify these issues. Relatedly, Coupland,
Coupland, and Grainger (1991), in their case study, have shown how the
same person can co-construct radically different personae across two
rapidly sequenced interactions. With one partner, an older woman self-
presents in a very socially active manner, but with another she exudes a
more frail, lonely, and aged performance—a phenomenon we are intent
on investigating much further (see also Taylor, 1992). Furthermore, there
is the wind of social change in matters pertaining to the elderly, such as
the Gray Panthers, and also, crucially, with activities of the middle-aged
(e.g., still-performing and respected pop music idols from the 1960s as
well as the accomplishments of tennis, boxing, and baseball stars in their
late 40s). Relatedly, Princeton Project 55 in the United States is a group
composed of materially successful people in their 50s who wish to
organize themselves politically and dedicate their efforts to contributing
positively to the development of society. (It is guesstimated by some that the
group's membership will be near 5 million by 1995.) Interestingly, there
are indications that certain American youths are mobilizing explicitly on
intergenerational lines, owing in part to their disavowal of the achieve
ments of the now middle-aged baby boomers and older individuals. Hence
exciting and extremely challenging changes are about to happen in the
sense that certain very different sectors of our society (see Rosenbaum &
Button, 1993) are beginning to question seriously the legitimacy and
stability of images of older people (see Turner & Brown, 1978).
Much, then, needs to be done at the interfaces of communication,
intergroup relations, aging, and health that are implicit in the above as
well as the obvious roles of societal, cultural, sociodemographic, and
individual difference factors (e.g., contextual and psychological age) in
communicating about and across the life span. That said, we are not
advocating that communicative processes themselves can account for the
social construction of aging, or that the recourse to both quantitative
positivistic and qualitative social constructivist methods described above
has not caused us and colleagues some epistemological dilemmas and
ideological angst. However, the evidence supports the notion that talking
age and aging talk affect interlocutors across the life span, and decipher
ing how these processes operate can have both macro and micro implica
tions. Obviously, we need to move cautiously, yet steadfastly, toward even
more radical interdisciplinary positions to assess the boundaries of our

explanatory roles and forge connections with other societal as well as
biological processes. Branco and Williamson's (1982) perspective on the
economic parameters of, and historical fluctuations in, age stereotyping
forms a useful backdrop to the foregoing. By accommodating language,
groups, and dilemmas in this way, we can be theoretically more incisive
about construing communication in a less ageist manner by pursuing the
ways in which our views about our aging selves are negotiated in dis-
course and are then accessed communicatively and, in part, construct the
age identities of others.
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7
Stereotypes of the Elderly

and Patronizing Speech
MARY LEE HUMMERT
Although elderly adults vary widely in their communication skills, with

many exhibiting no significant receptive or expressive impairments
(Albert, 1980; Cooper, 1990; Kemper, 1988; Kemper & Anagnopoulos,
1990; Ryan, 1991; Salthouse, 1982), they are sometimes the targets of
patronizing speech (Caporael, 1981; Coupland, Coupland, Giles, &
Henwood, 1988; Rubin & Brown, 1975). According to Ryan, Giles,
Bartolucci, and Henwood (1986), this speech is identified by the pres
ence of simplification strategies (e.g., slow speech, low grammatical
complexity, and a concrete and familiar vocabulary), clarification strate
gies (e.g., careful articulation and simple sentences), a demeaning
emotional tone (e.g., directive, overbearing, or, alternatively, overly
familiar), and a low quality of talk (i.e., superficial conversation). An
extreme form of patronizing speech is secondary baby talk, often
addressed to institutionalized adults (Caporael, 1981; Caporael &
C u l b e r t s o n , 1986; C a p o r a e l , L u k a s z e w s k i , & C u l b e r t s o n , 1983;
Culbertson & C a p o r a e l , 1983).
Negative stereotypes of aging are identified as the cognitive precursors
of patronizing speech and baby talk in both the research (Caporael et al.,
1983; Coupland & Coupland, 1990; Coupland et al., 1988; Feezel &
A U T H O R ' S NOTE: The research reported here was funded by Grant 1 R29 A G 0 9 4 3 3
f r o m the National Institute on Aging, National Institutes of Health. This chapter is a
revision of a paper presented at the annual meeting of the Gerontological Society of
America, Washington, D.C., November 1992.
162
S T E R E O T Y P E S OF T H E E L D E R L Y 163
Hawkins, 1988; Giles, Coupland, Coupland, Williams, & Nussbaum,

1992; Ryan et al., 1986; Ryan, Hamilton, & Kwong See, in press) and
practitioner literature (Anderson, 1990; Slocum, 1989). For example,
Coupland et al. (1988) hypothesize that younger speakers often adapt
"their speech to the elderly, producing linguistic behaviors targeted at the
often inappropriate, but previously stereotyped, social persona of the
'elderly communicator' " (p. 9). Likewise, Caporael et al. (1983) report
that caregivers' use of patronizing speech is apparently related to "a social
stereotype of institutionalized elderly people characterized by incipient
deafness, failing vision, and loss of independence" (p. 753). Anderson
(1990) cautions geriatricians that unsatisfactory communication with
elderly patients occurs most often when they fall "into the trap that more
experienced practitioners with the elderly avoid—managing the stereo
type, rather than the actual person" (p. 84).
Despite the intuitive validity of the hypothesized relationship between
negative stereotyping and the production of patronizing speech, study of
its empirical validity has only begun. In addition, this relationship is
complicated by research demonstrating the existence of positive, as well
as negative, stereotypes of older adults (Brewer, Dull, & Lui, 1981;
Schmidt & Boland, 1986; Hummert, 1990; Hummert, Garstka, Shaner, &
Strahm, in press). I begin this chapter with a review of the literature on
multiple stereotypes of the elderly and patronizing speech to the elderly.
The core of the chapter, however, is a two-part model illustrating how
characteristics of the interactants and cues in the social setting may lead
to the activation of age-related stereotypes and, as a result, the use of
patronizing speech with older adults. I conclude with a discussion of
research testing the model, as well as the model's implications for the
study of interpersonal communication with older adults.
Multiple Stereotypes of the Elderly
Rather than a single, pervasive negative stereotype of elderly individu

als, adults hold multiple stereotypes for that age group, some of which are
negative and some of which are positive (Brewer et al., 1981; Hummert,
1990; Hummert et al., in press; Schmidt & Boland, 1986). Initial studies
by Brewer and her colleagues confirmed the existence of three predefined
prototypes of elderly adults: Grandmother, a nurturing, family-oriented
woman; Elder Statesman, a distinguished, conservative man; and Senior
Citizen, an inactive, isolated person of either sex (Brewer et al., 1981;
Brewer & Lui, 1984). Using trait-generation and -sorting tasks, Schmidt
and Boland (1986) identified 12 stereotypes of the elderly held by their

young adult participants. Of these stereotypes, 4 were positive (John
Wayne Conservative, Liberal Matriarch/Patriarch, Perfect Grandparent,
and Sage) and 8 were negative (Severely Impaired, Mildly Impaired,
Shrew/Curmudgeon, Recluse, Despondent, Vulnerable, Nosy Neighbor,
Bag Lady/Vagrant). Each label was generated by the researchers to
describe a particular cluster of traits (including cognitive, personality, and
physical descriptors) that constituted a stereotype.
My colleagues and I have conducted a series of studies extending
Schmidt and Boland's research to other age groups, both as targets of
stereotypes and as informants regarding elderly stereotypes (Hummert,
1990,1993, in press; Hummert et al., in press; Hummert, Garstka, Bonnesen,
& Strahm, 1993). In the first such study (Hummert, 1990), young adult
informants were asked to sort a trait set (Schmidt & Boland, 1986) into
one or more groups with reference to either elderly or young adults.
Results confirmed the existence of multiple stereotypes of both age
groups. There was very little overlap, however, between stereotypes of
the elderly and those of the young, indicating that the trait groupings truly
reflected age-based categories and not general stereotypes of positive and
negative persons. In addition, 8 of the 10 elderly stereotypes identified in
this study corresponded to those reported by Schmidt and Boland (1986):
5 negative (Severely Impaired, Shrew/Curmudgeon, Recluse, Despon
dent, Vulnerable) and 3 positive (Perfect Grandparent, John Wayne Con
servative, and Liberal Matriarch/Patriarch).
More recently, Hummert et al. (in press) investigated the stereotypes
of the elderly held by young, middle-aged, and elderly adults. Results
revealed 7 stereotypes shared by those in all the age groups, 3 positive
(Perfect Grandparent, Golden Ager, and John Wayne Conservative) and
4 negative (Severely Impaired, Despondent, Shrew/Curmudgeon, and
Recluse). With the exception of the Golden Ager (which contained many
positive traits not included in earlier research), the shared stereotypes
were reported previously in both the Schmidt and Boland (1986) and the
Hummert (1990) studies. These stereotypes appear to represent powerful
cultural archetypes of aging.
In addition to the shared stereotypes, 3 positive stereotypes (Activist,
Liberal Matriarch/Patriarch, and Small Town Neighbor) and 4 negative
stereotypes (Self-Centered, Mildly Impaired, Vulnerable, and Elitist)
were included in the stereotype sets of at least one age group. The traits
associated with these and the shared stereotypes are presented in Table
8.1. Note that the negative stereotypes represent individuals who vary
S T E R E O T Y P E S O F THE E L D E R L Y 165
widely in their functional competence. Not all describe individuals with

severe cognitive and/or physical disabilities.
Specific ages may be components of the stereotypes, although the age
associations may differ for young, middle-aged, and elderly adults. When
asked to indicate the ages of individuals representing the stereotypes,
adults of all ages chose the older elderly age ranges (80 and above) for
the negative stereotypes (e.g., Severely Impaired) that included traits
suggesting physical and cognitive decline (Hummert, 1990,1993; Hummert
et al., 1993). However, only young adults associated the positive stereo
types almost exclusively with the youngest elderly age ranges (55-69).
Middle-aged and elderly adults were as likely to choose older age ranges
for the positive stereotypes as they were to choose younger age ranges.
As suggested by the age-association data, young adults have less
complex views of aging than do middle-aged and elderly adults. In turn,
middle-aged adults have less complex perceptions than do elderly adults.
Heckhausen, Dixon, and Baltes (1989), for example, found that, in com
parison with young adults, elderly and middle-aged adults identified more
developmental increases (in both positive and negative characteristics)
occurring with advancing age, and the elderly identified more than the
middle-aged. In the stereotype studies, these differences in complexity
are reflected in the number of stereotypes reported by those in an age
group and the number of positive traits associated with aging. In both
cases, the elderly report the most and the young report the least (Brewer
& Lui, 1984; Hummert et al., in press).
In sum, the multiple-stereotype studies indicate that adults of all ages
hold both positive and negative stereotypes of older adulthood, although
middle-aged and elderly adults have more stereotypes and associate more
positive traits with older adulthood than do young adults. All age groups
associate the physical and cognitive decline in some of the negative
stereotypes with the old-old age range (80 and above), but only young
adults believe that individuals representing the positive stereotypes are
primarily in the young-old age range (55-69).
Patronizing Speech to the Elderly
That patronizing speech is employed with at least some elders has been
documented through observation in nursing homes (Caporael, 1981;
Caporael & Culbertson, 1986) and through interviews with the elderly
(Hummert & Mazloff, 1993; Henwood & Giles, cited in Ryan et al., 1986).
Table 8.1 Stereotypes of the Elderly Held by Young, Middle-Aged,

and Elderly Adults
Stereotype Traits Age Group
Negative
Severely Impaired slow-thinking, incompetent, feeble, all
incoherent, inarticulate, senile
Despondent" depressed, sad, hopeless, afraid, all
neglected, lonely
Shrew/Curmudgeon a complaining, ill-tempered, bitter, all
prejudiced, demanding, inflexible,
selfish, jealous, stubborn, nosy
Recluse" quiet, timid, naive all
Mildly Impaired tired, fragile, slow-moving, elderly and
dependent middle-aged
Self-Centered greedy, miserly, humorless elderly and
middle-aged
Elitist demanding, prejudiced, wary, elderly
snobbish, naive
Vulnerable afraid, worried, victimized, young
hypochondriac, wary, bored,
sedentary, emotionless, miserly
Positive
Golden Ager" lively, adventurous, alert, active, all
sociable, witty, independent,
well-informed, skilled, productive,
successful, capable, volunteer,
well-traveled, future-oriented,
fun-loving, happy, curious, healthy,
sexual, self-accepting, health-
conscious, courageous, interesting
Perfect Grandparent" kind, loving, family-oriented, all
generous, grateful, supportive,
understanding, trustworthy,
intelligent, wise, knowledgeable
John Wayne Conservative" patriotic, religious, nostalgic, all
reminiscent, retired, conservative,
emotional, mellow, determined, proud
Activist political, sexual, health-conscious, elderly
liberal
emotional, frugal, old-fashioned, elderly
Small Town Neighbor
quiet, conservative, tough
liberal, mellow, wealthy middle-aged
Liberal Matriarch/Patriarch
SOURCE: Stereotypes identified in Hummert et al. (in press).

a. Trait set for stereotype includes traits grouped with the stereotype by those in all three age groups
plus traits grouped with the stereotype by those in at least two age groups.
STEREOTYPES OF THE ELDERLY 167
Caporael (1981) identifies secondary baby talk to institutionalized elders

as a specialized voice register characterized by high pitch and wide pitch
variations. This voice register corresponds to that used in baby talk to
children: young adult judges were largely unable to distinguish between
content-filtered secondary baby talk samples collected by Caporael and
baby talk directed to children. Other young adult judges rated content-filtered
secondary baby talk as more nurturing than either adult speech from one
caregiver to another or non-baby talk directed to elders. In a second study,
elderly judges of lower functional ability reported greater liking for
secondary baby talk than for other speech types (Caporael et al., 1983).
Caporael notes, however, that although the pitch variation in baby talk
may convey nurturance, the content itself may make the talk demeaning
when targeted at adults.
Ryan and her associates have conducted a series of studies focusing on
evaluations of the content aspects of patronizing speech (Ryan, Bourhis,
& Knops, 1991; Ryan, Hamilton, & Kwong See, 1994; Ryan, Meredith &
Shantz, in press). Transcripts of a simulated dialogue between a nurse and
a woman resident in a nursing home were constructed to conform to either
patronizing speech or normal adult speech. The patronizing transcript
contained brief imperatives, the expressions "poor dear" and "good girl,"
and a statement questioning the cognitive competence of the resident.
Regardless of differences in situation and alertness of the resident, adult
judges from young to elderly who read the patronizing sample rated the
caregiver as less respectful and nurturant and the resident as less satisfied
with the interaction than did those who read the neutral sample (Ryan
et al., 1991; Ryan, Meredith, & Shantz, in press). A slightly different
pattern of results was found when respondents listened to either a
neutral institutional dialogue or a patronizing dialogue with the para-
linguistic cues of secondary baby talk added (Ryan, et al., 1994). The adult
listeners evaluated the patronizing message more negatively than the
neutral institutional one on the dimensions of caregiver respectfulness and
resident satisfaction, but saw no differences between the messages on
nurturance.
Patronizing speech does not occur only in institutional settings, how
ever. In interviews, community-dwelling older adults have acknowledged
experiences with patronizing speech and indicated their dissatisfaction
with it (Hummert & Mazloff, 1993; Henwood & Giles, cited in Ryan et
al., 1986). For instance, Hummert and Mazloff (1993) asked elderly adults
in focus groups to describe situations in which they have heard younger
adults address elderly ones in a patronizing manner. Participants named
three situations that seemed to elicit patronizing speech: when an older

adult is in a health care setting, such as a hospital, nursing home, or
doctor's office; when disputes arise with family members; and when older
adults in public places, such as restaurants, banks, and stores, are moving
more slowly than younger adults. Participants expressed the opinion that
in many of these situations, younger adults treat older ones like children
or as "nonpeople," that is, with little respect. Further, they noted that
younger adults may use patronizing speech because they view all older
adults as physically or cognitively impaired.
Patronizing speech is a complex phenomenon. The voice register of
secondary baby talk, for example, may convey warmth and nurturance
(Caporael, 1981; Caporael et al., L983). At the same time, the overly
parental content of the message may convey disrespect, particularly to
young adults and community-dwelling elders (Hummert & Mazloff, 1993;
Henwood & Giles, cited in Ryan et al., 1986; Ryan, et al., 1994). Other
patronizing speech may combine exaggerated intonation with a disap
proving or controlling message, communicating not only disrespect to the
listener but also negative affect (Hummert & Mazloff, 1993; Ryan et al.,
1991; Ryan, Meredith, & Shantz, in press). Both types of patronizing
messages implicitly question the competence of an older listener, with
potentially negative effects on that listener's self-concept and interper
sonal interactions (Ryan et al., 1986). Whitbourne and Wills (1993), for
instance, have argued that patronizing speech contributes to the infantili
zation of institutionalized older adults. Nevertheless, researchers and
older adults acknowledge that patronizing speech may reflect good inten
tions on the part of caregivers and other younger adults, a desire to convey
warmth and/or to adapt their speech to stereotypical communicative needs
of older adults.
A Model of the Role of Age-Related Stereotypes

in the Production of Patronizing Speech
The evidence for the existence of both positive and negative stereo
types of the elderly is strong, as is the evidence that individuals sometimes
adopt a patronizing speech style when conversing with the elderly. Two
research issues of interest to communication scholars, however, remain
unanswered by these two lines of research: First, if people have both
positive and negative stereotypes of older adults, what factors influence
them to choose one stereotype over another in a particular communication
Figure 8.1. Age-Related Stereotypes in Interaction
encounter? Second, which stereotypes lead to the use of a patronizing

speech style?
Figure 8.1 depicts a model that shows how age-related stereotypes may
function to affect communication by and with older adults, in particular
to elicit patronizing speech toward older adults in first-time encounters.
Like earlier models of communication with older adults (Coupland et al.,
1988; Ryan et al., 1986), this model is grounded in communication
accommodation theory (Giles, Mulac, Bradac, & Johnson, 1987). That is,
it stipulates that communicators may overaccommodate speech to meet
stereotypical communication deficits in an elderly person, producing
patronizing speech (Coupland & Coupland, 1990; Coupland et al., 1988;
Ryan et al., 1986). Alternatively, communicators may choose to empha
size their distance from the negatively stereotyped individual and under-
accommodate their speech to the needs of the older adult (Coupland et
al., 1988; Giles et al., 1992; Ryan et al., 1986), perhaps by using slang
unfamiliar to the older person or by speaking more softly or more rapidly

than normal. In either case, communicators adopt age-adapted speech styles
without full knowledge of the communicative needs of the older adult.
Although consistent with earlier models in its theoretical underpin
nings, the model in Figure 8.1 differs from those models in three ways.
First, it is equally applicable to both intra- and intergenerational commu
nication. That is, previous models were developed to illustrate the dynam
ics of intergenerational interactions, focusing on communication with
older adults as an intergroup process (see Giles, Fox, Harwood, & Williams,
Chapter 7, this volume). This model acknowledges that older adults also
have stereotypes for their age group, and those stereotypes may affect
intragenerational interactions as well as intergenerational ones. Second,
this model attempts to specify the cognitive, physical, and contextual
factors that may lead to positive or negative stereotyping in interaction.
Third, it includes the possibility that activation of stereotypes may lead
to normal adult speech as well as age-adapted speech. Deaux and Major's
(1987) model of how gender stereotypes function in interaction suggested
some elements of this model of age-related stereotypes in interaction.
The model includes two elements of the interactants' cognitive sys
tems: their self-systems and their sets of age-related stereotypes (positive
and negative). As illustrated by the model, when a perceiver encounters
an elderly target, positive or negative stereotypes may be activated,
depending upon (a) the self-system of the perceiver, which would include
factors affecting the accessibility of particular stereotypes, such as age
and quality of contact with the elderly; (b) the physical characteristics of
the target, such as physiognomic cues to age; (c) situational cues that
increase the salience of age; (d) the communication behavior of the target
suggestive of particular cognitive or personality traits consistent with the
stereotypes; and (e) the perceiver's interpretation of his or her own
communication behavior. Likewise, for the elderly target, positive or
negative stereotypes may be activated by the self-system, the physical
characteristics of the perceiver, the situation, and the communication
behavior of either participant. Thus activation of the stereotypes may
occur at the start or during the course of the interaction.
Once activated, the nature of the stereotype should lead the perceiver
to choose either a normal adult or age-adapted speech style to address the
elderly target. Activation of positive stereotypes should be reflected in
the use of normal adult speech, whereas activation of negative stereotypes
should be reflected in the use of age-adapted speech (either overaccom
modating, i.e., patronizing, or underaccommodating). This should hold
true for the elderly target as well as for the perceiver (Giles & Williams,
1994).
Finally, the model shows that the type of speech used, age-adapted or
normal, will have an impact on the self-systems of the interactants. As
Ryan et al. (1986) and Coupland et al. (1988) point out, the use of
age-adapted speech, and patronizing speech in particular, is likely to have
a negative impact on the self-system of the older interactant. Ryan et al.
(1986) name four possible negative effects of patronizing speech on older
adults: constrained opportunities for communication, reinforcement for
age-stereotyped behaviors, loss of personal control and self-esteem, and
lessened psychological activity and social interaction. Patronizing speech
also has potential negative effects on the person who produces it, how
ever, in terms of reinforcement for negative stereotypes of aging and
unsatisfactory social interactions with older adults. In contrast, if the
participants use normal adult speech in their conversation, positive as
pects of both the target's and the perceiver's self-systems should be
reinforced. Presuming that normal adult speech is viewed by both partici
pants as appropriate convergence by the other (Giles et al., 1987), the
mutual acknowledgment of the other's competence implied by its use
should enhance both participants' personal senses of control and self-esteem
(McCall, 1987), strengthen positive beliefs about aging, and maximize
the potential for a satisfactory interpersonal interaction.
Figure 8.2 presents a more detailed model of the factors (self-system
of the perceiver, physical characteristics of the target, and situation)
affecting the activation of positive or negative stereotypes of the elderly
in a perceiver at the beginning of the interaction. It focuses on untangling
the cues in the natural setting and characteristics of the interactants that
lead to activation of a particular stereotype, and from the stereotype to
the use of a particular speech style with an elderly target.
Self-System of the Perceiver
Certain characteristics of the self-systems of perceivers may affect the

accessibility of positive versus negative stereotypes of the elderly. First,
the perceiver's age may have an impact. As noted earlier, middle-aged
and elderly perceivers have richer, more complex aging schemas than do
young adults (Brewer & Lui, 1984; Heckhausen et al., 1989; H u m m e r t et
al., in press). In particular, they are more likely to identify positive traits
of older adults than are young adults. If this is the case, positive stereo
types should be more accessible to middle-aged and elderly perceivers
than to young ones, and more accessible to the elderly perceivers than to
F i g u r e 8 . 2 . I n i t i a l A c t i v a t i o n of S t e r e o t y p e s o f t h e E l d e r l y in I n t e r a c t i o n
middle-aged ones. The reverse pattern should hold true for negative
stereotypes, as illustrated in Figure 8.2.
Age is only one individual difference that may influence an individual's
tendency to rely on negative stereotypes and, therefore, to use age-
adapted speech. Coupland et al. (1988) and Ryan et al. (1986) name
cognitive complexity (Crockett, 1965; Linville, 1982) and contact with
the elderly (Knox, Gekoski, & Johnson, 1986) as two additional individ
ual difference variables that may play roles'in reliance on stereotypes.
Cognitive complexity refers to the richness of an individual's person-

perception schema (Crockett, 1965), that is, the number of different
constructs an individual has available to use in categorizing and interpreting
other persons' behaviors. Constructivist researchers have found that indi
viduals of higher cognitive complexity produce speech that is more adapted
to the demands of communicating with a particular individual than do those
of lower cognitive complexity (see Burleson, 1984; Delia & Clark, 1977),
and there is some indication that such individuals may be more sensitive to
the face or self-esteem needs (Brown & Levinson, 1978) of their communi
cation partners than are those of lower cognitive complexity (O'Keefe, 1988;
O ' K e e f e & Shepherd, 1987). Presumably, then, individuals with higher
cognitive complexity would be more sensitive to the need to wait for trait
information before categorizing a person than would those of lower cognitive
complexity, as -well as more sensitive to the face threat (i.e., threat to
self-esteem) associated with the use of patronizing speech. As a result,
individuals with high cognitive complexity should be less likely to activate
negative stereotypes than should those of lower cognitive complexity.
Quality of contact with the elderly, but not frequency of contact, has
been found to be positively related to subjects' attitudes toward and
perceptions of elderly individuals (Knox et al., 1986; Robb, 1979; Rose-
Colley & Eddy, 1988; see also Fox & Giles, 1993). In the contact studies,
quality has been broadly defined and assessed primarily through subject
self-reports. The dimensions that constitute high-quality and low-quality
contact have not been identified empirically. For instance, Knox et al.
(1986) asked young adults to indicate the quality of their contact with
elderly people. Forty questions addressed the quality of contact at different
points in time (e.g., ages 0-5,6-10), with different people (neighbors/friends,
most familiar elderly person), and in different situations (work, service).
Respondents indicated the quality on 7-point scales in which 1 was a low
rating. Respondents also answered questions on frequency, voluntariness,
and other aspects of contact, and filled out attitude and knowledge
questionnaires on aging. Results indicated that specific quality items
significantly predicted from 13% to 25% of the variance in the attitude
judgments, whereas frequency of contact showed no relation to attitudes.
Neither quality nor quantity of contact was related to participants' knowl
edge about aging. This and other contact studies suggest that positive
evaluations of one's previous contact with older adults may increase the
accessibility of positive stereotypes in interaction, whereas negative
evaluations of prior contact may increase the accessibility of negative
stereotypes.
Physical Characteristics of the Elderly Target
Physical characteristics may be divided into three categories: physiog

nomic cues to age (facial features), physique, and personal appearance.
Ryan et al. (1986) have suggested that physiognomic cues to a person's
age may be sufficient to activate negative stereotypes of the elderly. This
hypothesis is consistent with the results of research on the effects of
age-related changes in facial structure on social perceptions (see Berry &
McArthur, 1985, 1986, 1988; McArthur, 1982; McArthur& Baron, 1983)
and the multiple-stereotype research (Hummert, 1990, 1993). Berry and
McArthur (1985, 1988) investigated the social consequences of having a
"baby face" for college-age males. They defined a baby-faced appearance
as including large, round eyes; short, narrow nose; large forehead; and
small chin. As the researchers predicted, the young men with more
baby-faced appearances were judged as warmer, kinder, more honest, and
more naive than were those with more mature facial configurations.
In two related studies, Montepare and McArthur (1985; cited in Berry
& McArthur, 1986) investigated the effects of facial wrinkling on chil
dren's perceptions of adults. In one study, the researchers created 35-, 55-,
and 75-year-old versions of the same two stimulus faces; in the other, they
varied wrinkling to create 19- and 53-year-old faces (as judged by adults).
The preschoolers involved in the studies not only judged the faces with
more wrinkles as older than the others, but also felt that the more wrinkled
person was more likely to say meanly, "Go away and don't bother me"
than was the less wrinkled person. These and other studies of facial
appearance (e.g., Secord, Dukes, & Bevan, 1954; Secord & Muthard,
1955) suggest that facial features activate particular trait associations, or
stereotypes, of persons with those features. It is reasonable to expect,
then, that the physiognomic signs of old age, such as wrinkles and gray
hair, would be sufficient to activate stereotypes of the elderly.
Whether the cues to age lead to positive or negative stereotypes,
however, should depend on the specific age or age range they suggest. As
described earlier, young and elderly adults in the stereotype studies chose
the oldest age ranges (80 and above) for the stereotypes indicating
cognitive and physical decline (Hummert, 1990; Hummert et al., 1993).
Physiognomic characteristics indicating advanced old age should be more
likely, then, to lead to negative stereotypes than to positive ones. In
contrast, physiognomic cues indicating young-old age should be more
likely to activate positive stereotypes of the elderly, particularly for young
adults. Recall that in the stereotype studies young adults associated the
positive stereotypes almost exclusively with the young-old (55-69) age

range (Hummert, 1990; Hummert et al., 1993).
As shown in Table 8.1, traits indicating physical health are components
of the positive stereotypes, and ill health is associated with some of the
negative stereotypes (Hummert, 1990; Hummert et al., in press; Schmidt
& Boland, 1986). Both the Golden Ager and Activist stereotypes, for
example, include the traits sexual and health-conscious. In addition, the
Golden Ager is seen as active, healthy, and alert, to name only a few traits.
Therefore a healthy physique (upright posture, good muscle tone) should
lead to positive stereotypes. In contrast, an infirm physique (poor posture,
use of cane or wheelchair) should activate negative stereotypes because
it would suggest such traits as feeble (Severely Impaired), slow-moving
(Mildly Impaired), and sedentary (Vulnerable).
Finally, the target's grooming and dress may suggest either positive or
negative stereotypes. The Schmidt and Boland (1986) and Hummert
(1990) stereotype research studies included a few traits describing appear
ance, such as distinguished-looking, dirty, and unattractive. In both stud
ies, distinguished-looking was associated with a positive stereotype (John
Wayne Conservative or Liberal Matriarch/Patriarch), whereas dirty and
unattractive were grouped with the negative stereotypes. In Schmidt and
Boland's research, those traits helped to define a Bag Lady/Vagrant
stereotype. Additionally, other traits (e.g., wealthy, poor) point indirectly
to appearance differences between positive and negative stereotypes. As
indicated in Figure 8.2, the stereotype research suggests that a well-
groomed, fashionable older target should activate positive stereotypes,
whereas a poorly groomed, unfashionable target should lead to negative
stereotypes.
Situation
The context of an interaction may direct an interactant's attention to

one characteristic of the partner over others. If the context emphasizes a
characteristic related to the partner's membership in a particular group
(e.g., race, sex, age), the interactant may react to the partner according to
stereotypes of that group (see Giles et al., 1987; McGuire, McGuire,
Child, & Fujioka, 1978; Tajfel & Turner, 1979). In the aging literature,
attitude and person perception studies have demonstrated that research
methodologies and situations that make age salient increase the probability
of negative evaluations of older targets in comparison with younger targets
(Crockett & Hummert, 1987; Kogan, 1979). Coupland et al. (1988) and
Ryan et al. (1986) have suggested, as a result, that situations that make
age salient should increase the likelihood of stereotyping of older adults
and the use of a patronizing speech style with them. However, the context
may make age salient in a positive way as well as in a negative way. For
instance, an upscale retirement community or a cruise ship may suggest
positive traits associated with the Golden Ager stereotype. In contrast, a
nursing home may suggest the negative traits of the Severely Impaired
stereotype. As shown in the model, when the situation makes age salient,
the valence of the association should lead to activation of either positive
or negative stereotypes. In the case of an age-neutral situation, however,
the physical characteristics of the target may assume increased promi
nence as a source of stereotype activation.
Stereotypes and Choice of a Speech Style
As Figure 8.2 shows, positive and negative stereotypes are related to

the perceiver's beliefs about the communication needs and capabilities of
persons fitting the stereotypical categories. Those beliefs, in turn, may
generate either normal adult or age-adapted speech styles. Ryan, Kwong
See, Meneer, and Trovato (Chapter 2, this volume) have shown that adults
of all ages believe that the typical 75-year-old is likely to experience more
problems with receptive and expressive communication skills than is the
typical 25-year-old. As a result, persons may think that they need to speak
more loudly and slowly with 75-year-olds than with 25-year-olds. In other
words, they might see a patronizing speech style as the appropriate
accommodation to the communicative needs of older adults when they
think of older adults as a group. In their interactions with older adults as
individuals, however, their beliefs about the communicative skills of each
individual are likely to vary with the nature of the stereotype. Certain
negative stereotypes should be more likely than others to lead to patron
izing speech, and positive stereotypes should suggest beliefs leading to
normal adult speech.
Caporael et al. (1983) found that caretakers' beliefs about the lowered
functional ability (helplessness) of elderly individuals were associated
with their beliefs that normal adult speech would be ineffective with those
individuals, suggesting that the caretakers would be most likely to use
patronizing speech or baby talk with the most dysfunctional elderly.
Likewise, Caporael and Culbertson (1986), Coupland et al. (1988), and
Ryan et al. (1986) have remarked on the relationship between the com
parative helplessness of a target and the interlocutor's use of patronizing
speech, pointing out that patronizing speech may be a more general
speech style used by caretakers to care receivers of all ages. These

theorists note that one goal of such a speech style might be nurturance of
the care receiver. In short, prior research suggests that patronizing speech
is most likely to be used by a person in a caretaker role with a care receiver
who is quite dependent, and least likely to be used by a person commu
nicating with another of equal functional ability.
The stereotypes of the elderly identified in the multiple-stereotype
research describe individuals who vary widely in functional ability (see
Table 8.1). Certainly all of the positive stereotypes call to mind individu
als who should be addressed as fully functioning adults in normal adult
speech. They include traits such as capable, alert (Golden Ager), and intel
ligent and knowledgeable (Perfect Grandparent). Within the negative stereo
types, the degree of competence varies from the Severely Impaired stereo
type to the relatively unimpaired Shrew/Curmudgeon. The latter type of
individual, though competent, possesses many negative personality traits,
such as complaining, ill-tempered, and bitter. In contrast, the Severely
Impaired individual is defined as senile, slow-thinking, inarticulate, in
coherent, feeble, and incompetent. Likewise, the Despondent individual
is depressed, sad, hopeless, afraid, neglected, and lonely. Given the
difference in functional competence suggested by these traits, the De
spondent and Severely Impaired stereotypes should be more likely than
the Shrew/Curmudgeon to lead to the perceiver's choosing a patronizing
speech style.
Summary
The model of the role of age-related stereotypes in interaction as
presented in Figures 8.1 and 8.2 provides a useful heuristic for conceptu
alizing interpersonal communication with older adults both across and
within generations. The model emphasizes both the transactional nature
of the communication process and the importance of contextual, cogni
tive, and nonverbal elements in the initial activation of stereotypes of
older adults. As illustrated in Figure 8.1, the interaction is transactional
in that communication choices of both participants are affected by those
of the other, and both can change the nature of the interaction at any point
in time. As a result, an interaction that begins with the perceiver using
age-adapted speech with a target need not end that way if the target's
communicative behavior indicates that the adaptation is unnecessary. Unfor
tunately, age-adapted speech by a perceiver may also initiate responses
from the target that reinforce negative stereotypes, so that the two com
municators collaborate in creating an interaction with a downward spiral.
The factors affecting initial activation of positive and negative stereo

types of the elderly in a perceiver (Figure 8.2) include cognitive (self-system
of the perceiver), contextual (situation), and nonverbal (physical charac
teristics of the target) elements. According to the model, these factors are
additive. That is, the greater the number of elements leading to negative
(positive) stereotypes, the more likely it is that the perceiver will nega
tively (positively) stereotype the older target. Therefore, a young adult
perceiver of low cognitive complexity with a history of low-quality
contacts with older adults who encounters a physically incapacitated,
poorly groomed target over 80 in a nursing home would be most likely to
stereotype the target negatively, and to use a patronizing speech style as
a result. At the opposite end of the spectrum, an elderly perceiver of high
cognitive complexity with a history of high-quality contacts with older
adults who encounters a healthy, well-groomed target in his or her 60s or
70s at a health club would be most likely to stereotype the target posi
tively, and to use normal adult speech as a result. Such situations, in which
all factors point to positive or negative stereotypes, probably represent
the exception. In most naturally occurring interpersonal encounters with
older adults, cues to both positive and negative stereotypes may be present.
Whether a perceiver positively or negatively stereotypes the older target in
such situations may depend not only on the number of cues indicating one
set or the other, but also the importance of individual cues in the person-
perception schema of the perceiver.
Finally, the model described above represents an attempt to define the
role of stereotypes in first-time encounters with older adults. Although
stereotypes and the activation cues in the model also may play a role in
interactions with well-known older adults, their impact would be affected
by the history of the relationship and the emotional ties between the two
parties.
Conclusions
Two studies have tested aspects of the stereotype activation model

described in this chapter. The first focused on the role of physiognomic
cues in the activation of age-related stereotypes (Hummert, 1994). In that
study, young adults paired photographs of older adults of different ages
with sets of traits describing 10 stereotypes of the elderly (Hummert,
1990). As predicted by the model, the participants paired photographs of
young-old individuals most often with positive stereotypes, and matched
photographs of old-old individuals most often with negative ones. The

photograph-stereotype study also suggests, however, that sex, as well as
age, may be a component of some stereotypes. The photographs paired
most often with the Perfect Grandparent and Severely Impaired stereo
types were of females, whereas those paired most often with the Liberal
Matriarch/Patriarch stereotype were of males (Hummert, 1994). The
extent of the sex-stereotype association requires further study, however,
before sex is added to the model as a stereotype activation cue.
Using an extreme case design, the second study focused on the link
between the nature of the elderly stereotype activated and a perceiver's
beliefs about communication, as well as the link between the stereotype
and the perceiver's speech style (Hummert & Shaner, in press). Young
adult subjects participated in a role-playing task in which they constructed
persuasive messages to two older targets, one representing a positive
stereotype (Perfect Grandparent) and one representing a negative stereo
type (Severely Impaired). The stereotype manipulation was accomplished
by presenting the subject with a photograph and a set of traits correspond
ing to the stereotype of interest. Photographs and trait sets were paired
based upon the results of the first study, described above (Hummert,
1994). Prior to delivering the message, subjects made judgments about
the nonverbal vocal style of the target and the nonverbal vocal style they
would use with the target. Beliefs were assessed using measures devel
oped by Ryan et al. (1991).
The belief and message data supported the hypothesis that the negative
target would receive more patronizing messages than would the positive
target. Subjects' ratings indicated they would use nonverbal charac
teristics associated with the patronizing speech style more with the
negative target than with the positive one, and that they believed the
negative target possessed more vocal qualities associated with the older
adult voice than did the positive one. Specifically, subjects indicated that
they would speak significantly more slowly, loudly, expressively, and
hesitantly, and with more exaggerated pronunciation, to the negative
target than they would to the positive target.
Consistent with the characteristics of patronizing speech, messages to
negative targets contained significantly fewer arguments and shorter
utterances, and were more likely to be condescending in emotional tone
than those to positive targets. Contrary to expectations, however, subjects
spoke no more slowly to the negative target than they did to the positive
target, nor did they use more directives with the negative target than with
the positive one.
These studies provide the foundation for additional research on the role
of stereotypes in interaction. Future research should involve middle-aged
and elderly adults, as well as young adults, as perceivers. In addition,
elderly individuals representing a variety of stereotypes should be in
cluded as targets. These modifications to the protocol used by Hummert
and Shaner (in press) would allow a test of the model's predictions that
(a) within the set of negative elderly targets, subjects will use more
patronizing speech with targets of lower functional ability than with
targets of higher functional ability; and (b) ages of subjects will be
linearly related to their use of patronizing speech with elderly targets, with
the young using more patronizing speech than the middle-aged, and the
middle-aged using more patronizing speech than the elderly. A second
line of research should vary the amount and type of information presented
about the targets to assess the relative impact of physical characteristics,
situation, and cognitive/personality traits on the activation of positive
versus negative stereotypes, and the resulting use of age-adapted or
normal adult speech. Third, the hypothesized relationship between indi
vidual differences in age, cognitive complexity, and quality of contact
with the elderly and an individual's reliance on positive or negative
stereotypes should be examined. Finally, research should address the
•strategies elderly adults can use to encourage coconversants to address
them appropriately, using accommodations tailored to their individual
needs rather than to their age status.
Although research on stereotypes of the elderly has successfully de
bunked the myth of widespread negative stereotyping of the elderly, it has
demonstrated that some elderly individuals are negatively evaluated, and
that the probability of negative evaluations increases with target age. In
addition, research on communication with the elderly has shown that
under some circumstances young adults use patronizing speech with
elders, a speech choice consistent with a negative stereotype of the
elderly. The relationship between stereotypes and communication repre
sents an important focus for scholars interested in interpersonal commu
nication with older adults. Although many elderly view this speech style
as demeaning, they may tolerate it, with potentially negative effects
(Coupland & Coupland, 1990; Coupland et al., 1988; Ryan et al., 1986).
As Ryan et al. (1986) state, this "mismanaged demeaning talk may not
only induce momentary feelings of worthlessness in elderly people but
may also lead to reduced life satisfaction and mental and physical decline
in the long run" (p. 14). Results of research on stereotypes and c o m m u
nication will carry implications for strategies designed to reduce the use
of patronizing speech, either through the training of individuals who work

with the elderly or through educating the elderly themselves about how
to manage conversations to discourage its use.
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10
Frailty, Language,
and Elderly Identity
Interpretive and Critical Perspectives
on the Aging Subject
B R Y A N C. TAYLOR
I suppose I deserve being talked to that way, I've gotten so old. Most people
think that when you get so old, you either freeze to death, or you burn up.
But you don't. When you get so old, all that happens is that people talk to
you that way.
Grandmother, in Albee, The American Dream (1961, p. 19)
Even though we are old, we are not yet finished. We still come into new
things and could change yet a lot before we die.
Informant quoted in Meyerhoff (1986, p. 277)
W h e t h e r experienced as growth or decline, aging brings limits to the

older adult. Over time, the aging body is variously marked by limits to its
vision, hearing, speech, memory, strength, mobility, speed, endurance,
A U T H O R ' S N O T E : I would like to thank Judith H a m e r a for her generous contributions

to the ideas developed in this essay.
185
and balance. As they emerge, these limits signal the possibilities of

chronic illness, injury and dependence, and the approach of mortality.
They affect the relationships of older adults as their friends, family
members, and professionals mobilize to provide them with care and to
cope with subsequent financial and emotional costs. Additionally, these
limits create opportunities for the older adult to reflect on personal
meanings for time, the self, and the body. In the wake of limits,
existential questions arise: Who am I now that I am not what I was?
What will I be after this?
More than 10 years ago, Streib (1983) described the frail elderly—
those with cognitive dysfunction and physical impairments that require
continued care and substantially limit their independence—as "one of the
[populations] least studied by social researchers" (p. 40). The frail elderly
have been more difficult than other older persons for researchers to locate
(the majority are cared for at home by family and friends) and to interview
with standard methods and instruments (e.g., they can be demented and
resentful). Several factors have recently combined, however, to influence
the recovery of this excluded group. One involves demographics that
project a dramatic increase in the need for care by the frail elderly. The
"old-old," the majority of whom are women and who are at the greatest
risk of frailty and institutionalization, are the fastest-growing segment of
the elderly population (Barusch, 1991; Streib, 1983). Even assuming that
there are no further decreases in the mortality rate or innovations in
biomedicine, their numbers are expected to double by 2020 and to triple
by 2040 (Newman, 1990). The number of those aged 85 and older, more
than half of whom require assistance, is expected to quadruple by 2030
(Cohn & Sugar, 1991). Their burden on formal and informal care systems
is expected to increase commensurately.
Physical frailty affects between 3 million and 5 million older Ameri
cans (National Institutes of Health, 1991; Newman, 1990) and generates
annual costs of $54-80 billion. By 2030, these figures are projected to
grow to 13.8 million and $132 billion, respectively. Between 6 million
and 7 million U.S. elderly are functionally disabled (an estimated 25%;
Albert, 1990) and require long-term assistance with daily tasks of eating,
toileting, bathing, dressing, and taking medication, as well as with instru
mental activities such as transportation, shopping, cooking, cleaning, and
bill paying (National Institutes of Health, 1991; Tilson & Fahey, 1990).
The vast majority of these older adults (5.6 million) live at home and
receive some improvised combination of formal and informal care.
FRAILTY, LANGUAGE, AND ELDERLY IDENTITY 187
Two other factors signal an impending increase in demand by the frail

elderly for long-term health care and social support. The first involves an
increase in the number of young and middle-aged women entering the
workforce, and who are thus no longer able to provide traditional, infor
mal care for the frail elderly. Many of these women are divorced and
single parents, and lack the emotional and financial resources to assume
additional caregiving responsibilities. The second factor involves the
disproportionate concentration of frailty in the oldest—and thus poorest—
segment of the elderly: The majority have annual incomes of less than
$6,000 (Strauss et al., 1984; Tilson & Fahey, 1990).
Collectively, these statistics establish the long-term care of the frail
elderly as a major social problem. Most states do not possess the services
or infrastructures to accommodate the emerging needs of this population.
Unable to maintain self-sufficiency, the frail elderly may turn instead to
family members and friends, who are increasingly unable or unwilling to
assist them in their independence. At the same time, public policy makers
looking to control health care costs are naming the family as caregiver of
first resort (Barusch, 1991). Increasingly, reimbursement systems for
health care institutions encourage the early discharge of elderly patients,
and advancements in pharmacology and technology allow the acutely ill
elderly to be cared for at home.
As these forces converge, little is known about how the state and the
family are going to cope with these demands. Researchers have sub
sequently attempted to fill this knowledge gap by exploring such diverse
topics as how families deliver care in the home and accommodate in
creased stress (Gubrium & Sankar, 1990); the value of social workers in
mediating between frail elderly clients and their families and health care
bureaucracies (Fauri & Bradford, 1986); factors that increase the prob
ability of caregiver withdrawal (Boaz & Muller, 1991); psychological and
cultural factors that influence the deterioration of the older body (e.g., the
nursing-home practice of managing residents through medication re
gimes; Diamond, 1983; Spirduso & Gilliam-Macrae, 1991); differing per
ceptions of the frail elderly's quality of life among nursing-home staff,
residents, and their family members (Cohn & Sugar, 1991); and the ethical
obligations of adult children to care for their frail parents (Wicclair, 1990).
Such research is conducted from multiple perspectives that differ
markedly in goals, preferred methodologies, and representations of the
elderly self, the frail body, and communication. The dominant perspec
tive, well represented in this volume (see Ryan, Kwong See, Meneer, &
Trovato, Chapter 2; Cohen, Chapter 3; Kemper & Lyons, Chapter 4), can
be described as functionalism (after Morgan, 1980; Putnam, 1983). In
functionalist research, the aging self is a unique, essential, and stable
entity that exists prior to expression and knowledge (Kerby, 1991; Kreitler
& Kreitler, 1987). The aging body forms a material container for this
internal, Cartesian self; its psychology and physiology are subsequently
marked by frailty as an objective condition that creates distinguishable
traits (e.g., arthritis, heart disease). In this view, frailty is either a preex
isting cause that affects the communication of older adults or a topic of
reflection and conversation through which older adults integrate these
changes into their self-concepts and relationships (Atchley, 1991; Dittman-
Kohli, 1990; Wood & Ryan, 1991).
Functionalist research, additionally, holds that frailty and the elderly
self can be directly accessed through self-reports and observations of
behavior. It commonly employs experimental, cross-sectional survey and
factor-analytic methods to aggregate quantitative measurements of eti
cally derived traits (e.g., rates of speech, attitudes toward frailty), seeking
to generalize findings from samples to populations, and converge through
repeated attempts on a single correct and nomothetic explanation of
frailty (Anderson, 1987). Much of this research is policy-oriented and
practical, concerned with minimizing the cost and maximizing the effec
tiveness of care delivery (Arnold, 1991; Taber, Anichini, Anderson, Weagant,
& the Community Care Project, 1986). In this concern, it advances the
interests of various institutions (e.g., of the nursing-home industry, of
gerontology itself) that claim the frail elderly as subjects of profit,
management, and theoretical knowledge.
Although functionalism forms the dominant perspective in research on
elderly frailty and communication, it is complemented by two other
perspectives, which can be described as interpretivist and critical. C o m
paring and contrasting these alternate perspectives, and noting their
relationship to functionalism, helps to clarify the boundaries, premises,
and themes of frailty research. It problematizes, however, the status of
research claims of direct knowledge and absolute Truth concerning frailty.
Instead, "frailty and communication" appears as a site of symbolic strug
gle between theoretical and methodological narratives attempting to
establish themselves as the dominant mode of understanding of the topic.
These narratives do not reflect the objective statuses of phenomena so
much as they construct them through implicit norms, values, metaphors,
tropes, and premises. My purpose in this chapter is to examine these
alternate perspectives and to evaluate their narrative constructions of
F R A I L T Y , L A N G U A G E , AND E L D E R L Y I D E N T I T Y 189
elderly frailty. Because both of the perspectives are to some extent

reactions to functionalism, in this evaluation I will return frequently to
the characteristics of that dominant paradigm. After introducing the two
perspectives, I will review research conducted from each, and conclude
by speculating about the future of elderly frailty research.
I emphasize here at the outset that this analysis reflects the heuristic
grouping of research findings according to their similarities and differ
ences. Often, these elements involve taken-for-granted and coded as
sumptions, and require critical interpretation. This attempt to characterize
the organizing principles of frailty research does not exhaust this litera
ture, and—for expedience—occasionally glosses distinctions within the
perspectives (e.g., between the streams of thought that constitute inter
pretivism) in order to emphasize differences between them. Some find
ings, further, display multiple and conflicting assumptions, and defy
exclusive categorization (e.g., the use of both hermeneutical and quanti
tative methods by Thomas & Chambers, 1989). It is more useful, then, to
consider the perspectives as points along a continuum of ontological and
epistemological positions concerning elderly frailty and communication.
Movement between the perspectives involves shifts between competing
explanations of the self, the body and language, and of the methods and
goals of frailty research.
Having reviewed functionalism, I now outline the two competing
perspectives as follows. Interpretivist research is characterized by a
"process" view of the self (Chappell & Orbach, 1986; Spence, 1986) as
a shifting, situated construct of symbolic interaction. This inductive,
idiographic perspective draws on the traditions of phenomenology, her
meneutics, ethnomethodology, existentialism, and symbolic interaction-
ism. It rejects the positivist practice of aggregating measurements of the
frail elderly based on their categorical similarities, and argues that they
should be studied in the natural settings and social networks of their
everyday lives. Bodily experience and cognitive knowledge of frailty are
assumed to be outcomes of communication between conversational and
relational partners—that is, collaborative productions rather than preex
isting conditions.
Interpretivists frequently employ discourse-analytic and ethnographic
methods (e.g., participant observation and interviewing) to detail the
micropractical features, strategies, and organization of talk. These meth
ods also depict the localized meanings that form the consequential,
intersubjective reality of interaction (e.g., in attempts by the frail elderly
to pass as normal functioning; Strauss et al., 1984, chap. 7). Frailty talk
is conceptualized as a text subject to interpretation by researchers con

cerned with intergenerational pragmatics and ethics (e.g., the ways in
which chronological age and painful self-disclosure are negotiated as
dimensions of elderly identity, and potentially lead to ageism; Coupland,
Coupland, & Giles, 1989; Coupland, Coupland, Giles, Henwood, &
Wiemann, 1988). Interpret!vist research expands basic knowledge about
the complex experiences and practices surrounding frailty, and opposes
the reduction of their variance in functionalist discourses of theory and
policy (e.g., Gubrium & Sankar, 1990).
The second alternate perspective, critical research, is characterized by
an explicitly oppositional and reflexive stance toward the discursive
construction of frailty. Here the frail self is completely decentered and
deconstructed as a subject of talk and knowledge. This deconstruction
proceeds at three levels. At the level of the individual, frailty is conceived
to be a purely linguistic entity, existing as one possible subject position
in the web of signs that constitute language, and that precede and mediate
all social knowledge. Over the course of their development, older adults
and their relational partners are interpellated into multiple cultural and
historical discourses, of which frailty is a part. These differing, even
contradictory, discourses both orient and fragment personal conscious
ness, and constrain the meanings of personal identity, time, and the body
(e.g., as aging normally; Strine, 1992). Frailty is a structural position in
language for producing meaningful speech and provides an organizing
principle for the fragmented, irrational, contradictory, and ambiguous
experiences of human aging (e.g., the way in which the "obvious reality"
and durability of the frail body are juxtaposed through reminiscence with
a lifetime of close calls and traumas; Cole & Premo, 1987, p. 81).
At the second and related level, critical research historicizes and
relativizes all discourses of frailty, and suspiciously (Lyotard, 1984)
examines their assertion of knowledge claims as truth. Theories of devel
opment and the life course, for example, have recently been criticized for
modeling universal stages and for arbitrarily upholding stability, continu
ity, and progress in personal identity as criteria of successful aging
(Featherstone & Hepworth, 1989; Gergen & Gergen, 1987; Handel,
1987). In this view, "aging" and "frailty" are symbolic constructs whose
meanings are continually shifting in relation to worldly forces of econom
ics, politics, technology, and history. Knowledge claims about these
phenomena must be evaluated accordingly: in context.
At the third and Final level, critical research considers the utility and
consequences of professional discourses about frailty. It examines the
FRAILTY, L A N G U A G E , AND ELDERLY IDENTITY 191
ways in which theory and policy construct the identities and bodies of the
frail elderly so that they may be subjected—for a variety of motives and
purposes—to institutional practices of power: diagnosis, labeling, regu
lation, surveillance, management, care, and discipline (Henriques, Hollway,
Urwin, Venn, & Walkerdine, 1984; Sampson, 1989). While acknowledging
the ideal of benevolent care for the frail elderly, criticism is also sensitized
to the varieties of naivete, cruelty, mystery, absurdity, paradox, pleasure,
and growth that surround its practices.
Critical research draws its methods f r o m poststructuralist and postmod
ernist theories about the relationships among language, reality, institu
tions, and power (Belsey, 1980; Foster, 1983). In these critical theories,
language is seen as a network of ultimately self-referential signifiers that
reconstitutes social structure and ideology through its orientation of
subjectivity and social practices. Meaning reflects the temporary and
arbitrary fixing of reference between linguistic signs, based upon cultural
and historical traditions (Coward & Ellis, 1977). Language thus becomes
a resource through which various cultural interests struggle to define
various conditions, events, and figures as a means of regulating their
existence. N o narrative is innocent in this view, or unconnected to social,
political, and economic interests. Critical research thus closely attends to
the specific images, metaphors, and conventions of frailty discourse. It
clarifies how that discourse privileges certain meanings and institution
alized arrangements as true, normal, and possible at the expense of others,
and tries to disguise its own cultural and historical contingency.
Having introduced the two perspectives, I now turn to the charac
teristics and themes of frailty research, which may be organized according
to their distinctions.
Interpretivist Research of
Elderly Frailty and Communication
To reiterate, interpretivist research of frailty is characterized by the

following beliefs: The self is a situational process and product of interac
tion; chronological age and the bodily experience of frailty are symbolic
constructions whose meanings are continually negotiated; researchers
should use discourse-analytic and ethnographic methods to preserve the
situated meanings and practices of intergenerational communication; and
research should ethically illuminate the complex, lived experience of the
subjects of policy and theory.
Three themes appear in interpretivist research of elderly frailty: The

first involves the critique and revision of functionalist premises and
methodology ; the second involves the depiction of chronological age and
frailty as collaborative, narrative productions; and the third involves the
dialectic of problems and productivity in relationships between the frail
elderly and their caregivers.
Critique and Revision of Functionalism
The first theme arises out of the continuing struggle between dominant
and marginalized research paradigms for the study of elderly frailty.
Postwar, American social scientists have traditionally chosen quantitative
and positivist paradigms as strategies for establishing the validity and
legitimacy of their research within various economies of knowledge. In
contrast, interpretivist researchers base their work on historical chal
lenges to positivist epistemology and experimental methodology (Marcus
& Fischer, 1986). In the interpretivist view, positivist researchers have
misconstrued the aging self as a static, substantial entity spatialized within
the individual (Chappell & Orbach, 1986), when it is actually a dynamic and
temporal process, existing solely in and through interaction (Coupland,
Coupland, Giles, & Henwood, 1991; Paoletti, 1991). As a result, positivists
perpetuate misguided beliefs: that elderly identity develops as an extension
of the young adult self through an orderly series of stages, when that process
is in fact indeterminate, discontinuous, and irrational (see especially Hazan,
1983; Spence, 1986; Starr, 1983); that survey samples should aggregate
the frail elderly based on their individual traits, when they actually live
as situated members of local networks and communities (Streib, 1983);
and that theories refer to real social practices and experiences, when they
are actually closed discursive logics whose concepts refer only to each other
and constrain the potential trajectories of research (Ainlay & Redfoot, 1982;
Atchley, 1991). A final criticism concerns ethics: that traditional psycholin
guistic research may perpetuate ageist tendencies by emphasizing deficien
cies of older adults' speech and cognition (Coupland, 1991).
Interpretivist researchers uphold qualitative methodologies such as
discourse analysis and participant observation as the means to access and
represent the phenomena of elderly frailty. Traditional research, they
argue, has successfully detailed the formal linguistic features of elderly
speech and the broad demographic variables of its speakers. Something
else is required to capture the middle ground of interaction: "[Actual] talk
to, from, and about the elderly is perhaps the area in which we are least
well informed" (Giles, Williams, & Coupland, 1990, p. 6). Qualitative
FRAILTY, L A N G U A G E , A N D E L D E R L Y I D E N T I T Y 193
methods, interpretivists believe, provide "a depth of insight and sensitiv-

ity not easily available to more traditional sociolinguistic approaches"
(Coupland, Coupland, Giles, & Henwood, 1988, p. 15). Thomas and
Chambers (1989), for example, compared quantitative and qualitative
analyses of expressed life satisfaction among two samples of older Eng-
lish and Indian men. Although the men's scores on the quantitative
measures differed very little, a hermeneutical analysis of their interview
responses revealed significant differences in the values and concerns that
inflected their subjective experience of aging: The English men displayed
a somber, stoic acceptance of loss, whereas the Indian men focused on the
importance of family, and on religious beliefs. The researchers concluded
that increasingly refined survey items and psychometric scales "strip"
(p. 289) the subjective experience of aging.
Applied by researchers, these methods recover what is absent in func-
tionalist research: the voice of the frail, older adult, speaking the vivid,
textured meaning of his or her personal being in time. An excerpt may
serve to demonstrate the qualities and dynamics of mundane interaction
that subsequently become visible in interpretivist research (Taylor, 1992,
p. 508). In the following, the first speaker (B) is a 96-year-old male. He
is talking with a male researcher (BT) and with his much younger, live-in,
female caregiver (S). (Numerals enclosed in parentheses measure the
lengths of silences, in seconds.)
1 B: Y'know, I' m on the very edge of life. As near the edge

2 as one can get. Don't know, there aren't many my age
3 who're still alive.
4 (6.0)
5 BT: How d'you feel about that, Biff? What does it feel like?
6 Β: I feel like a worn-out agent or man. Finished. Right on
7 the edge of life. We all get there, y'know. And I'm
8 here now.
9 (3.0)
10 S: N'yer doin'a good job!
11 B: How could I do otherwise with a nice lady like you
12 around?
13 Β &S: [laugh]
A close reading of this interaction reveals how the frail elderly can
construct and offer their profound experience of finitude (lines 1-3,
6-8), only to have younger partners redefine their disclosure as an issue

of p e r f o r m a n c e and competence (line 10), shying away, perhaps, f r o m
what is threatening to those partners in an ageist culture: accepted
mortality.
Social Construction of Frailty and Aging
The excerpt above also signals the second theme in interpretivist

research: the narrative, interactive production of frailty. In a seminal
piece, Dowd (1981) theorizes conversation as the arena in which the frail
elderly negotiate the exchange value of their identities, progressively
losing status as the patterns of their interactions solidify into ageism.
Increasingly, researchers have directly examined the construction of
frailty, empowerment, and ageism in and through actual talk. These
research programs have elaborated how linguistic identity markers such
as chronological age and painful self-disclosure can serve multiple,
strategic purposes in intergenerational talk (e.g., to account for frailty; to,
paradoxically, preempt more negative stereotyping; to organize the tem
poral relationship between the present and the past; and to elicit praise
and sympathy) (Coupland, Coupland, Giles, & Henwood, 1991; Coupland,
Coupland, Giles, Henwood, & Wiemann, 1988). The meaning and value
of these elements shift from context to context. Middle-aged adults, for
example, view the disclosure of chronological age (DCA) with anxiety
and reluctance. In later life, however, DCA "resurfaces from its under
ground life" (Coupland et al., 1989, p. 130), and is not only tolerated, but
positively construed in some encounters between the elderly.
In these cumulative analyses, the ontological status of frailty begins to
shift from that of a stable trait existing in space to a collaborative
performance existing in time. Meyerhoff (1986), for example, provides a
close reading of two "definitional ceremonies" used by older Jewish
adults in a Venice, California, community center to combat their invisi
bility in the surrounding community. In the first, they marched from the
center to a synagogue in a mock funeral procession, bearing the " c o f f i n "
of a woman killed by a bicyclist, returning afterward to celebrate the
100th birthday of another woman. In the second, they collaborated in the
painting of a mural depicting their ethnic histories and their collective
strength.
Taylor (1992), alternately, used discourse analysis and G a d o w ' s (1983)
description of frailty as the tension between bodily desire and capacity
for expression to examine relationships between older homeowners and
FRAILTY, LANGUAGE, AND ELDERLY IDENTITY 195
their younger live-in caregivers. In those relationships, friends, caregiv

ers, and the older adults themselves actively constructed frail identities
for the elders, in order to account for problematic events, to orient
conversationalists toward the older adult's impending death, to d e f i n e —
and thus indirectly control—the older adult, and to locate the existing self
in relation to the past and establish its moral meaning.
Coupland, Coupland, and Grainger (1991), similarly, provide a com
pelling case study that shows how very different age identities can be
created for the same person in two different interactions. In their research,
"May," a 79-year-old English widow, was paired in two separate conver
sations with strangers: first with an 82-year-old woman, "Nora," and then
with a 39-year-old woman, "Jenny." Close reading of the transcripts
shows how the two older adults shared positive and humorous life expe
riences, systematically diverging f r o m decremental themes to focus on
M a y ' s coping strategies and social activities. In the other conversation,
however, Jenny continually projected an identity of dependency and
vulnerability on May, emphasizing her restricted mobility, institutionali
zation, economic hardship, potential loneliness, and chronic illness. This
juxtaposition is vivid and decentering; the authors conclude that, "on this
evidence, who May developmentally 'is' seems elusive" (p. 205).
The Dialectic of Problems and Productivity

in Frail Elderly-Caregiver Relationships
The third theme in interpretivist research involves a tension between

positive and problematic dimensions of the relationship between the frail
elderly and their caregivers. Here, qualitative researchers uncover the
multiple and conflicting meanings that animate the lived experience of
" h o m e " and "quality of life," and the identities of relational partners. A
home, for example, is both a material and a symbolic construction, embody
ing the residents' values concerning (re)generation, independence, space,
comfort, and security. When a frail or demented older adult is introduced,
the home's various orders are first threatened and then reformed as
members provide care, perform various models of family, and paradoxi
cally attempt to preserve the older adult's independence while constrain
ing his or her irrational and destructive behaviors (Rubenstein, 1990).
Typically, households have already undergone periods of rehearsal for
this change (e.g., through increasingly frequent and extended visits by the
older adult). Principal caregivers encounter and establish their own limits
in this process, often unconsciously creating patterns of care that take on
the magical power of rituals (e.g., with believed healing effects). Most
important, caregivers find themselves renegotiating their relationship
with a declining, "disappearing" parent. Now it is the child who dresses,
diapers, bathes, and feeds the newly vulnerable parent. To cope with the
accompanying anxiety, adult children may objectify and redefine the
parent as an infant, patient, and, most poignantly, "someone else" who
"used to be" the parent (Albert, 1990). As a result of their gender
socialization, women struggle profoundly with issues of identification
and individuation in caring for their frail mothers, choosing to both repeat
and transcend old patterns of conflict in their relationships (Abel, 1990).
This tension between positive and problematic outcomes in caregiving
relationships is reproduced in research on formal institutions such as
nursing homes. Here the tension centers on competing logics of "care"
and "quality of life" held by different constituencies, typically defined by
their members in terms of the domains over which they hold power.
Family members, for example, may believe that frequent visits to resi
dents are beneficial, when in fact the residents may resent the visits
because they remind them of their dependence (Nussbaum, 1991). Like
wise, staff members and aides typically conceptualize care and quality of
life in terms of control and the successful discharge of their professional
duties (e.g., cleaning, feeding). Residents, however, often desire rela
tional closeness with staff members, which can disrupt s t a f f ' s efficient
and orderly performance of duties. Staff members thus often fail to
reciprocate distracting elderly self-disclosure; older residents may sub
sequently feel hurt and neglected (Cohn & Sugar, 1991; Nussbaum,
1991). Collectively, these findings illuminate the many practical and
ethical dilemmas of caregiving.
Summary
These three themes in interpretivist research—the critique and revision

of functionalism, the social construction of aging and frailty, and the
tension between problems and productivity in caregiving—both add to
and strip away from the metaphoric "flesh" of the "body" of research on
elderly frailty. On the one hand, interpretivist research adds to our knowl
edge of the lived experience and mundane activities surrounding elderly
frailty. On the other, it decenters our conventional sense of frailty's
substance (i.e., it is in the flesh), arguing instead for its temporality and
process (i.e., frailty is meaning cocreated through symbols). In the critical
perspective, this deconstruction is completed as frailty is further grounded
in language, history, and politics.
Critical Research of
Elderly Frailty and Communication
To reiterate, critical research is characterized by the following four

beliefs. First, aging and frailty are historical and cultural constructs that
mediate personal knowledge and intergenerational relations. Second, the
frail elderly body is a site of struggle between different narratives seeking
to authorize their particular versions of its meaning, value, capacities, and
limitations. These narratives seek further to incorporate that body into or
liberate itfrom various institutional regimes of discipline and care. Third,
the contingent premises and naturalized conventions of these narratives
may be critically deconstructed to evaluate ethically their operations and
consequences. And fourth, researchers should continually question their
complicity in the symbolic construction and regulation of the frail elderly.
To paraphrase Paoletti (1991, p. 16), the metatheoretical issue becomes,
Which elderly person am I helping to make, and for what purpose?
Two themes appear in frailty research conducted f r o m this perspective.
The first depicts aging and frailty as symbolic constructs that are always
embedded in political and economic contexts. These contexts structure
their shifting meanings, modes of performance, and consequences. The
second theme depicts frailty as a limited case for theorizing the relations
among culture, language, and subjectivity. Here, poststructuralist theory
is used to conceptualize frailty as a form of experience that defies
expression and unravels language, yet paradoxically establishes the pos
sibility of community. Because frailty is an absence or negation of
meaning that can be evoked but not expressed, its "official" truth will
continue to be colonized by professional discourses unless evaluative
criteria are revised to consider the validity of personal narratives.
Aging and Frailty as Symbolic Constructs
The first theme involves recent, critical deconstruction of the concept

o f " o l d a g e " ( s e e B a r u s c h , 1991,chap. 1; Featherstone & Hepworth, 1989;
Turner, 1987, chap. 6). This work establishes how public attitudes toward
older adults have historically shifted in relation to political and economic
developments within cultures. In the United States, for example, the
elderly were widely venerated during the early colonial period as reposi
tories of wisdom and morality. Populist rhetoric of the American Revolu
tion, however, emphasized equality among its cultural members; this
narrative frame dissolved the elderly's prestige, and morally contrasted
their frailty with youthful vigor. The rise of industrial capitalism during
the nineteenth century further transformed the traditional age-based stratifi

cation of society: Property, wealth, and status now fell "naturally" to those
controlling the means of production. Industrialism's privileged values—
speed, efficiency, productivity, innovation, and invulnerability—also un
dercut the identity of elderly workers: Mass-production machinery replaced
the need for their expert, craft knowledge. During the nineteenth century,
and into the mid-twentieth century, the elderly were increasingly por
trayed as feeble, lascivious, parasitic, and greedy. Since 1970, however,
aging has been predominantly symbolized as an illness and a social
problem, requiring the intervention of state bureaucracies and profes
sional disciplines (e.g., through extensive welfare programs, through the
creation of gerontology as a distinctive academic field).
In addition to historical developments, critical scholars (Featherstone
& Hepworth, 1989; Giddens, 1991) argue, the meaning of old age is
mediated by popular and professional narratives of the aging process (i.e.,
of "human development"). The cultural practice, for example, of using
chronological age to indicate an individual's maturity and progress along
career trajectories is arbitrary and uniquely modern. This practice seg
ments and moralizes the temporality of human existence by identifying
stages of development and prescribing "normal" patterns of behavior as
their content (e.g., the midlife crisis). Aside from essentializing the self
as an evolving structure, this rhetoric also supports the growth of various
social apparatuses of surveillance and control (e.g., of hospital-marketed
seminars for identifying and treating "troubled teens").
Traditional narratives of age identity are changing, however, in con
temporary postmodern culture. Instead of distinguishing age groups, for
example, fashion advertisements now display a uni-age style (e.g., in the
juxtaposition of young boys and older men wearing designer clothing).
Manufacturers now seek to tap the growing market of older adults for
goods and services that mediate their frailty (e.g., diapers for inconti
nence, the infamous Clapper remote-control device). Old age is also now
seen as an opportunity to maintain—through careful diet and the adoption
of rigorous exercise—the lifestyles and pleasures of middle age. Older
adults are increasingly constructed in public imagery as lively consumers:
witness the recent Diet Coke ad campaign ("In the 1800s, 60 was consid
ered ancient") that foregrounds the active, risk-taking older adult. Aging
itself will likely continue to be seen as a "mask," a process that marks and
distorts the body's surfaces and forces changes in one's personal narra
tive, but that cannot alter the presumably core, essential self (Frank,
1990).
Collectively, these analyses establish that "older adults" and "frailty"

can be understood only in relation to the cultural vocabularies that exist
to segment, theorize, and moralize the aging process. In any historical
moment, the meanings of these two symbols will be constructed relative
to at least two factors: the previous life experiences of the elderly, which
ground their expectations and experiences of old age (e.g., "You think
times are hard? Now, back in the Depression . . . "), and the relations
between older adults and younger generations, who objectify them ac
cording to their own desires and conditions (e.g., the resentment among
contemporary young adults toward subsidizing the elderly through Social
Security withholding, when they may not enjoy the same level of support
themselves at a later age). Cole and Premo (1987) describe one example
of historical subjectivity in the autobiography of an aging nineteenth-
century Yankee farmer who experienced considerable pain, homeless-
ness, and persecution. He interpreted his condition, however, through the
archetype of "the itinerant Christian pilgrim" as "successful aging" (p. 79),
as that which prepared his soul for its ascent to God. The authors note
how this form of identity contrasts with contemporary expectations that
health, security, and vitality are essential for successful aging.
The construction, maintenance, and transformation of frail identities,
finally, are always embedded in relations and practices of power. Dia
mond (1983), for example, has detailed how the ideology of capitalist
medicine functions in nursing homes. Residents are objectified as lucra
tive commodities whose value is secured through the discouragement of
their independence. They are continually medicated ("a culture of sleep";
p. 281) as a strategy to reduce both their activity and the potential lawsuits
that might result from any subsequent injuries (Spirduso & Gilliam-Macrae,
1991). Caregiving is performed as the codification of medical data in
documentation systems ("There was a place to record [one w o m a n ' s high
blood pressure] numbers, but not her crying"; p. 274). Older adults have
also been traditionally "punished" for displaying frailty in HUD-financed
congregate housing facilities, which stipulate that as soon as residents
require assistance in daily activities, they must transfer to nursing h o m e s
(Tilson & Fahey, 1990).
In summary, this first theme suggests how the subjective experience of
aging and its cultural representations (e.g., in literature, advertising, and
folklore) interpenetrate in mundane episodes of media consumption and
interaction: home video viewings, family dinners, polite conversations be
tween strangers. Although this volume focuses on interpersonal c o m m u
nication per se, critical theory urges a cultural, historical, and politically
engaged understanding of that phenomenon, one sensitive to its overde

terinination, ironic outcomes, and reproduction of power imbalances
(e.g., through the ageist-capitalist belief that the elderly are unproductive,
having spent their labor power; see Lannaman, 1991).
Language and the

Subjective Experience of Frailty
The second theme in critical scholarship explores the limits of language

in communicating the disembodying experience of frailty. This explora
tion proceeds on two levels. The first involves a review of Lacanian
psychoanalytic theory about the role of the body in structuring the
subject's relationship to language and culture (Bowie, 1979; Coward &
Ellis, 1977; Woodward, 1991). Frailty, in this view, represents a crucial
moment in human development because it threatens our natural attitude
toward the integration of language, the self, and the body. The second
level involves considering frailty as a flickering dialectic of evocation
and expression, and as the possible basis for community (Scarry, 1985).
Jacques Lacan's contribution to critical understanding of frailty is
based on his reinterpretation of Freudian psychoanalytic theory and the
role of language in the development of human consciousness (Woodward,
1991). Lacan argues that when children learn their culture's language they
are subjected to its norms and demands, and separated from their initial,
oceanic sense of fusion with their environment. In this process, children
gain the symbolic codes of cultural knowledge, but retain an ineffable
sense of longing for that presymbolic and unorganized state.
Crucial in this development process is the "mirror stage," in which the
child first recognizes and identifies with his or her own visible reflection.
Here, the child perceives his or her body as a unified and coherent object,
a perception that nonetheless opposes the child's experience of uncoordi
nation and fragmentation. Lacan holds that this identification satisfies the
child's desire to be recognized as whole by those around him or her, and
prepares the child for entry into language and its more complex system
of objectification. As mentioned, however, the child's primordial m e m o
ries continue to exist without sense of time or language in the uncon
scious, emerging in dreams, slips of the tongue, and extreme experiences
of fear, anger, desire, and ecstasy.
Throughout its life, then, the body is the site of culturally induced
relations between "the speaking subject" (the material body) and "the
subject of speech" (the purely linguistic entity signified by the utterance
"I") (Bowie, 1979; Kerby, 1991). The body is where language is socially
reproduced by human speakers, and where its tensions and moral orders
(e.g., "Be a good girl") are posed against the unruly unconscious and its
energetically resistant desires. No human speaker "gets out alive" from
language, or remains unmarked by this conflict. Culture conspires to
efface the arbitrariness of its demands, however, by asserting them as
natural, real, and inevitable (Hawes, 1988), and by providing narratives
that appear to resolve the contradictions and irrationality of social order.
The connection between Lacanian theory and elderly frailty may be
summarized as follows: After a lifetime of experiencing the relationships
among the body, language, and consciousness as relatively unproblematic
(e.g., in the belief that language "expresses" the self and its intentions),
frailty provides a form of experience that threatens to expose and unravel
their artificial conflation. Specifically, frailty marks the body in ways that
culture designates as undesirable and unattractive: The frail elderly strug
gle to locate and assemble a narrative that adequately expresses their
growing alienation from the body and its strangeness. Here, the body's
reflection functions as the inverse of the Lacanian mirror stage: The aging
adult rejects the body's objectification as not me, and begins to withdraw
from a previously secure network of subject positions that provided the
illusion of coherence (Woodward, 1991).
There are at least two ways for speakers to cope with this language
and-identity crisis. One is to use the metaphor of aging as "mask"
(discussed above), in which frailty alters the container but does not reach
the essential, internal self. An alternative is to see frailty as the transfor
mation of conventional embodiment, as a disruption of the subject's
certainty about its own existence, which was always only an effect
produced by language (Giddens, 1991). Frailty forms an opportunity to
reflect on culture's shaping through language of the subjective experience
of identity, time, and the body. In the critical view, then, it is not that the
essential self endures beyond frailty, but that the very possibility to
conceive of that distinction between self and body has been made possible
by the naturalized, historical construction of an inner, psychologized
Cartesian self.
Experimental and poetic narratives of frailty, alternately, reject the
premise of a discrete, continuous self, and depict the transformation of
identity through the tropes of metaphor, paradox, irony, and schizophre
nia. There may, possibly, exist pleasures and liberation in this transforma
tion: With the disintegration of subjectivity comes release from constraints
and limits that have held it in place. Some women's narratives of aging,
for example, reflect a sense of return to and "at-onement" with their
mothers and grandmothers, a transcendence of ageism that had previously

blocked their identification with those bodies and identities (see Alexander,
Barrow, Domitrovich, Donnelly, & McLean, 1986; Martz, 1987). A cen
tral question, then, involves whether frailty represents the gradual loss of
narrative potential for the body and its self-consciousness or the acquisi
tion of new narrative possibilities.
The second dimension of this final theme involves revising the logo-
centrism of functionalist research: its belief in a transcendent "frailty"
that both precedes and stands outside language as a presence, as the
unproblematic referent of communication. For those who actually expe
rience pain and frailty, however, these conditions form an absence of
speech, not a presence. The lived truth of dementia, pain, and frailty—
what they do to a person, what they are felt as—cannot be adequately
expressed in language. They are asymptotic structures of feeling that can
be talked about, but not reproduced; evoked, but not expressed. The
human experience of extremity is instead shared in halting, mystical, and
poetic speech (e.g., " I ' m on the edge of life") that can form the basis for
community (e.g., among combat soldiers, monks, and telephone crisis
hot-line volunteers; among adolescent ballerinas discussing their pointe
shoes and bleeding feet; see Hamera, 1989, 1992; Pearce & Branham,
1978; Taylor, 1991). This understanding redirects positivist concern with
the validity-in-reference of frailty communication to focus on frailty as a
strategic evocation, an invitation offered by older adults to share in the
occult unspeakable of aging (Tyler, 1986).
Summary
Critical research on frailty, then, attempts to deconstruct its meanings

and ground them in the shifting, historical, and cultural forces that
construct the relationships among time, the body, and identity. Frailty is
returned to the body, but the body is understood to exist neither prior to
nor outside of language. Rather, the possibilities for knowledge and
narration of bodily experience are understood to be enabled and con
strained by language.
Conclusion
In this essay I have attempted to clarify the organizing principles of

frailty and communication research by contrasting two perspectives and
positioning them in relation to the dominant perspective of functionalism.
Functionalist research claims certain knowledge of frailty in order to

diagnose and care for speaking elderly bodies. Interpretivist research
depicts the interactive construction of elderly identities to extend basic
knowledge and ethical deliberations. Critical research stretches the bounda
ries of theory concerning aging, the body, and language, and politicizes
it. Each perspective possesses distinctive assumptions and methodology
that are incompatible with those of the others. None is "right," if that term
is used to describe an ultimate discourse that resolves all difference and
silences dialogue. Rather, the validity of research conducted within each
perspective is based upon accountability to its inherent premises and
logic. Metatheoretical questions to be asked in evaluating research pro
duced from each perspective, however, might include the following: What
are the practical consequences for elderly care produced by this perspec
tive? To what extent does this perspective acknowledge its relationship
to the institutional management of the frail elderly? Does this perspective
reflect on its own premises and conventions as a narrative of elderly
frailty? What possibilities for intergenerational communication does this
perspective encourage? What possibilities does it foreclose?
The development and application of these criteria should accompany
the advancement of research within each perspective. If published calls
for further research are any indicators of future activity, the following
predictions may be supported. Functionalist research will pursue statisti
cal information about the characteristics and needs of the frail elderly; the
relationships among environmental variables, elderly communication,
and psychological phenomena such as life satisfaction; and applied knowl
edge about the design and management of care facilities (Tilson & Fahey,
1990). Intepretivist research will include studies on the relationships
among personal narratives, self-image, and the changing elderly body; the
relationships between the frail elderly and service bureaucracies; the legal
aspects of providing care services; the decision process surrounding
institutionalization (Streib, 1983); and the relational practices through
which the elderly maintain their autonomy within shrinking spheres of
competence (Lawton, 1991; Rubenstein, Kilbride, & Nagy, 1992). Criti
cal research should continue to historicize the concept of aging as a theme
in social relations and media depictions (Cole, 1992), and to deconstruct
professional narratives to see how they objectify aging, normalize par
ticular forms of relationships, and advance particular interests over others
(Green, 1993). A related project involves understanding how language
and narrative operate to structure (e.g., periodize and moralize) bodily
consciousness in time.
Aging and the potential for frailty come for us all. No one escapes their
practical or theoretical nets. Medical knowledge and marketed commodi-
ties increasingly offer us the means to mediate frailty, but it is also
important to consider the narratives we use to "launch and float" our agin^
selves in conversations and relationships. Critical attention to the prem-
ises, operations, and consequences of these narratives may help us to
answer Frank's (1990) provocative question: "What definition of bodily
experience do we wish to have to live up to, when we no longer enjoy the
bodies we now inhabit?" (p. 143). Those definitions are inevitably pro-
duced in conversations, both interpersonal and theoretical.
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10
Friendship in Older Adulthood
J O N F. NUSSBAUM
An important feature of this book is the fine collection of scholar-

authors representing numerous disciplines who have contributed origi
nal chapters. The rich diversity of theoretical and methodological
perspectives highlighted by these scholars adds both conceptual breadth
and depth to the book that would be absent without such an interdisci
plinary emphasis. This particular chapter, concentrating upon friend
ship in older adulthood, could not have been written without my being
able to gather information from throughout the entirety of social science
literature. The friendship relationship, which was virtually ignored by
social scientists for the first 70 years of this century, has produced a
massive and impressive amount of interdisciplinary empirical investi
gation within the past two decades. This surge of interest is especially
true for research into older adult friendships. Within the past few years,
several excellent books have appeared that report upon both the latest
findings and extensive original research into friendship in older adult
hood, including the work of Adams and Blieszner (1989), Blieszner &
Adams (1992), Duck (1983), Matthews (1986), and Rawlins (1992).
Although these books do reflect the interdisciplinary nature of study
into older adult friendship, only the work of Bill Rawlins has emerged
from the subdiscipline of interpersonal communication.
My purpose in this chapter is to present a conceptualization of friend
ship in older adulthood grounded in the relatively new theoretical "tradition"
A U T H O R ' S NOTE: This chapter utilizes data from a larger series of studies conducted
at the University of Oklahoma by Jon Nussbaum, Brian Patterson, and Lorraine Bettini.
209
of interpersonal communication. A major research initiative within the

Department of Communication at the University of Oklahoma to define
as well as to measure older adult friendships provides evidence as to how
interpersonal communication scholars can add to an understanding of
older adult friendships. However, before any credible reconceptualization
of older adult friendships can be proposed, a brief review of existing
knowledge with regard to friendship in general and to what is known
about older adult friendships is in order.
Friendship
Friendship is one relationship that most social scientists would rather

not have to define. The difficulty in defining friendship is always made
clear by the researcher in his or her introductory remarks. This is rather
curious, given that most individuals can without hesitation give their own
precise definitions of what friendship means to them. Nevertheless,
several scholars have provided quite simple and eloquent notions of
friendship. The British sociologist Graham Allan (1979) writes that "the
term 'friend' is applied only to people who have a personal relationship
that is qualitatively of a particular sort. It is the actual relationship itself
that is the most important factor in deciding whether someone can or
cannot be labeled a friend" (p. 34). Argyle and Henderson (1985) consider
friendship as "people who like each other, and enjoy doing certain things
together" (p. 64). Adams and Blieszner (1989) gathered an impressive
group of sociologists and psychologists to discuss the structure and
process of friendship. After customarily pointing out (hat friendship is
difficult to define, their contributors proceeded to describe several com
mon structural characteristics of friendship.
Friendship is a voluntary relationship. Although several scholars may
argue about precisely how voluntary friendship really is, compared with
kin relationships we are free to choose our friends. One marker of the
voluntary nature of friendship is the lack of a ceremony to frame the
relationship. Unlike marriage, there is rarely a formal, public announcement
of a friendship, and no formal dissolution decree is needed to end one.
Friendship appears to be a relationship based on equality. "Unlike many
other kinds of relationships, friendship does not entail authority, patron
age, or any other sort of structural hierarchy" (Allan & Adams, 1989,
p. 48). This equality is evidenced in everything from the usually similar
ages of friends to their similar social status and similar values. This
F R I E N D S H I P IN O L D E R A D U L T H O O D 211
equality, however, may not be as apparent as one might expect. Equality

in friendship is negotiated (a characteristic of friendship that I will
elaborate upon later). Friends may occupy different positions on a social
ladder or be of different ages, but within the friendship itself these
differences are not meaningful.
Friendship is a relationship uniquely suited to provide emotional sup
port to the individuals within the relationship. This support may be linked
to the nonobligatory nature of friendship. An example that I often use with
students when discussing the differences between friendship and kin
relationships is the ride to the airport case. If a family member asks us to
provide transportation to the airport at an inopportune time of day, we are
obliged because of familial ties to provide that ride. A friend would not
have to ask for the ride. As friends, we would volunteer a ride, and the
feeling of obligation is nonexistent. This lack of obligation provides a
relational climate of trust that is optimal for emotional support. Just as
the ride to the airport is freely given, emotional support is freely shared.
One knows that the friend will be there to provide support and at the same
time will not tell other people that a problem exists.
Friendship is a relationship that exists on a continuum of intimacy
levels. A friend can be a fellow student, a colleague who is seen every day
but rarely talked to, or an individual whom we call our best friend. The
best friend is someone we trust to share the most intimate parts of our
lives. We may never be as close to anyone else throughout our lives as we
are to our best friends. On the other hand, a friend can be someone we
rarely share intimate information with, but whom we trust to watch our
pets while we are out of town. This feature of friendship has been a
sticking point for most social scientists studying friendship. It is quite
common for social scientists studying friendship to include only best
friends within their samples and then to discuss the entire domain of
friendship.
A final characteristic of friendship is the life-span nature of the rela
tionship. Friendship can be a lifelong relationship as well as a relationship
that forms at any point in the life span. Litwak (1989) hints that the very
nature of friendship may change across the life span. He asserts that an
older individual "in a modern industrial society is optimally served by at
least three different types of friendship groups based on time" (p. 77). The
long-term friend, the intermediate-term friend, and the short-term friend
are structurally different, and they accomplish different friendship tasks.
The above discussion offers a brief description of the traditional notions
of the nature of friendship. Friendship is voluntary, based on equality,
nonobligatory, can exist on a continuum of intimacy levels, and is truly a

life-span phenomenon. In the next section, I will consider the existing
literature on older adult friendships. Social scientists who have studied
older adult friendships have focused on the functions of older friendships.
That is, rather than attempting to understand the nature of friendship
among older adults, researchers have primarily asked how the relation
ship serves those who are within the friendship.
Older Adult Friendships
When reading the massive amount of literature that now exists explor
ing older adult friendships, one is struck by the almost overnight fascina
tion of social scientists with this particular relationship. My interpretation
of this research interest in the later stages of the twentieth century rests
on the discovery that familial relationships are not as all-satisfying and
functionally necessary as our popular notions of family have led us to
believe. The 1970s and 1980s brought us research results that time and
again point to the friendship relationship as a major predictor of success
ful adaptation to aging (Nussbaum, Thompson, & Robinson, 1989). From
the various social models of aging that produced a positive relationship
between friendship and successful adaptation to aging, and at the same
time rarely included the finding that all a person would need as he or she
grew older would be a solid family network, a series of scholars began to
investigate exactly how the older friendship relationship served those
within the relationship.
The pioneering work of Arling (1976), Larson (1978), Wood and Robertson
(1978), Mancini (1980), Beckman (1981), and many others, as well as my
own research (Nussbaum, 1983a, 1983b, 1985), showed that interacting
with close friends in later life is more associated with psychological
well-being than is interaction with other types of individuals, including
family members. Nussbaum et al. (1989) explored the various functions
of friendship for elderly individuals and concluded that the most signifi
cant impact older adult friendship has upon individuals is the improve
ment of the psychological well-being and morale of the participants.
Kahn and Antonucci (1980) and Crohan and Antonucci (1989) have
developed a theory that helps to explain the positive relationship between
friendship and successful adaptation to the aging process. They postulate
that individuals progress through the life span surrounded by other indi
viduals to whom they give and from whom they receive social support.
Crohan and Antonucci (1989) define social support as "interpersonal
transactions that include one or more of the following key elements:

affect, aid, and affirmation" (p. 131). Although any interpersonal transac
tion can be characterized as a socially supportive transaction, friendship
appears to be optimally conducive to the giving and receiving of social
support. As long as this convoy of support exists throughout an individ
ual's life span, that individual will adapt and develop in positive ways.
This is evidenced in higher levels of reported psychological well-being
later in life.
Two characteristics of friendship that serve older adults quite well are
its nonobligatory nature and its egalitarian quality. Social support is freely
given, with very little of the expectation of support often associated with
the family. In addition, this support is both given and received to maintain
a healthy relational balance and is not judged to be part of a relational role
of dominance or submission. Adult children and elderly parents are often
troubled by their changing power roles within the relationship. By its very
nature, friendship does not have changing power roles. Given these two
characteristics of friendship, when support is given or received it is
evaluated in a positive way and positively affects daily lives.
Crohan and Antonucci (1989) point to several types of social support
that are effective for older adults. Emotional intimacy and companionship
are the most frequent types of social support provided by older adult
friends. Loneliness is a major cause of depression throughout life and can
be especially troublesome for some older individuals. The companionship
that friendship provides later in life can serve as an excellent buffer
against the depression that often accompanies feelings of loneliness.
Close to three decades ago, Lowenthal and Haven (1968) noted the
importance of an aging individual's having at least one confidant in his
or her life. Friendship provides the opportunity for close emotional
interaction and the expression of concerns that transpire only in a close
relationship with a confidant.
An additional type of social support provided by friendship in later life
is the maintenance of the individual's contact with the larger society.
Whether the elderly individual is less mobile, cannot afford certain
luxuries of social interaction, or wishes to travel the world with others,
the interaction that takes place within friendship can keep him or her
caught up with current events in the community or the world. This
interaction can. also open up the friends to new experiences that an
individual would not normally take part in alone. Often, an older adult's
first trip to a senior center, and all the attendant introductions, is accom
plished within the context of a friendship.
A final type of social support that serves the elderly quite well is the
protective nature of friendship. Elderly individuals are quite susceptible
to loss of health and to physical as well as emotional insecurity. Friend
ship can provide a very secure context in which declining health can be
managed. In addition, having someone with whom to take walks or visit
others can make the elderly less likely to be targets for crime. Finally, during
times of loss, friends can provide emotional support that may no longer exist
within the family because of the deaths of close family members.
Friendship and the social support friends provide have an overwhelm
ingly positive impact upon the lives of elderly individuals. However,
recent research provides evidence that social support can also lead to
negative consequences and may strain older adult friendships (Rook,
1989). Because of the very nature of friendship and the often sole reliance
on friends for the social support that buffers the elderly from severe
psychosocial problems, friendships can be fragile. Even though friend
ship is essentially voluntary, behavioral norms and expectations do build
over time within friendships. If a norm is violated, this violation can
produce resentment. On occasion, support may be given when it is not
wanted; such support may be perceived by the receiver as a message that
he or she is helpless or in need, and the receiver may become angry or
distraught at the idea that the friend sees him or her as being in a needy
state. In such cases, friendship—or, more precisely, the negative conse
quences of strain within the friendship—can lead to emotional instability.
A second area of older adult friendship research has involved the
attempt to describe the structural components of the relationship. Struc
ture has been defined in a very traditional sociological manner as having
two components: one internal and one external. The internal structure of
the older adult friendship relationship includes the age, gender, and
various personality traits of the interactants, the size of the friendship
network, and the attitudes an interactant holds toward a friend or the
relationship itself. External structure includes those events outside the
control of the individuals within the friendship, such as retirement,
widowhood, institutionalization, loss of mobility, or familial obligations
that can affect the friendship relationship.
Blieszner and Adams (1992) have reviewed research on internal struc
tural factors that affect older adult friendships. Included in their list of
internal factors are the size of the older adult's friendship network, the
network homogeneity among the elderly, the density and configuration
within the friendship network, and feelings of solidarity within the friend
ship network. They also give special attention to gender and older adult
friendships. With the exception of gender, no particular pattern of internal

factors in older friendships emerges from the literature. Very little re
search has been done on most factors, and the results of the published
research are quite contradictory. At this point, it makes no sense to
stipulate what the most advantageous friendship network would be, or
even to try to describe average network size and level of closeness. As
noted, the one exception to this is the literature on gender differences in
older adult friendships.
Nussbaum et al. (1989) note the significant impact external structural
factors can have upon all forms of elderly interaction. The loss of identity,
self-esteem, companionship, and interactive partners that follow retire
ment, widowhood, and institutionalization are not difficult to imagine and
are well documented. It is more important to keep in mind that the effects
of such external structural changes have the potential to affect elderly
individuals more than they do individuals at other points in the life span.
This would be especially true for those elderly whose health is suffering,
whose income is stagnant, and whose networks of friends have moved
away or have died. Any study of older adult friendship must account for
such external factors, which would have significant impact upon any
friendship relationship.
Powers and Bultena (1976) reason that patterns of friendship behavior
learned in childhood continue throughout life. Females learn to be in
volved in relationships that reinforce expressive behavior and encourage
them to discuss intimate problems and needs openly. Men, on the other
hand, model the masculine sex role, which emphasizes unemotional
behavior. Thus older adult females should have different patterns of
intimate friendship behavior from those of older men. The results of
Powers and Bultena's investigation show that older males have more
frequent social contact than do older females, but older women are more
likely to have intimate friends in later life than are older males. In
addition, these researchers conclude that women have more diverse social
worlds than do men, who tend to limit their networks of interaction to
their immediate families. This diversity is seen as a positive adaptation
technique used by older females. Its absence may hamper the successful
adaptation to the aging process on the part of older males.
Adams (1986) studied the secondary friendship networks of older
women. Secondary friendship networks involve those individuals with
whom a person currently spends time, rather than lifelong friends with
whom the person may or may not interact on a regular basis. Adams's
results indicate that elderly women who are actively involved in secondary
friendship networks are able to meet new people and to remain socially
active. The formation of these secondary friendship networks seems to be
more conducive to the learned friendship behavior of elderly women than to
that of elderly men. If this is true, elderly men may have a difficult time
remaining socially active after retirement or the death of a spouse.
The problems associated with forming and maintaining friendships late
in life are highlighted in a recent article by Jacobs (1990). Although it is
true that many women have the skills to engage in effective social activity,
the loss of a spouse to whom a woman has dedicated her life and the
general discrimination toward women in our society make it difficult for
elderly women to have adequate social lives. Jacobs calls on community
organizations to provide safe, exciting environments where friendships
can develop.
In an excellent article, Wright (1989) reviews a great deal of literature
concerning gender differences in older adult friendships. His work rein
forces the notions put forth above, and also addresses issues related to
cross-gender friendships. The literature on such friendships, although
sparse, indicates that elderly men are more likely to report being involved
in cross-gender friendships than are elderly women. Elderly men report
more openness in their communication and a higher level of intimacy in
their friendships with elderly women than in their friendships with other
men. Elderly women report lower levels of openness, self-disclosure, and
intimacy with their elderly men friends than with their elderly women
friends. An important element of gender differences in older adult friend
ships involves the major external events that tend to shape the social lives
of individuals who are over the age of 65. Whereas retirement is the major
event that reshapes the friendship networks of men, for older women the
most likely major event to reshape their lives is the need to cope with the
death of a spouse. These different impacts may disappear as more women
pursue lifelong careers, but for now, gender differences in older adult
friendships are the norm. *
Interpersonal Communication
and Older Adult Friendships
In their most recent, and in many ways most visionary, tome on adult
friendship, Blieszner and Adams (1992) discuss six trends in friendship
research that have occurred oyer the past two decades. Three of these
research trends have the potential to move future investigations of the
older adult friendship relationship away from the mainstream psychologi

cal and sociological tradition of concentrating upon the individuals within
the friendship and more toward studying the relationship itself. This move
is complemented by the trend of moving toward investigations of the
qualitative dimensions of friendship and the use of multiple research
methods that are more conducive to the study of relationship processes.
Focusing on older adult friendship as a relationship will ultimately tell us
more about the nature of friendship than we will learn by focusing on the
individuals who participate in friendships.
The move to study friendship as a relationship is one that interpersonal
communication scholars can and should embrace. Although friendship
has received very little attention from the communication discipline in
general, several interpersonal communication scholars have called for a
more thorough investigation of older adult friendships from a relationship
perspective (Duck, 1983; Nussbaum et al., 1989; Rawlins, 1992). It
should be noted that when friendship has been studied by communication
scholars, the conceptualizations and research methods utilized have typi
cally mimicked those of traditional social scientific perspectives. A move
toward a relationship perspective de-emphasizes the individuals within
the relationship and concentrates upon the attributes of the relationship
itself. These relational attributes are made known through observation of
the ongoing relationship. In the purest sense, the relationship is constantly
being redefined by the interactants through their verbal and nonverbal
behavior. The shared messages are the data through which researchers can
understand the relationship. The collection of this type of data is very
difficult and often an imposition upon the relationship. Therefore, re
searchers often have interactants reproduce the interactive dynamics of
their relationships by describing in detail the meanings of particular
relationships.
Rawlins (1992) has spent more than a decade studying friendship from
the perspective of an interpersonal communication scholar. He views
friendship as an ongoing communicative achievement, a relationship that
is constantly negotiated in the face of incompatible requirements. "Em
phasizing these notions places communication and a dialectical perspec
tive in a conversation about relational and social life that has been
dominated by individualists (psychologists) and social structuralists (so
ciologists)" (p. 3). Rawlins posits four interactional dialectics as useful
interpretive tools for understanding the friendship relationship: the dialectic
of the freedom to be independent and the freedom to be dependent, the
dialectic of affection and instrumentality, the dialectic of judgment and
acceptance, and the dialectic of expressiveness and protectiveness. Rawlins

reasons that these dialectical features of managing friendship differ ac
cording to each participant's attributes, the type or degree of friendship
enacted, the life stage of the friendship, and the prevailing cultural
practices of the moment. He asked more than 100 individuals of differing
ages about "meanings, expectations, communicative practices, activities
and important events of their friendships" (p. 3). Results from these inter
views indicate that managing the inherent contradictions of friendship re
mains a major feature of friendship into old age. The dialectics that appear
to be most salient for older adult friendships include the dialectic of the
freedom to be independent versus dependent, the dialectic of judgment
and acceptance, and the dialectic of expressiveness and protectiveness.
Rawlins's major contribution, beyond the individual results of his
massive study, is his contention that the friendship relationship is con
stantly negotiated throughout the life span. Friendship is a dynamic
relationship that involves the complex management of often contradictory
forces. This management is evidenced in the communicative behavior that
transpires within the relationship.
A programmatic research effort investigating the quality of interper
sonal relationships and the link between relational quality and successful
adaptation to aging is ongoing within the Department of Communication
at the University of Oklahoma (Bettini & Norton, 1991; Downs, Javidi, &
Nussbaum, 1988; Nussbaum, 1983a, 1983b, 1985, 1990, 1991; Nussbaum
& Robinson, 1990; Nussbaum, Robinson, & Grew, 1985; Patterson,
Bettini, & Nussbaum, 1993). The research effort began with an explora
tion of various quantitative and qualitative factors of relationships and
the building of causal models that utilized these factors to predict suc
cessful aging. As in the majority of the research published during the late
1970s and early 1980s, the researchers discovered that the quality of the
elderly individual friendship relationship is predictive of successful ag
ing. The most interesting context in which this finding emerged was
within nursing homes. The institutionalized elderly reported a higher
level of satisfaction with life than was expected, and the link between
friendship and this satisfaction appeared to be more robust than for
individuals living at home or in retirement communities. Further studies
into the friendship-life satisfaction link within nursing homes indicated
that the elderly residents had more complex notions of friendship than did
the younger nurses or nurse's aides. Elderly residents of nursing homes
reported that friendship with the nursing staff is quite normal at this stage
of their lives, and that within this context the professional taboos of
patient-staff friendship do not make much sense. The younger nursing

staff reported a much narrower conceptual notion of friendship, and only
in rare encounters did they conceive of friendships existing between them
and residents. From this foundation, the research team began a systematic
exploration of older adult friendships within the "healthy," independent-
living elderly community. Essentially, they reasoned that the friendship
relationship for older adults may be more complex than for younger individu
als and that within this complexity may lie additional evidence explaining
why friendship is more predictive of successful aging and why intergen
erational friendships are relatively rare and communicatively difficult.
In order to capture the complexity of older adult friendships, the
researchers arranged in-depth interviews with 20 elderly subjects (aver
age age, 84 years). The 16 women and 4 men were healthy residents of a
privately owned retirement center located in Norman, Oklahoma. Each
interview was conducted by one of seven highly trained interviewers. The
interviews were meant to be as open as possible, and subjects were free
to describe the meaning of friendship at length. The elderly individuals
were asked a series of questions that included "What does friendship mean
to you?" and "Has your view of friendship changed over the years?"
Although this method—in-depth interviews concentrating upon the
meaning of friendship—had been used in the past, rarely did the re
searchers examine the texts of the interviews for relational complexity.
Rather, the data from elderly individuals who were asked to describe their
friendships were coded into the minimal number of categories to empha
size the commonalities across friendships. In this case, the taped inter
views were transcribed into 237 semantic utterances of friendship. Each
individual utterance was placed on a file card, and 13 graduate students
in communication were asked to sort the cards into distinct categories.
The purpose of the sorting procedure was to organize the utterances into
similar clusters but at the same time maintain the inherent complexity
within the utterances. The clustering technique produced nine unique
clusters of utterances that these older adults used when describing their
friendships.
The first cluster of 83 friendship utterances was labeled devotion. The
utterances spoke to the notions of loyalty to friends, the confidentiality
that is a major part of friendship, and the love that is shared within
friendship. Typical utterances within the devotion cluster included "A
friend knows all about you and still loves you"; "If you have problems,
you kind of find out who your friends are because they're the ones that
stick with you"; and "A friendship is accepting people as they are."
A second cluster consisted of 47 statements that reflected a common

ality of interests shared by friends. The elderly individuals interviewed
talked about the activities or circumstances that they share with their
friends. These common activities or common life circumstances make
interacting with friends very comfortable and therefore quite pleasurable.
A third cluster of 25 statements referred to friendship as a reciprocal
relationship. Utterances such as "There was an even exchange of things
worthwhile" and "We help each other" suggest that equality in friendship
is maintained by an unselfish giving of oneself to the friend. Friendship
is the knowledge that as you do for the friend, the friend will do for you.
A fourth cluster of statements consisting of 20 utterances reflected a
concept that has not been reported in previous studies investigating the
meaning of older adult friendships. This cluster, labeled relational strati
fication, places older adult friendships upon a continuum of intimacy.
Previous research concentrated upon only best friends or acquaintances,
as if all friends could be categorized into two or three distinct intimacy
levels. The utterances within this cluster clearly show that older adult
friendships operate not so much within a few distinct categories as along
a continuum of closeness, from acquaintance to best friend. Utterances
such as "You have friendships on many levels" and "There's a difference
between a friend and a buddy" indicate that within a friendship network
many distinctions are made as to the relational quality of given friend
ships. These distinctions can become quite complex. Friendship emerges
as a relationship that can include acquaintances as well as several differ
ent levels of "best friends."
Communication was the label given to a series of 16 utterances that
referred to the interpersonal contact between friends. The simple pleasure
of talking to a friend either by telephone or face-to-face was mentioned
as a major component of friendship. Other utterances within this cluster
described the way friendship transcends frequent contact: "I still consider
her a friend even though I don't get to visit with her that much." Although
frequent talk is a highlight of friendship, friendships can nevertheless be
maintained without frequent interaction.
The sixth cluster, with 9 utterances, was labeled positive regard. The
common sentiment within these statements was a feeling of positive affect
not only for the friend but also for the relationship. Nice things happen
within friendships, and the elderly individuals interviewed for this study
pointed to the positive affect they feel toward those who share friendships
with them.
A seventh cluster of 5 utterances was labeled positive impact. These

utterances reflected what life would be like without friendship. Utterances
such as "We'd be awful lonesome without friends" indicate that older
adults do consider the importance of friendship in their lives and feel that
without their friends, life would not be as satisfying.
The eighth cluster of utterances was composed of several statements
that linked friendship directly to understanding. To be a friend means to
have reached a level of understanding that nonfriends simply do not have.
The final cluster of utterances was labeled/awi/ia/ comparison. Several
older adults made comparisons between their familial relationships and
their friend relationships. It is interesting to note that several of the
utterances pointed out that friendship is a closer relationship than those
found within families.
The nine clusters of friendship meaning reported by the elderly indi
viduals within this investigation represent an initial piece of evidence
underscoring the relational complexity of friendship in older adulthood.
Several of the utterance clusters reflect the definitions of friendship often
found in the literature. Older adult friendships have quite often been
conceptualized as relationships that involve devotion and a sharing of
common interests based upon equality and positive regard. Yet, very few
of these same studies have discussed the notion that as we age, the
friendship relationship itself changes. Researchers have pointed to exter
nal structural changes, such as retirement and declining health, that
indirectly affect friendships, but these same researchers have not indi
cated that the very nature of friendship may change without the onset of
such dramatic external factors. The evolution of the friendship relation
ship may be a broadening of the very nature of friendship. Evidence for
this notion can be found within the relational stratification cluster of
utterances. These elderly individuals discussed their open ideas of friend
ship. Although they discussed best friends, their friendship networks were
not limited to best friends and then all others. Friendship can occur on
many levels of closeness, with each relationship ultimately fulfilling
certain distinct relational needs. This relational stratification has not been
reported in the literature that discusses the meaning of friendship at
younger ages. For the most part, social scientists have simplified their
own studies of friendship by eliminating all but the "best friend" relation
ship. These "less than best friend" relationships may take on added
importance as we age and may actually form the foundation of solid social
networks.
Communication is a second quite interesting cluster that is rarely

discussed in the literature. Our common notion of friendship based upon
studies using much younger subjects is biased toward frequent interac
tion. That is, friends interact frequently and best friends interact the most.
The older adults interviewed in this study reported that talk is an impor
tant ingredient of friendship, but it is not a necessary ingredient. As we
grow older, it becomes more likely that we will be separated from friends.
This separation, which at younger ages may impair a relationship, is more
normal in old age and thus not perceived as a major difficulty for the
relationship itself. Two of the elderly individuals in this particular study
discussed their best friends who had died years before. These older adults
maintained that they talked to their dead friends every day and kept their
friendships living. With older adults a relationship that is meaningful and
rewarding is not dependent upon overt, behavioral interaction, but can be
maintained as a normal extension when friends physically move apart. To
date, no one has investigated friendships for older adults that remain an
active part of an individual's life even though interpersonal contact is very
limited or nonexistent.
Both Rawlins (1992) and the researchers at Oklahoma have focused
upon friendship as a relationship. The relationship has dimensions or
attributes that cannot be fully explored by concentrating efforts only upon
the individuals within the friendship. In other words, the friendship
relationship is more than the sum of the individual attributes of the two
friends and the environmental factors that affect the friendship. Interper
sonal communication scholars can add to the basic understanding of older
adult friendships by exploring the dynamic interactive processes that
transpire as part of this complex relationship.
Research Agenda for

Older Adult Friendships
The results of the 20 interviews reported above are only a very small step
forward in an attempt to understand older adult friendships. To date, psycholo
gists and sociologists have produced an impressive amount of literature
exploring the functional and so-called structural dimensions of older adult
friendships. Interpersonal communication scholars, however, have only
begun to add their unique point of view to this endeavor. Wiemann and
Bradac (1989), in their exploration of metatheoretical issues in the study
of communicative competence, not only call attention to what communi
cation scholars consider the study of structure, the characterization of

message patterns, but also support the examination of people and their
actions from diverse perspectives based upon behavior. The study of the
exchange of messages within friendship and the grounding of our concep
tualizations of friendship in the relational behaviors of friendship are two
areas of future research for interpersonal scholars interested in older adult
friendships.
Social scientists should explore the negotiation process of friendship.
By studying message exchange within the relationship, researchers can
explore exactly how friendship is initiated and maintained. The various
conceptual dimensions of older adult friendships, such as devotion, com
monality, reciprocity, and relational stratification, are acted out within
message exchanges and can be revealed by the thorough investigation of
interactions between friends. Friendships could be tracked over extended
periods, and any changes in message content or style could be identified
as the fuel as well as the results of any redefinition of the friendships. If
older adult friendships are more complex, then the messages shared by
the participants should reveal that complexity. If external structural events
such as retirement or declining health change the internal structure of the
friendship, the messages shared within the friendship should provide
behavioral evidence of that change. Finally, if friendship relationships
function in a more positive manner for older adults than do family
relationships, the shared messages of friendship should differ from shared
messages within family relationships, and the various support functions
that appear unique to friendship will be made clear.
Studying friendship as a relationship ultimately means treating the
relationship itself as the unit of analysis. The individuals within the
relationship can provide valuable information about the relationship, but
the relationship is not reducible to the perceptions or actions of the
individuals. In addition, the final statement about friendship should not
be about the individuals within the friendship but about the friendship
itself. The methods used to study older adult friendships should incorpo
rate ways to capture the entirety of these relationships. Eventually, re
searchers will need to observe the ongoing interaction of friendship over
long periods to unlock the unique features of this relationship. Observa
tions of precisely how friends manage the contradictions of friendship or
move to a state of best friends will provide invaluable information on
friendship. Multiple methods that include in-depth interpretive studies as
well as sound experimental studies can only help to reveal the complexity
of older adult friendship.
224 Interpersonal Commitnication in Older Adulthood
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10
The Patient's Presentation of Self

in an Initial Medical Encounter
M I C H E L E G. G R E E N E
R O N A L D D. A D E L M A N
CONNIE RIZZO
ERIKA FRIEDMANN
The significance of knowing the patient as a total person has long been
recognized by sociologists, anthropologists, and medical professionals
(American Board of Internal Medicine, 1992; Balint, 1964; Kleinman,
1988; Mishler, 1984). In knowing the patient's beliefs and his or her
unique constellation of social, cultural, and psychological characteristics,
the physician is better able to diagnose, treat, and care for the patient.
Kleinman (1988) eloquently describes the dynamic interrelationship
between the patient's disease (a biological phenomenon) and the pa
tient's illness (his or her subjective experience of disease). He and
others argue that to heal, "in its deepest sense" (McWhinney, 1989,
p. 29), the medical professional must look beyond the disease entity and
perceive the patient as a whole person who is in need of cure, relief,
and comfort (see, e.g., Cassell, 1976; Engel, 1977; McWhinney, 1989).
How does a physician come to know the human side of the patient? One
way he or she begins to acquire this knowledge is through the patient's
presentation of self. The pursuit of this knowledge begins in the first
A U T H O R S ' NOTE: We would like to acknowledge the A A R P Andrus Foundation and

the Professional Staff Congress Research Award Program of the City University of New
York for support of this work. We appreciate the assistance of S. Deborah Majerovitz in
conducting our analyses.
226
P A T I E N T ' S P R E S E N T A T I O N OF S E L F 227
meeting between doctor and patient. Although researchers have studied

the content of older patient talk during encounters with physicians (Adelman,
Greene, Charon, & Friedmann, 1992), how patients create personal im
ages or identities of themselves for physicians has not been studied. In
this chapter, we examine the older patient's presentation of self in the
initial medical encounter, providing a conceptual f r a m e w o r k and a dis
cussion of how the presentation of self arises within the context of the
physician-patient relationship. Using data from a study of the physician-
elderly patient relationship, we analyze the content, time orientation, and
intimacy of older patients' presentations of self and physicians' responses
to the presentations. Finally, excerpts from transcripts of two audiotaped
first visits provide illustrative examples of how self-presentations are
accomplished in medical encounters and how physicians respond to older
patients' presentations of self.
The Presentation of Self
The notion of the presentation of self is derived from G o f f m a n ' s work,

The Presentation of Self in Everyday Life (1959). In our conceptualiza
tion, the patient's presentation of self includes both the public " f a c e " or
image the older patient presents to the physician and the patient's personal
self-disclosures. As G o f f m a n (1967) has suggested, in all social encoun
ters, each individual presents a particular " f a c e " to the other in the
interaction, through which the individual wishes to be defined. This face
is an impression that the individual desires to create.
Self-disclosure has been defined as the "intentional revelation of infor
mation about one's self that would be unavailable to others by alternative
means of discovery" (Brown & Rogers, 1991, p. 151). In many cases, for
a medical encounter to succeed, the patient must disclose personal infor
mation. Such self-disclosure may enhance or undermine the public face
the patient wants to create. Thus, in the medical context, a patient presents
his or her face as well as the more personal side of who he or she is. By
presentation of self, we are referring to the patient's full presentation of
his or her identity or personhood to the physician.
In the medical interview, the patient's presentation of self arises pri
marily in two ways: in response to physician inquiries and in self-disclosures
initiated by the patient. With respect to the former, a doctor may question
a patient in an effort to diagnose and treat and/or in an effort to build an
interpersonal relationship with the patient. Although it is understood in
general medicine that a psychosocial assessment should be included in a

medical evaluation, geriatric medicine is specifically conceptualized as
requiring a multidimensional evaluation, and geriatric physicians are
explicitly trained to embrace a wide range of medical, psychological, and
social topics in the medical interview (Cadieux, Kales, & Zimmerman,
1985; Cassel, Walsh, Shepard, & Riesenberg, 1990; Libow & Sherman,
1981). A comprehensive geriatric evaluation may include special empha
sis on such personal topics as losses, sexual function, economic difficul
ties, alcohol use, potential future incapacity, and decision making about
heroic measures to prolong life. Thus, self-disclosures may be considered
an essential component of the physician-older patient medical interview.
When the patient initiates the presentation of self, the goals of that
presentation may be quite different from when the presentation is physician-
initiated. Some patients provide information to ensure that physicians in
a busy clinic will remember them; that is, they want to be individually
identified as more than just another elderly patient in a panel of many
elderly patients. Or, perhaps, patients want physicians to think well of
them, or they want to receive special treatment or consideration. Simi
larly, patients may want something specific from a physician (ranging
from a prescription to emotional support) and thus they provide informa
tion that will be useful in achieving that goal. Recognizing their generally
lower social status in society, some elderly patients may construct images
in which their social worth is emphasized, as they try to counter what they
perceive as physicians' negative beliefs about older patients. Other older
patients, especially those who believe in the authority of medicine and
doctors, may present themselves in such a way as to demonstrate their
respect for the physician. Finally, some patients may provide information
that they hope will function to encourage the development of the physi
cian-patient relationship. As in other social encounters, the individual's
presentation of self in the medical encounter may have multiple goals.
The presentation of self probably includes a mixture of manipulative
strategies, social status posturing, and efforts to develop a meaningful
interpersonal relationship. Whatever the latent or manifest functions of
the presentation of self, these self-disclosures provide information to the
physician about who the patient is, beyond the medical setting and the
medical diagnosis.
Older patients may present themselves using past, present, and/or
future time orientations. For instance, in narratives about their lives, older
patients may draw upon their past experiences to create their identiy. Or
they may rely on their present familial or other affiliations to formulate
PATIENT'S PRESENTATION OF SELF 229
images (as in, "My daughter, the n e u r o s u r g e o n . . . ")· Some patients may
identify themselves based on their current or past occupational or profes
sional identities. Other older patients may focus on their future.
The Patient's Presentation of Self,

Self-Disclosures, and the Physician-Patient Relationship
The patient's presentation of self occurs within the context of the

physician-patient relationship, which is typified by asymmetric power
relations (Freidson, 1970; Parsons, 1951), with the physician as the
dominant interactive participant. The physician's power is largely based
on his or her medical knowledge and expertise (Parsons, 1951).
Although the physician's presentation of self is not the subject of this
chapter, it is worthwhile to note that physicians, too, present public faces by
which they wish to be defined. Their professional demeanors, including their
"affective neutrality" (Parsons, 1951), their use of technical language and
jargon, and their white coats serve to achieve a particular image.
Patient self-disclosures in the physician-patient encounter are quite
different from self-disclosures that occur in other social relationships.
Perhaps the most significant difference is that self-disclosures in medical
interviews usually occur in only one direction—from patient to physician.
There is no expectation on the part of either the doctor or the patient that
the physician will self-disclose. Indeed, inherent in the early conceptuali
zations of the appropriate role of the physician is the professional norm
that the doctor will maintain a social distance from the patient, so as not
to impede the supposedly objective tasks of diagnosis and treatment
(Parsons, 1951). And even in later conceptualizations of the physician
role, which recognize that doctors do have feelings and emotions about
patients that affect diagnosis and treatment (Gorlin & Zucker, 1983;
Groves, 1978), there is still the norm that doctors do not disclose personal
information (Candib, 1987). If doctors disclose personal information, it
is usually limited and circumscribed to "safe" topics, such as vacations,
the ages of their children, or their favorite sports teams.
Additionally, the norms of first medical interviews allow physicians to
ask questions that would not ordinarily be asked in other new social
encounters (e.g., Do you use drugs? How many sexual partners do you
have and what sex are they?). However, it is not expected that patients
can ask similar questions of physicians. Moreover, within this context,
when physicians are asked personal questions, they are normatively
exempted from responding. That physicians may query patients about

extremely intimate aspects of patients' lives and patients are expected to
self-disclose, whereas physicians are not, further establishes the asymme
try of the relationship between the interactive participants.
Patient Expectations for Self-Disclosures
Older patients' expectations and desires about self-disclosures during

medical visits are probably quite varied. The amounts and types of
self-disclosures that occur in initial medical interviews may vary signifi
cantly, depending upon the patient's predisposition to disclose and the
physician's receptivity to the self-disclosure information. Whereas some
patients may provide extremely intimate details of their lives, others may
choose to focus on only the medical content of the visit.
Indeed, the major goal of most medical visits is to deal with immediate
medical problems, and all that some older patients may want from a visit
to the doctor is efficient medical management of the problem at hand.
Marshall (1981) suggests that older patients may not want doctors' in
volvement in psychosocial matters. One study of follow-up medical visits
found that psychosocial talk was less frequent in older patient medical
interviews than in younger patient medical interviews, perhaps suggest
ing that older patients have fewer psychosocial issues to raise. On the
other hand, physicians responded better to the psychosocial topics that
younger patients introduced than to the psychosocial topics that older
patients introduced. Thus, it may be that older patients are discouraged
from raising psychosocial issues by doctors' lack of responsiveness to
these concerns (Greene, Hoffman, Charon, & Adelman, 1987).
Other older individuals, such as those who are socially isolated, lonely,
or depressed (Coupland, Coupland, Giles, Henwood, & Wiemann, 1988),
may desire to disclose a great deal of intimate information to their
physician. Perhaps, physician visits take on much more importance for
older individuals who have relatively limited social contacts. Also, some
older patients may recall the era of the family physician who routinely
made home visits and knew patients and their families in much more
personal ways than do most physicians today. These older patients may
desire to re-create those more intimate relationships.
Physician Expectations for Self-Disclosure
Physicians' expectations regarding older patients' self-disclosures may

be based in negative stereotypes about older individuals' propensity to
talk too much (Butler, 1975; Gold, Arbuckle, & Andres, Chapter 6, this
volume). In particular, negative views of women (Fisher, 1988) and the
stereotyped notion that they talk a great deal about personal topics has
been noted (Collins & Gould, 1992; Coupland, Coupland, & Giles, 1991).
That the preponderance of geriatric patients are women makes this addi
tional negative bias particularly relevant.
Despite the desirability of eliciting self-disclosures, some physicians
may fear that by showing any interest in an elderly patient's presentation
of self they will open a Pandora's box of concerns and issues. Indeed, one
study of female conversants in a nonmedical setting found that the
expression of sympathy by a recipient of a self-disclosure tended to elicit
additional self-disclosures (Coupland et al., 1988).
Other Factors Affecting

the Patient's Presentation
of Self in Medical Encounters
There are several other factors that are likely to influence the older
patient's presentation of self in medical visits. We believe that the pres
ence of a third person in the medical visit, the sociodemographic homo
phily of the interactive participants, and the context of medical practice
all affect the amount and type of patient self-presentations.
Triadic Medical Visits
Frequently, an older patient is accompanied to the medical encounter

by a spouse, adult child, or professional caregiver. The presence of a third
person during the medical visit significantly influences the subjects an
older patient is likely to introduce and discuss (Adelman, Greene, &
Charon, 1987). Using a matched sample of dyadic and triadic older patient
initial medical interviews, we found that when an accompanying individ
ual was present, the older patient was less likely to raise medical topics,
personal habits topics, and psychosocial topics than when he or she was
unaccompanied (Greene, Majerovitz, Adelman, & Rizzo, 1994). It is
possible, then, that patients' self-presentations may be discouraged or
significantly inhibited in triadic encounters.
Moreover, in geriatric encounters, the physician's knowledge about the
patient may arise from information transmitted by a third person who
accompanies the patient to the medical visit. Although the accompanying
individual's representation of the identity of the patient may not be an
accurate one, the doctor may nonetheless use this information in evaluat
ing the patient. For instance, the accompanying individual may suggest
to the physician that the patient has some cognitive impairments when
none is present. Even the presence of an accompanying individual may
suggest to some physicians that the patient's cognitive abilities are in
question. If the physician relies upon the third person's impressions and
information about the patient as the sole source of information about the
personhood of the patient, the physician may never achieve an under
standing of the patient's identity.
Sociodemographic Homophily
Although some research suggests that communication in dyads is

facilitated when there is sociodemographic homophily between the inter
active participants (Collins & Gould, 1992; Rogers & Bhowmik, 1970),
it is yet to be empirically determined if the patient's presentation of self
is facilitated when the physician and patient are of similar age, gender,
and race/ethnicity.
The Context of Medical Care
In considering the patient's presentation of self and the physician's

response to the patient's presentation during a first visit, one must con
sider the context of care. In bureaucratic settings, such as a clinic in a
hospital or a health maintenance organization, physicians are often rushed
and required to see a set number of patients within a specified period of
time. Private geriatric practices are affected, too; Medicare reimburse
ment for care of elderly patients is limited. The specified amount of time
allocated for a first visit may not be enough even to cover the multitude
of basic medical tasks that must be accomplished. Indeed, older patients
generally have more chronic diseases and longer medical histories than
do younger patients, so that the tasks of an initial encounter will take
longer than those for a younger patient's first visit. In addition, for those
older patients who have trouble with mobility, extra time is needed for
undressing and preparing to see the doctor. Thus there may be little, if
any, attention to the psychosocial dimensions of care, much less an
attempt to personalize the encounter by delving into the personhood of
the older patient. At the macro level, the structure of care has created
institutional ageism that serves to support micro-level ageist behaviors of
individual physicians.
Although patients place great importance on the humane, interpersonal

components of medical care (Bensing, 1991; Wiemann, Gravell, &
Wiemann, 1990), they are also aware of the rushed nature of medical
practice and may opt not to disclose personal information rather than have
their presentations of self ignored, abruptly attended to, or dealt with as
inconsequential. When systems of care place great value on technology,
speed of disposition, and cost-benefit analyses, it is likely that the inter
personal aspects of the physician-patient relationship will be severely
compromised.
A Study of Older Patients'

Presentations of Self and Physicians'
Responses to Patients' Presentations
Since no prior research had examined patients' presentations of self,

we conducted a study to explore (a) how older patients present themselves
to physicians and (b) how physicians respond to the patients' presenta
tions. In particular, we were interested in investigating the content of older
patients' presentations of self. We sought to determine the time orientations
of these self-presentations: Were they based on past, present, or future aspects
of patients' lives? We also were interested in the levels of intimacy of the
self-disclosures. We wondered if physicians' responses to patients' pres
entations of self would vary depending on the time orientation of the
presentation and the level of intimacy of the information.
We employed both qualitative and quantitative research methods to
answer our research questions. Others have also acknowledged the neces
sity of using multiple research approaches to study self-disclosures (e.g.,
Coupland et al., 1988). To give the reader a deeper understanding of the
complexities and richness of studying older patients' presentations of self
during initial medical encounters, later in the chapter we present excerpts
of dialogue from two cases in our data set.
Methods
Setting and Sample
The study was conducted in a medical primary care group practice at a

major teaching hospital in New York City. The setting is typical of a busy,
inner-city outpatient service.
The patient population in the ambulatory care area is largely composed

of poor African American and Hispanic individuals living in the c o m m u
nity surrounding the hospital. About two thirds of all visits to the group
practice are made by individuals 60 years old and older. T h e patients tend
to have chronic medical conditions: hypertension, osteoarthritis, coronary
heart disease, and diabetes mellitus predominate.
The group practice is staffed by full-time attending general internists.
Of the 20 physicians in the practice who were asked to participate in the
study, all but 2 participated.
The patient sample was composed of new patients who were cogni
tively unimpaired, w h o spoke English, and who were 60 years of age or
older. A "new patient" was defined as an individual making her or his first
visit to the study physician. Transfer patients (patients who were pre
viously seen by other physicians in the hospital) were also considered new
for the purposes of the study. Patients meeting study criteria were asked
to participate in the study; a total of 80% agreed to participate.
Audiotapes in which parts of visits were not audible or the tape was
turned off at any point were excluded from the sample because we wanted
to be sure that we captured all verbal communications during the visit.
The resulting sample was composed of 81 first visits.
The patient sample was predominantly female (79%). The average age
of the patients was 72 years; 72% were African American, 18% were
white, and 10% were Hispanic. About half of the patients had completed
at least high school, and 60% lived alone. Most of the patients required
no assistance in ambulation.
The 18 physicians who participated in the study were all attending
physicians who were either board-certified (89%) or board-eligible (11%)
in internal medicine. There were 9 female physicians and 9 male physi
cians, most of whom were white (1 was Asian, 1 was African American,
and 1 was Hispanic). The physicians ranged in age from 29 to 5 0 years
old; mean physician age was 39.7 years.
The average length of the first visit was 34.9 minutes (range = 5 - 7 6
minutes).
Procedure
Data collection took place from May 1989 through September 1990.
All patients who met the study criteria were approached by a research
assistant while they were waiting for their first visit. T h e patients were
told that the research focused on how physicians and patients talk with
one another and that their participation in the study would involve the
tape-recording of their visit. After the patient agreed to participate and a

consent form was signed, the research assistant placed the audiotape
equipment in the physician's office.
Measurement
Audiotapes were coded using the Multi-Dimensional Interaction Analysis

(MDIA) system. The MDIA system was developed by this research team
in previous studies (Greene, Adelman, Charon, & Friedmann, 1989; Greene,
Adelman, Charon, & Hoffman, 1986) to examine the content, process,
language, and communication behaviors of physicians and patients. The
MDIA system is a quantitative and qualitative coding method. With the
original MDIA system, the following communication variables are stud
ied: (a) the specific content of visits and who initiates topics for discussion,
(b) the quality of interactional processes (i.e., question asking, information
giving, and supportiveness), (c) the frequency of selected communication
behaviors (e.g., social amenities, shared laughter, open-ended questions, ques
tions asked in the negative), and (d) physicians' and patients' overall mood
and tone during the visit. When we had an opportunity to study a longitudinal
series of physician-older patient medical visits, we added the following
elements to the original MDIA coding system: the content, time orientation,
and level of intimacy of patients' presentations of self; physicians' responses
to patients' presentations of self; and specific interactional strategies that
physicians use to enable or to impede patients' presentations.
To identify how patients presented themselves to physicians, coders
(two social scientists and one physician) listened to audiotapes and noted
in brief phrases which aspects of self the patient talked about that could
have helped the physician to identify the patient as a unique individual.
The unit of analysis was the specific topic of the presentation. Because
of time constraints, coders were instructed to record a maximum of five
presentation topics for each patient. Two of the original coders, a physi
cian and a social scientist, reviewed the entire list of topics and created a
summary classification of the topics based on the content of the patient's
presentation. These coders then determined the time orientation of the
presentation. The presentation was coded as coming from the patient's
past if it was based on events that occurred more than one year prior to
the visit. If the presentation was based on current life situations, it was
coded as being in the present. If patients referred to future plans or
endeavors, the presentation was coded as being of a future orientation.
The original three coders noted how the physician responded to each
presentation of self and assigned a score based on a scale from 1 to 4. If
the physician encouraged, facilitated, and supported the patient's presen

tation of self, a score of 4 was given. A physician who just listened and
acknowledged the presentation of self received a score of 3. If the
physician ignored the presentation of self, he or she received a score of
2. A physician who discounted or derided the presentation of self earned
a score of 1.
Coders then recorded how physicians enabled or impeded the patient's
presentation of self, recording in words the interactional strategies that
physicians used. One social scientist and one physician coder together
reviewed the physicians' communication techniques for each presentation
topic and created a summary classification.
The coders also evaluated the level of intimacy of the informational
disclosures. We developed an intimacy scale, based on the work of Collins
and Gould (1992), and the level of intimacy was determined within the
context of a first medical primary care visit. The coding rules for the
determination of the degree of intimacy of the disclosure appear in Table
11.1. Scores from 1 to 3 were given to denote the varying degrees of
intimacy (1 indicated no intimacy, 2 indicated somewhat intimate content,
and 3 indicated very intimate content). (Specific coding and scoring rules
for the MDIA system are available from the authors.)
Interrater reliability of the coders was established using the percentage
agreement method. Overall interrater reliability for the entire M D I A
coding system was 79%. Intrarater reliability .was similarly examined and
determined to be above 90%.
W e calculated a simple frequency distribution to describe the content of
the patient's presentation of self, and conducted t tests to evaluate the
differences in physicians' responsiveness to patients' presentations of self.
Results
The Patient's Presentation of Self

•
For the 81 patients, there were a total of 182 presentations of self (the
average number of topic presentations per patient was 2.25). We aggre
gated the topics into 14 mutually exclusive content areas. Table 11.2
displays the array of the content of the patients' presentations, f r o m most
frequent to least frequent presentation topic. More than half of the
presentations focused on patients' occupations or work situations, medi
cal conditions, and family issues. Patients were also likely to present
themselves as individuals who took care of themselves and were knowl
edgeable about health and disease. In general, the presentation topics least
Table 11.1 Coding Rules for Determining the Level of Intimacy of the
Older Patient's Presentation of Self During an Initial Visit
With a Primary Care Physician
No intimacy (score of 1): N o expression of feelings. Factual statements regarding
occupation, ethnicity, age, educational level, leisure time; description of family
structure and physical location of residence.
Somewhat intimate (score of 2): Some feelings expressed, but not about m a j o r life
issues. Patient uses adjectives to describe self and situations. Includes discussions
of unhealthy behaviors, taking care of oneself, knowledge about medicine and health,
satisfaction with the health care system.
Very intimate (score of 3): Emotion expressed. Discussions of significant life events,
problems with family and significant others, quality of life issues, sadness, depression,
losses, grief, worries regarding health, fears about medical tests or procedures, e m b a r
rassment or shame about their body, dissatisfactions with the medical care system.
likely to be discussed involved negatively valenced emotional subjects:

embarrassment, worries, and fears. These subjects may be especially
difficult to talk about when meeting an individual, even a physician, for
the first time. Moreover, as most of these medical encounters were
intergenerational meetings (with a younger physician and an older pa
tient), patients may have felt uncomfortable about disclosing such emo
tional information with physicians who, they feared, would not be able to
understand or empathize, at least at this early point in the physician-
patient relationship.
Time Orientation
More than 28% of the presentations were based in the past. The
remaining presentations were chronologically lodged in patients' present
identities and situations. None of the presentations of self focused on future
plans or wishes. Contrary to stereotypical expectations that elderly individu
als would dwell on the past (Butler, 1975), the majority of patients' presen
tations of self were focused on current life events and problems. That no
talk of patients' futures occurred may reflect older patients' desires to deal
with present-oriented concerns first in an initial medical encounter and/or
infrequent questioning about the future by physicians.
Intimacy of the Presentation of Self
Using the coding system described in Table 11.1, we found about 40%
of the presentations of self to have no intimate content, 27% to be
Table 11.2 Distribution of the Content of Older Patients' Presentations

of Self
Content of Presentation Percentage of Total
1. Work 18.1
2. Medical problems 16.5
3. Family issues 16.5
4. Takes care of self 8.8
5. Quality of life (including losses, sadness, depression) 6.6
6. Satisfaction or dissatisfaction with the medical care system 6.0
7. Knowledgeable about health and medicine 6.0
8. Ethnicity, race, religion, age, formal education 4.4
9. Engages in unhealthy behavior 4.4
10. Living location and situation 3.8
11. Fearful or scared about medical tests, procedures, or doctors 2.8
12. Worries about money and finances 2.8
13. Concerned about health 2.2
14. Embarrassed or ashamed about their body or medical tests and procedures 1.1
Total 100.0
(N = 182)
somewhat intimate, and about 33% to be very intimate. As previously

discussed, the very nature of a geriatric medical interview may promote
discussion of intimate subjects. In a comprehensive geriatric evaluation,
physicians are expected to raise such personal topics as the patient's
quality of life, losses, and significant others. Nonetheless, we were
surprised by the frequency of very intimate disclosures. Of equal or more
importance, however, were the physicians' responses to these very inti-
mate subjects.
Physicians' Responsiveness
to Patients' Presentations of Self
The average physician score for a presentation based on the past of the
patient's life was 3.28, compared with a score of 3.04 for physician
responsiveness to a presentation based in the present time. This difference
was statistically significant Oil, 176] = 1.99, ρ < .05) and somewhat
unexpected. Initially, we believed that physicians would respond better
to presentation topics lodged in the present context because, we thought,
the relatively young physicians in the sample might not be interested in

patients' past experiences. The finding in the opposite direction may
suggest that physicians were more apt to be sympathetic and listen to
patients' life issues that had already reached closure, but were less
understanding of current presentation issues that might require consider-
able time and work on their part. The extensive work a physician might
need to do to help a patient deal with a current personal issue is illustrated
in the second of the two cases presented later in this chapter.
Because the coding system to determine the level of intimacy was
developed de novo for this particular study and not previously tested, we
decided that we could best test comparisons of the physicians' responses
to the different levels of intimacy by examining only the polar ends of the
three-part intimacy rating—"not intimate" and "very intimate" ("some-
what intimate" was excluded from this analysis). The mean physician
responsiveness score for "not intimate" disclosures was 3.14, compared
with the mean physician responsiveness score of 2.91 for "very intimate"
disclosures. Although this difference does not quite reach statistical
significance ( i [ l , 128] = 1.76, ρ < .08), it does suggest that a trend is
present. The physicians in this sample were evidently uncomfortable with
intimate information that patients disclosed. Trained to deal primarily
with the biomedical agenda of the visit, the physicians poorly managed
the intimate content of patients' presentations of self. This finding is well
demonstrated in Case 1, presented below.
Interactional Strategies of Physicians
In reviewing and summarizing coders' notes about the specific methods

that physicians employed to promote patients' presentations of self, it
became clear that those medical interviewing techniques that are consid-
ered productive for good communication in general between physicians
and patients (Bates, 1983; Engel & Morgan, 1983) were also operative in
this situation. In order of decreasing frequency of occurrence, patients
were better able to disclose personal information when physicians (a)
listened and allowed patients to express themselves fully, without inter-
ruptions; (b) explored patients' issues by asking questions and following
up on concerns expressed; (c) actively supported patients, showing sym-
pathy and warmth on patient-raised topics; and (d) related their own or
others' stories that demonstrated empathy with the patients.
However, coders also noted a number of interactional techniques that
dissuaded patients from disclosing information about their personhood.
Some physicians focused the interviews on purely biomedical talk and
either completely ignored the personal information offered by patients or

did not actively pursue it by asking questions. In some instances, physi
cians interrupted patients or allowed interruptions in the office (e.g.,
multiple telephone calls). And on a few occasions, physicians made
derogatory comments, displayed scorn, or laughed in response to patient
disclosures.
Case Illustrations of Patients' Presentations of Self
The following two cases are transcribed excerpts from actual first-visit
audiotapes. They were selected to illustrate the range of patients' disclo
sures and physicians' responses. In each case, we include portions of the
dialogue that demonstrate how the patient (PT) presented him- or herself
to the doctor and how the physician (MD) responded to the presentation.
Case 1
In this case, a 77-year-old man is making his first visit to the group
practice in more than a year. The physician he was previously seeing has
left the practice, as have four of the patient's previous physicians. His
chief medical complaints are difficulty with urination, hernia, and angina.
He has previously had surgery for prostate cancer and a hernia. The
physician in this case is male and 37 years old. The visit lasts 22 minutes.
The patient's speech during the visit is slow and deliberate; his tone is
sad.
Excerpt I
1.1 MD: Please sit down. I'm Dr. G. It's been about a year since
1.2 you last saw Dr. Z.
1.3 PT: That long, was it?
1.4 MD: It's been about a year.
1.5 PT: Yeah, and the reason that I haven't shown up, you know, was
1.6 that for the first in a long time, I got a job, a
1.7 temporary job and I been working at it, you know.
1.8 MD: I see.
1.9 PT: I really needed to work down debts that I piled up, so
1.10 that was the reason.
1.11 MD: What are you doing now?
1.12 PT: In a job?

1.13 MD: Yeah.
1.14 PT: I'm working for the Board of Ed.
1.15 MD: 1 see.
The physician now turns to reading the chart (silence and sounds of
page turning are heard on the audiotape) and there is no further discussion
of the patient's situation. By not exploring why a 77-year-old has b e c o m e
so heavily in debt (line 1.9) that he must return to work, the physician
misses an opportunity to pursue an important issue in the patient's life.
Excerpt 2
2.1 MD:It must be difficult living there.

2.2 PT:Oh, it is.
2.3 MD:It must be very dangerous.
2.4 PT:I was mugged twice, actually.
2.5 MD: Is the building okay?
2.6 PT: Well, aside from being the noisiest building, it's
2.7 taken care of.
2.8 MD: I see. Are you there a long time?
2.9 PT: About 12, 13, 14 years, about.
2.100 MD
2.1 MD:: Are you having any chest pain?
Once again, an opportunity has been missed. By abruptly changing the

subject (line 2.10), the physician has ignored an issue that the patient has
raised (line 2.4) and thus invalidates the significance of the disclosure.
Excerpt 3
3.1 PT: I wanted to ask you—I see the ads about the Canadian
3.2 method [regarding hernia surgery].
3.3 MD: They do that here, if it's necessary.
3.4 PT: What's the difference between that and the . . . [MD interrupts]
3.5 MD: It's done under a local anesthesia.
3.6 PT: That's all?
3.7 MD: And you're in and out in one day.
3.8 PT: You can actually walk home or something?
3.9 MD: Yeah, if you're 30 years old you can walk home.
The patient, who has had previous hernia surgery, is interested in new
techniques that may help him in the future (line 3.1). The physician first
interrupts him (line 3.4) and then derides him (line 3.9). These c o m m u
nication behaviors clearly do not facilitate the patient's presentation of
self.
Excerpt 4
The following dialogue occurred during the physical examination.
4.1 MD: Are you married?

4.2 PT: Yeah, slightly.
4.3 MD: What does that mean, sir?
4.4 PT: I have no old yearnings.
4.5 MD: Your prostate feels a little rough, but I'm not sure
4.6 what it felt like before. You should follow up with
4.7 your old surgeon.
Although the physician queried the patient (line 4.3) and in turn the
patient m a d e a very personal disclosure (line 4.4), the physician d o e s
not follow through by either asking additional questions or s h o w i n g any
concern.
Excerpt 5
5.1 PT: By the way, you know, they found out that there are
5.2 two oils that are pretty interesting besides olive oil.
5.3 There's this canola oil that people don't seem to know
5.4 about, the only one that has that 0 - 3 something.
5.5 MD: Omega-3.
5.6 PT: That's right. It's only found in fish oil. I've been
5.7 using it. It's pretty nice to work with.
5.8 MD: Do you do the cooking or your wife?
5.9 PT: I'm not living with her, you see. So I do my own cooking.
5.100
5.1 MD
MD:: How are you as a cook?
The physician provides no support to the patient's attempt to e n g a g e in

an interesting conversation regarding new medical k n o w l e d g e (lines
5.1-5.7). M o r e problematic, however, is that the physician ignores the
patient's disclosure that he does not live with his wife (line 5.9).
Thus, what we learn of this patient is only what he presents, with very
little aid from the physician. The patient bases most of his presentation of
self in his recent life situation, and the intimacy of the disclosures vary
from somewhat intimate (the patient's knowledge of health and medicine,
line 3.1-3.2, 5.1-5.4) to very intimate (the patient's revelation that he has
"no old yearnings," line 4.4; he doesn't live with his wife, line 5.9; and
he is financially in debt, line 1.9). Although the doctor's questioning about
these subjects appears to be relevant and sufficient, it is only superficial.
The doctor steers clear of probing questions that would have shed light
on the circumstances of this patient's life and would have provided
answers to the issues that the patient himself has raised. How has this
elderly patient become so heavily in debt (line 1.9)? What does he mean
by being only "slightly married" (line 4.2), and how does this relate to his
not having "old yearnings" (line 4.4)?
The physician in no way enables the patient to explain his situation or
to explore his feelings. Instead, he abruptly shifts topics. The patient
mentions that he lives alone in the context of doing his own cooking (line
5.9). The doctor does not pursue this disclosure; rather, he asks, "How are
you as a cook?" (line 5.10). When the patient presents himself as a
knowledgeable man (line 5.1-5.4), the doctor does not provide any af
firmation, support, or encouragement of this presentation of self.
The visit ends, and the man leaves with his prescriptions, but we are
left feeling that this patient's needs were not met, that his agenda was
larger than his medical complaints and that he had indeed tried to engage
the doctor. The doctor discouraged and impeded this man's presentation
of self by not pursuing or exploring genuinely the topics the patient raised,
by ignoring obvious areas of distress, and by being unsupportive and even
somewhat derogatory. The doctor asked only "safe" questions, ignoring
those issues that might have prolonged the visit. In so doing, however, he
also missed vital information about this individual and a chance to engage
more fully in the personhood of his patient.
The interactional strategies this physician used to end the patient's
presentation of self are remarkably similar to strategies described by
Coupland et al. (1988) in their intergenerational study of painful self-
disclosures of younger and older women in a nonmedical encounter.
These researchers found that the most common method young recipients
of information used to end elders' painful self-disclosures was to "elicit
on related but non-painful disclosure topics" (p. 123). This young doc
tor's quick topic switches successfully moved the talk from intimate to
nonintimate subject areas.
Case 2
The patient in this case is an 80-year-old woman who has occasional

elevations in cholesterol levels and blood pressure. The physician is male
and 50 years old. The visit lasts 1 hour and 16 minutes.
Excerpt 6
6.1 PT: Well, here I am, and I don'l know.
6.2 MD: What don't you know? What are you thinking?
6.3 PT: I have problems. My main problem, of course, being M.
6.4 She has nobody but me.
6.5 MD: That's your daughter?
6.6 PT: Yeah. The family don't want her, any part of her.
6.7 And she has me and I have her.
The physician's active probing (line 6.2) of the patient's vague c o m -

ments (line 6.1) illustrates his concern for the patient. He discovers,
through extensive questioning, that the patient's daughter, M, has been
in a state mental hospital for the past year, and has had a long history
of mental illness.
Excerpt 7
7.1 PT: [sounding very agitated] They want me to take her home
7.2 and I can't. I just can't. You know, what would
7.3 happen if suddenly 1 die, and she was left all alone?
7.4 But they don't take that into consideration at all.
7.5 MD: So they really have been pressuring you.
7.6 PT: They've been putting a lot of pressure on me and it's
7.7 made me very nervous.
7.8 MD: Maybe there's a way I can help.
7.9 Well, I can see what you said that you have a lot of
7.10 things on your mind. An awful lot of pressure and
7.11 tension.
In this excerpt, the physician not only acknowledges the patient's distress
(line 7.5), but offers assistance in resolving her situation (line 7.8).
Excerpt 8
8.1 P T : Μ is v e r y u n h a p p y . I k n o w it. T h a t ' s w h a t t h e
8.2 trouble is. They're trying to pressure me to take her

8.3 home and that's bad because it's a terrible, terrible
8.4 mistake.
8.5 MD: Well, maybe, again, there may be something that I
8.6 could help with. Maybe if I wrote a note saying
8.7 medically . . . [PT interrupts]
8.8 PT: Oh, that would be wonderful! A great help! A great help!
T h e physician repeats his offer to help the patient (lines 8.5-8.6 and line
7.8) and demonstrates his genuine concern by giving the patient a
tangible solution to her problem (lines 8.6-8.7). T h e visit ends with the
f o l l o w i n g remark:
Excerpt 9
9.1 MD: Well, you've shared a lot of things with me, which I
9.2 think are important, and useful for our keeping a
9.3 relationship.
In his concluding statement, the physician summarizes the significance

of the visit (line 9.1) and indicates his desire to continue his relationship
with the patient (lines 9.2-9.3).
Once again, we have a patient who reveals very intimate information
about her past and present. She tells the doctor of her fears and her
burdens. The patient's most pressing problem is the imminent discharge
of her 63-year-old mentally ill daughter from the state hospital. With the
aid of a sensitive physician who facilitates the evolution of this patient's
life history, we learn of the many difficulties she's faced with her daughter
and the effects of these problems on her health. In stark contrast to the
first case, the physician permits the patient to reveal herself fully and, in so
doing, allows her to become a unique individual above and beyond just
another 80-year-old woman with mild hypertension and elevated cholesterol.
The physician's response to this patient's presentation of self was
remarkable in its sensitivity, genuine interest, and concern. He used a
variety of well-established, effective interviewing techniques (Bates,
1983; Engel & Morgan, 1983). First and foremost, he explored patient-
raised topics by asking probing questions that showed interest and a desire
to learn more. Second, and of equal importance, he allowed the patient to
express herself fully without interruption. The physician added another
dimension to these two primary techniques—a human element—by giving
support, showing sympathy (line 7.5), and feeling empathy (lines 7.9
7.11). He thus validated the woman's presentation as unique, memorable,
and worthwhile. By responding to the patient's presentation, and listening
carefully, the physician gained the kind of vital information that was
missed by the doctor in Case 1.
The two cases we have presented here are part of a larger longitudinal
study in which doctor-patient pairs were followed over the course of a
year or more after the initial visit. For the doctor and patient in Case 1, a
total of six visits were recorded, after which, nearly a year later, the patient
never returned, telling the research assistant that he was very dissatisfied.
The five follow-up visits were very short (averaging 8 minutes), with the
physician's responses becoming more abrupt and unsupportive with each
visit. The last visit, 5 minutes in length, was outright neglectful of the
patient as a person. The physician and patient in Case 2, also followed for
well over a year, had very positive outcomes. The physician did intervene
on the patient's behalf, and, in cooperation with several social workers
whom the doctor consulted, the patient's daughter was sent to an adult
home near her mother. The patient expressed her gratitude and relief
repeatedly to the physician.
Discussion
The findings from this study suggest that elderly patients' presentations
of self in medical encounters constitute a subject that requires further
examination on multiple levels. Although the elderly patients in this sample
were seemingly reluctant to provide negatively valenced emotional self-
disclosures at first visits, they were still able to talk about some intimate
material. Physicians, however, had difficulty responding to or exploring the
intimate talk that was presented by older patients. That is, physician response
scores were lower on topics defined as intimate versus not intimate.
The findings from this small study are only preliminary. Because this
convenience sample of younger physicians was mostly white and the
sample of older patients was mostly African American and Hispanic, it is
inappropriate to attribute the results solely to intergenerational c o m m u
nication problems. It may be that the mismatch of physician and patient
race/ethnicity plays a greater role in influencing patient self-presentations
and physicians' responses than do physician and patient age differences.
Further investigation of the homophily/heterophily of physician-patient
pairs is warranted.
Knowing the personhood of the patient is an essential component of

geriatric care. Because older patients are more likely than their younger
counterparts to suffer multiple, chronic, and serious illnesses, there is a
strong imperative for the physician to understand the patient's value
preferences early in the relationship. Indeed, some practitioners have
advocated the inclusion of a "values history" in every geriatric evaluation
(Doukas & McCullough, 1991). Through this communication strategy,
patients' values concerning issues such as the importance of length of life
versus the quality of life, expectations about the future, and how the
patient wishes to die may be discussed. It is assumed that obtaining such
intimate information is a first step in ensuring that the patient's wishes
can be respected should decision making by the patient no longer be
possible. If a values history perspective is adopted, it thrusts the patient
and the physician into an extraordinarily intimate discussion. To know
such facts about a patient, the physician must seriously attend to the
patient's presentation of self.
Some geriatricians also advocate obtaining a "life review" from the
elderly patient (e.g., Butler, 1963). It is expected that this review of the
patient's past experiences and unique life history will have psychothera
peutic benefits. The life review may also serve to decrease physicians'
ageist biases in that the older patient may come to be seen as a unique
individual, not just another elderly patient. It is interesting that in this
study, only 28% of the patients' presentations of self were based on their
past experiences.
Although the life review is important, it assumes that the patient's life
has already been lived and makes no reference to the future. Indeed,
concentrating on the older patient's present life and future options may
be the least ageist and most life-affirming approach. That is, it may be as
important (and therapeutic) to have a life preview as to have a life review:
recognizing that important life events have occurred, but also allowing
that life events are yet to occur. Life reviews and life previews are
theoretically excellent methods for accessing patients' presentations of
self. Further, hearing patients' unique life perspectives, accomplishments,
and hopes has the potential to help health providers abandon ageist
beliefs.
The physician's own personal experience as a provider of care will be
enriched by his or her knowing more about the personhood of the patient
(Branch & Suchman, 1990). One could imagine that treating 10 elderly
patients in a day for uncomplicated hypertension could become routine,
if not downright boring. However, caring for the elderly hypertensive
patient who has traveled around the country with Duke Ellington's band,
or the elderly hypertensive patient who is writing a book on labor law
(two cases from our study), adds a novel dimension to an ordinary practice
day. That physicians can learn and grow from their interpersonal relation
ships with patients is rarely acknowledged or investigated.
Future Research
This study suggests many new areas for research. We believe that it
would be worthwhile to investigate the patient and physician determinants
of patients' presentations of self. It is possible that patients' ages, genders,
social classes, and/or diagnoses will influence their propensities to self-
disclose and the content of those self-disclosures. Patients' expectations
about their role and the doctor's role in the medical encounter and their prior
experiences with physicians' responses to their self-presentations may also
influence their future self-presentations.
Physicians' responsiveness to patients' presentations of self may be
influenced by their medical school and residency training, how they are
compensated for the visit, and the time constraints in their medical
practices. We believe that it would also be worthwhile to investigate
further whether physicians' responses are influenced by the specific
content of patients' self-disclosures.
The outcomes of patients' presentations of self require exploration.
Physicians' lack of attentiveness to patients' disclosures are likely to
affect patients and their satisfaction with the care they receive. W h e n an
older patient feels that the physician has ignored his or her human side,
the patient may be less likely to adhere to therapeutic regimens. S o m e
older patients may doctor-shop when their physicians are interpersonally
unavailable.
More investigations of a longitudinal series of physician-older patient
medical visits would reveal if a patient's desire to disclose and the type of
disclosures change as the physician-patient relationship develops over time.
Perhaps patients are more willing to disclose and physicians are more
willing to attend to self-disclosures at a later point in their relationship.
Conclusion
By valuing the personhood of the patient and the patient's presentation

of self, the physician humanizes the medical encounter. The better physi
cians know geriatric patients, the less likely they are to use ageist or other
stereotypes to guide communication, diagnosis, treatment, and care. Al-
though this personalization of the medical encounter may take extra time
and effort on both participants' parts, the interpersonal and medical
rewards of this work are likely to be great.
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Author Index
Abel, Ε. K„ 196, 204 Anderson E. S., 61, 64, 80, 81

Abrams, D „ 148,158 Anderson J., 188, 204
Adams, R. G., 209, 210, 215-217, 224 Anderson R. G „ 85, 103
Adelman, R. D „ 7, 11-13, 227, 230, 231, Anderson S., 188, 207
235, 249, 250 Anderson, D. W„ 58, 82
Ainley, S. 192, 204 Andres, D „ 10, 18, 26, 28, 37, 83, 107,
Albee, E„ 1 8 5 , 2 0 5 108, 110, 111, 113- 118, 124, 127,
Albert, M. L., 6 6 - 6 8 , 7 3 , 7 9 , 81, 118-120, 128, 231
129, 162, 181 Anichini, Μ. Α., 188, 207
Albert, M. S., 58, 80 Antonucci, T. C „ 212-213, 224
Albert, S. M „ 196, 204 Appell, J., 7 0 - 7 1 , 7 9
Alberts, J. K„ 141, 158 Arbuckle, Τ. Y . 10, 18, 26, 36, 37, 83,
Albertson, S. Α., 41 57 107-111, 113-121, 124-128, 231
Aldwin, C. M „ 86-87, 103 Argyle, M „ 210, 224
Alexander, J., 202, 204 Arkin, R. M „ 141, 156
Alexander, M. P., 59, 79 Arling, G „ 212, 224
Allan, G. Α., 210, 214-215, 224 Arnesen, A. J., 85, 103
Allard, L„ 73, 82 Arnold, S. B„ 188, 204
American Association of Retired Persons, Atchley, R. C. 188, 192, 204
2, 12 Atkinson, K„ 138, 156, 158
American Board of Family Practice, 151,
156, 182
American Board of Internal Medicine, Baddeley, A. D„ 4 1 , 5 7
226, 249 Balint, M., 226, 249
Anagnopoulos, C., 73, 75, 76, 80, 162, 182 Baltes, P. B„ 3, 13, 35, 87, 165, 171, 182
Anderson E. G „ 163, 181 Barbato, C. Α., 6, 12, 155, 156
251
Barker, L. L., 89, 90, 105 Bourhis, R. Y„ 102, 105, 142, 160, 167,
Baron, R. M „ 174, 183 168, 179, 183
Barrow, D„ 202, 204 Bowie, M „ 200, 204
Bartolucci, G., 5, 13, 31, 36, 39, 76, 81, Bowles, N. L„ 49, 56
86, 105, 138, 160-163, 165, 167- Boyd, J. W„ 147, 156
169, 171, 172, 174, 175, 180, 183 Bradac, J. J., 8, 12, 140, 142, 156, 159,
Bartus, R., 65, 80 169, 175, 182, 222-224
Barusch, A. S„ 186, 187, 197, 204 Bradford, J. B„ 187, 205
Bates, B., 239, 249 Brady, C. B„ 6 7 , 6 8 , 81
Baum, Η. M „ 85, 104 Branch, W„ 247, 249
Baumgardner, A. H., 141, 156 Branco, K. J . 131, 156
Bayles, Κ. Α., 16, 30, 31, 37, 56, 59. 63, Branham, R. J., 202, 207
69, 73, 79 Brewer, Μ. B„ 136, 156, 163, 165, 171,
Beasley, D. S„ 86, 104 181
Beavin, J., 87, 105 Brizzer, K. R , 85, 103
Becker, J. T„ 72, 79 Brown J. R., 87, 103, 227, 249
Beckinan, L. J., 212, 224 Brown Μ. H„ 10, 83, 89-93, 105
Beisecker, A. E., 6, 12 Brown, I. D. R„ 20, 39, 162, 183
Belal, Α., 84, 103 Brown, J. K„ 148, 159
Bell, J., 153, 156 Brown, P. 173, 181
Belscy, C., 191, 204 Brown, R„ 151, 158
Ben Z u r , H „ 4 1 , 5 7 Brown, R. P., 155, 161
Bensing, J., 233, 249 Bruce, V.. 49, 50, 52, 53, 56
Benson, D. F„ 77, 79 Bub, D., 63, 79
Benton, Α., 121, 127 Bultena, G. L„ 215, 224
Berg, C. Α., 20, 35, 37 Burke, D. M., 16, 30, 34, 37, 38, 4 2 , 4 3 ,
Berger, C. R„ 140, 156 45-49, 52, 56
Berkovic, M „ 120, 127 Burleson, B. R„ 173, 181
Berman, L., 152, 156 Burton, A. M , 52, 53, 56
Berry, D „ 174, 183 Buss, T, F„ 155, 158
Bess, F. Η , 86, 104 Butler, R„ 2 3 1 , 2 3 7 , 2 4 7 , 2 4 9
Bettini, L. M „ 218, 224 Butters, N. 62, 69, 80, 82
Bevan, W. W„ 174, 183 Button, J. W„ 155, 160
Bhonmik, D., 2 3 1 , 2 5 0
Birren, Β. Α., 8, 9, 12
Birren, J. E„ 8, 9, 12
Cadieux, R., 228, 249
Bishop, J. M „ 156, 156 Campain, R. F„ 89, 104
Blessed, G„ 59, 82 Canadian Study of Health and Aging, 32,
Blieszner, R„ 209, 210, 214-217, 224 37
Blishen, B. R„ 114, 115, 127 Candib, L„ 229, 249
Blythe.R., 112, 127 Cantor, J., 155, 159
Boaz, R . F . , 187,204 Caplan, D„ 70, 78, 79
Boland, S. M „ 163-164, 175, 183 Caporael, L. R., 5, 12, 19, 37, 76, 79, 138,
Boiler, F„ 67, 6 8 , 7 2 , 7 9 , 8 1 156, 162, 163, 165, 167, 168, 181,
Bollinger, D„ 88, 103 182
Boone, D. R „ 73, 79 Carmichael, C. W„ 86, 103
Boothroyd, Α., 86, 104 Carver, C. S., 134, 156
Botwinick, J„ 18, 37, 8 5 , 1 0 3 Cassel, C , 228, 249
AUTHOR INDEX 253
Cassell, E „ 226, 249 Culbertson, G. H „ 5, 12, 7 6 , 7 9 , 1 3 8 , 156,

Cavanaugh, J. C., 19, 37 162, 163, 165, 167, 168, 176, 181,
Cerella, J., 79, 69 182
Chaikelson, J., 115,120,127 Culver, C., 36, 38
Chambers, K.O., 189, 193, 207 Cummins, J. L„ 7 7 , 7 9
Chapman, S.B., 73, 82 Curtiss, S., 71, 81
Chappell, N.L, 188, 192, 204 Cutler, N. R., 86, 103
Charon. R „ 7, 12, 13 ,227, 230, 231, 235,
249, 250
Chertkow, H., 63, 79 Dail, P.W., 132, 157
Cheung, H . , 7 1 , 7 2 , 80 Dancer, J., 87, 103
Cheung, H„ 7 1 , 7 2 , 80 Dannefer, D „ 78, 80
Cheung, M , 145, 156 Darbyshine, J. O., 86, 103
Child, P., 175, 183 Darling, R„ 10, 83, 89-93, 105
Chui, H. C „ 5 9 , 7 9 Davidson, H„ 19, 38
Clancy, P., 64, 80 Davis, R. H„ 152, 157
Clark, R. Α., 173,182 Davison, L „ 121, 129
Clark-Lewis, S., 83, 89-91, 105 de Bot, K., 22, 37
Clement, R„ 145, 155, 156, 158 de la Garza, Ν. H., 1 3 4 , 1 5 6
Cohen, G., 5, 9, 12, 41, 43-46, 50, 52, 54, Deaux, K „ 155,157, 170, 182
56, 57, 8 9 , 1 0 3 Delia, J. G „ 8, 12, 1 7 3 , 1 8 2
Cohn, J., 186, 187, 196, 205 Delis, D. C . , 6 2 , 81
Cole, R., 19, 39, 138, 142, 160 Deser, T„ 118,119, 128
Cole, T. R., 190, 199, 203, 205 Diamond, T„ 187, 205
Collins, C „ 231, 232, 2 3 6 , 2 4 9 Dillard, J., 135, 136, 157
Community Care Project, 188, 207 Dittman-Kohli, F„ 188, 205
Connelly, S„ 119, 127 Dixon, R. Α., 3, 13, 17, 18, 21, 24, 31, 35,
Cooper, P. V. 118, 128, 162, 181 37, 38, 165, 171, 182
Corbin, J., 187, 189, 207 Domitrovich, L., 202, 204
Corkin, S„ 62, 65, 80 Donnell, Α., 73, 82
Costa, P. T„ 112, 128 Donnelly, ML, 202, 204
Coupland, J., 5, 6, 12, 16, 36, 37, 131-136, Donnerstein, E„ 152, 159
139, 140, 147, 148, 153-158, 162, Doukas, D., 247, 249
163, 169, 171, 172, 175, 176, 182, Dowd, J. J., 26, 37, 147, 156, 194, 205
181, 190, 192-195, 205, 230, 231, Downs, V . C . , 218, 224
233, 243, 249 Dronkers, N. F„ 62, 81
Coupland, N „ 5 , 6 , 12, 16, 18, 22, 36, 37, Duck, S„ 209, 217, 224
45, 56, 131-136, 139, 140, 147, 148, Dukes, W. F„ 174, 183
153-158, 162, 163, 169, 171, 172, Dull, V., 136, 156, 163, 181
175, 176, 180-182, 190, 192-195, Duncan, S „ Jr., 88, 103
205, 230, 231, 233, 243, 249 Dyne, K. J., 20, 34, 38
Courtright, J. Α., 91, 104
Coward, R., 191, 200, 205
Craik, F. I. M „ 4 1 , 5 7 Eddy, J. M „ 173, 183
Crockett, W. H„ 4, 12, 34, 37, 172,173, Edwards, H„ 144, 157
175, 181 Elkins, E. F„ 85, 104
Crohan, S . E . , 212-213, 224 Ellard, J. H. : 130, 159
Crook, Τ. H „ 47, 48, 5 6 , 6 5 , 80 Ellis, A. W„ 49, 56
Ellis, J., 1 9 1 , 2 0 0 , 2 0 5 Gaeth, J., 84, 103

Engel, G „ 226, 239, 245, 250 Gandell, D, L„ 77, 80
Erber, J. T„ 20, 37 Garron, D, C „ 77, 80
Etholm, B., 84, 103 Garstka, Τ. Α., 163-165, 171, 174, 175, 182
Evans, D. Α., 58, 80 Gekoski, W. L„ 20, 34, 35, 38, 172, 173,
Eysenck, Η. J., 112, 115, 116, 126, 128 182
Eysenck, S. B. G., 115, 116, 126, 128 Gel man, R„ 150, 160
Gerard, L„ 119, 120, 128
Gerber, S. E„ 86, 103
Fagerhaugh, B„ 187, 189, 207 Gerbner, G „ 152, 157
Fahey, C. J., 186, 187, 199, 203, 207 Gergen, K„ 190, 205
Fairchild, H„ 152, 159 Gergen, M „ 190, 205
Faulkner, D„ 5 , 1 2 , 4 1 , 4 3 - 4 6 , 5 4 , 5 6 , 8 9 , 103 Gerwirth, L. R., 61, 80
Fauri, D. P., 187, 205 Giddens, Α., 1 9 8 , 2 0 1 , 2 0 5
Featherstone, M „ 190, 197, 198, 205 Giles, H., 5, 6, 8, 10, 12, 13, 16, 18, 22,
Fedio, R., 6 5 , 8 1 31, 35-37, 39, 45, 54, 56, 76, 81, 86-
88, 103, 105, 131-145, 147, 148,
Feezel, J., 162, 163, 182
151, 153, 154, 156-163, 165, 167-
Ferraro, R„ 71, 72, 80
176, 181, 182, 190, 192, 193, 194,
Ferris, S. H„ 65, 80
205, 230, 231, 233, 243, 249
Ferris, S. R„ 88, 104
Gilewski, M. J., 31, 37
Feshbach, N „ 152, 159
Gilliam-Macrae, P., 187, 199, 207
Fischer, Μ. M. J., 192, 206
Glaser, G„ 187, 189, 207
Fisher, S., 231, 250
Glosser, G„ 118, 119, 128
Fiske, D. W„ 88, 103
Goffman, E„ 98, 103, 227, 250
Fisman, M „ 70, 7 1 , 7 9
Gold, D. P., 10, 18, 26, 36, 37, 83, 107-
Flicker, C„ 65, 80
Flude, Β. M., 49, 56 111, 113-121, 124-128, 231
Fodor, J. Α., 77, 80 Goldfarb, R . , 6 1 , 82
Foster, Η., 1 9 1 , 2 0 5 Goldstein, D. P., 87, 105
Fox, J. H., 77, 80 Gorlin, R., 229, 250
Fox, S., 6, 10, 22, 35, 36, 45, 76, 142, 144, Gould, O., 2 3 1 , 2 3 2 , 236, 249
145, 151, 157, 158, 170, 173, 182 Grady, C. L„ 86, 103
Fozard, J. L., 16, 179 Grafman, J., 64, 80
Frank, A. W„ 198, 205 Grainger, K „ 138, 155, 157, 158, 195, 205
Frank, I., 119, 127 Gravell, R., 6, 7, 14, 233, 250
Franklyn-Stokes, Α., 135, 157 Green, B. S., 203, 206
Freed, D. M . , 6 1 , 80 Green, E E . , 19, 37
Freidson, E„ 229, 250 Greene, M. G„ 7, 11-13, 227, 230, 231,
Frick, R. W„ 88, 103 235, 249, 250
Fried, B. R., 147, 157 Grew, D. J., 218, 224
Friedland, R. P., 62, 81 Grice, H. P., 123, 128
Friedmann, E „ 7. 11, 12, 227, 235, 249, Grimes, A. M „ 86, 103
250 Grodzinsky, Y„ 78, 80
Fujioka, T„ 175, 183 Gronden, J. H„ 62, 65, 80
Funkenstein, Η. H„ 58, 7 9 Gross, L „ 152, 157
Groves, J., 229, 250
Gubrium, J. F„ 187, 1 9 0 , 2 0 6
Gadon, S„ 194, 205 Gunther, B., 152, 161
AUTHOR INDEX 255
Haerer, A. F., 58, 82 Hill, M., 85, 89, 90, 104

Hagenlocker, D „ 73, 80 Hoag, J., 148, 159
Hamera, J., 202, 206 Hodges, J. R„ 69, 80
Hamilton, J. M „ 163, 167, 168, 183 Hoffman, S„ 7, 12, 230, 250
Hampson, P., 54, 57 Hoffstetter, C. R., 155, 158
Hamsher, K„ 121, 127 Hogg, M., 148, 158
Handel, Α., 190, 206 Holland, Α., 67, 68, 72, 7 9 , 8 1
Harkins, S. W„ 30, 38 Holland, U„ 31, 38
Harriman, J., 132-134, 157, 158 Hollway, W„ 191, 206
Harris, J . E . , 4 1 , 5 7 Holtgraves, T„ 139, 159
Harris, L „ 19, 37 Hooper, Α., 1 1 6 , 1 2 9
Harrold, R. M „ 64, 80 Hooyman, N. R., 89, 104
Hartman, M „ 68, 80, 120, 128 Horn, L. C„ 6 6 , 8 1
Harwood, J., 6, 10, 22, 35, 36, 45, 76, 144, Huckman, M. S., 77, 80
145, 147, 152, 153, 158 170 Huff, F. J., 6 2 , 6 5 , 67, 68, 7 2 , 7 9 - 8 1
Hasher, L „ 16, 17, 38, 119, 120, 123, 127, Hultsch, D. F„ 17, 19, 21, 24, 31 38
128 Hummert, M. L„ 4, 10, 12, 13, 20, 22, 34-
Haven, C „ 213, 224 37, 54, 76, 102, 131, 138, 159, 163-
Hawes, L. C „ 201, 206 165, 167, 168, 171, 174, 175,
Hawk, R„ 83, 8 9 , 9 1 - 9 3 , 105 178-182
Hawkins, R „ 163, 182 Hunt, M., 61, 81
Hawkins, R. Α., 7 7 , 7 9 Hunter, S„ 147, 159
Hazen, H„ 192, 206 Huston, Α., 1 5 2 , 1 5 9
Healy, M. P., 85, 105 Hutchinson, J. M „ 73, 80, 123, 128
Heberlein, W„ 73, 7 5 , 7 6 , 80
Hecht, M. L„ 141, 158
Heckhausen, J., 3, 13, 35, 38, 165, 171, Irigaray, L „ 70, 80
182 Izard, C. E„ 36, 38
Hedrick, D. L „ 20, 34, 38, 118, 129, 135
Helm-Estabrooks, N „ 73, 81, 119, 129
Henderson, M „ 210, 224 Jackson, C . , 7 1 , 8 1
Henderson, V. W„ 59, 6 1 , 7 9 , 80, 81 Jackson, D „ 8 7 , 1 0 5
Henriques, J., 191, 206 Jackson, L. Α., 34, 38
Henry, D., 83, 8 9 , 9 1 , 92, 93, 105 Jacobs, R. L., 216, 224
Henwood, K„ 5, 6, 12, 13, 16, 31, 36, 39, Javidi, M., 218, 224
76, 81, 86,105, 132-136, 138, 140, Jensen, M „ 73, 8 0 , 1 2 3 , 128
141, 147, 148, 156-158, 160, 162, Jerger, J., 85, 104, 105
163, 165, 167-169,171, 172, 174- Jerger, S., 85, 104
176, 181, 183, 188, 190, 192, 194, Johnson, Β. T„ 20, 38, 131, 159
205, 230, 231, 233, 243, 249 Johnson, Ε. Α., 172, 173, 182
Hepworth, M., 190, 197, 198, 205 Johnson, P., 8, 12, 169, 175, 182
Herbst, K. G„ 86, 104 Johnston, D„ 134, 160
Herrick, L. R „ 140, 159 Jones, G. V., 43, 56
Herrman, D. J., 21, 23, 38 Jones, S„ 54, 57
Hertzog, C., 19, 38
Hewitt, J., 93, 105
Hewstone, M „ 151, 152, 158 Kahn, R. L., 212, 224
H i e r . D . B . , 6 1 , 7 3 , 80 Kales, J., 228, 249
Kaszniak, A, W„ 16, 30, 37, 58, 59, 69, 73, Lawton, M. P., 203, 206
77, 79, 80 Lee, L „ 81, 72
Katz, P., 152, 159 Lehman, D. R „ 130, 159
Kay, J., 49, 56 Lenhardt, M. L „ 30, 38
Kearl, M. C „ 148, 159 Levelt, W. J. M „ 88, 104
Kemper, S„ 3, 4, 9, 10, 16, 17, 19, 38, 57, Levin, W. C„ 148, 159
7 1 - 7 3 , 7 5 , 76, 80, 118, 128, 142, Levinson, S., 173, 181
159, 162, 182, 188 Lezak, M. D„ 121, 128
Kempler, D„ 61, 64, 70, 71, 80, 81 Libow, L. S., 228, 250
Kenyon, G. M „ 8 , 9 , 13 Lieberman, D. Α., 89, 104
Kerby, A, P., 188, 200, 206 Liebert, R. S„ 147, 159
Kerns, V., 148, 159 Light, L. L„ 3, 4, 13, 16, 17, 30, 34, 38,
Kertesz, Α., 7 0 - 7 1 , 7 9 41,49,57
Killbride, J. C„ 203, 207 Linstsen, T„ 22, 37
Kim, Y. Y„ 154, 159 Linville, P. W„ 172, 183
Kite, Μ. E., 2 0 , 3 8 . 131, 159 Litwak, E„ 211, 224
Kiyak, Η. A„ 89, 104 Lowell, S. H., 83. 84, 104
Kleck, R. E„ 142, 160 Lowenthal, M. F., 213, 224
Kleinman, Α., 226, 250 Lubinski, R„ 59, 81
Knops, U., 102, 105, 142, 160, 167, 168, Lucas, D „ 43, 57
179, 183 Lui, L., 136, 156, 163, 165, 171, 181
Knox, V. J., 20, 34, 35, 38, 172, 173, 182 Lukaszewski, M. P., 76, 79, 162, 163, 167,
Kogan, N„ 20, 38, 175, 183 168, 176, 181
Konigsmark, E., 84, 104 Lyman, Κ. Α., 78, 81
Konkle, D. F„ 85, 86, 104 Lyons, K„ 9, 10, 73, 75, 76, 80, 188
Koriat, Α., 4 1 , 5 7 Lyotard, J.-F., 190, 206
Koss, E „ 62, 81
Kozma, A„ 116, 128
Krause, D.R., 152, 156 Mack, W.. 61, 80
Kreitler, H., 188, 206 MacKay, D. G., 34, 37, 43, 45, 46, 47, 48,
Kreitler, S„ 188, 206 52, 56
Kubey, R . W . , 150, 152, 157, 159 Mahoney, D. F„ 84, 104, 158
Kuhl, D. E„ 77, 79 Mahoney, S. M „ 155, 158
Kwong See, S„ 4, 8, 10, 17, 20, 21, 35, 39, Maines, D„ 187, 189, 207
54, 83, 134, 145, 150, 163, 167, 168, Majerovitz, D „ 231, 235, 250
175, 183, 187, 188 Major, B „ 170, 182
Kynette, D „ 3, 4, 13, 19, 38, 118, 128 Malatesta, C. Z „ 36, 38
Malmstrom, P. M „ 150, 159
Mancini, J. A . , 2 1 2 , 224
LaBarge, E., 71, 72, 80 Marcus, G. E „ 192, 206
Mares, M. L„ 155, 159
Lahar, C. J., 89, 106
Marin, O.S.M.; 70, 82
Langer, E„ 151, 160
Marshall, L„ 84, 104
Langer, E. J., 18, 19, 20, 31, 39
Marshall, V., 230, 250
Lannaman, J. W., 200, 206
Martin, Α., 65, 81
Larson, R„ 150, 159,212, 224
Martin, M „ 85, 104
Laurie, S„ 19, 20, 39
Martin, R. N„ 66, 72
Laver, G. D.. 16, 37, 42, 47, 49, 56
Martinez, R , 64, 80
Lawlor, Β. Α., 64, 80
AUTHOR INDEX 257
Martinez, S. A „ 84, 104 Motard, D., 1 1 9 , 1 2 7

Martkin, N. D„ 85, 104 Moy, A. C. I., 59, 79
Martz, S„ 202, 206 Mulac, Α., 8, 12, 169, 175, 182
Matthews, S. H„ 209, 224 Muller, C. F„ 187, 204
Maylor, E., 43, 47,-57 Murray, J., 152, 159
Mazloff, D „ 165, 167, 168, 182 Muthard, J. E„ 174, 183
McArthur, L. Z„ 174, 183, 181
McCall, G. J., 171, 183
McCluskey-Fawcett, Κ. Α., 1 5 3 , 1 5 9 Nabelek, A. K., 86, 104
McCrae, R. R „ 112, 126, 128 Nagy, S„ 203, 207
McCullough, D„ 62, 82 Nahemow, L., 153, 159
McCullough, L„ 249, 247 National Institute on Health, 186, 206
McGhee, P. E„ 153, 159 National Institute on Aging, 2
M c G i l l i s . D , 151, 160 Nebes, R. D„ 59, 66-68, 7 2 , 7 9 , 81
McGuire, C, V., 175, 183 Neils, J., 85, 89, 90, 104
McGuire, W. J., 175,183 Neisser, U., 21, 23, 38
Mclntyre, J. S„ 4 1 , 5 7 Nerbonne, Μ. Α., 8 4 , 9 0 , 104
McLean, C., 202, 204 Newman, C. W„ 85, 8 9 , 9 0 , 104, 206
McMahon, A. W„ 116, 128 Newman, S., 186, 206
McNamara, P. M., 85, 104 N g , S . H „ 135, 142, 159
McRoberts, Η. Α., 114, 115, 127 Nicholas, M . , 7 3 , 81, 119, 129
McTavish, D. G „ 20, 24, 38 Nicolich, M „ 36, 38
McWhinney, I., 226, 250 Nittrouer, S., 86, 104
Mehrabian, Α., 88, 92, 104, 105 Noels, K., 155, 156
Mendez, Μ. Α., 8 1 , 7 2 Noller, P., 144, 157
Mendez, Μ. Ε , 8 1 , 7 2 Norman, S., 19, 38
Meneer, W. Β., 4, 8, 10, 13, 17, 39, 54, 83, Norris, J. E „ 112, 129
134, 150, 160, 176,187, 188 Norton, M. L „ 218, 224
Meredith, S. D „ 144, 160, 167, 168, 183 Notarius, C. I., 140, 159
Meyer, D. E., 66, 81 Nussbaum, J. F„ 5 , 6 , 10,12, 13, 86, 104,
Meyerhoff, Β. M „ 185, 194, 206 1 0 5 , 1 3 1 , 1 3 2 , 1 5 4 , 1 6 3 , 1 9 6 , 157-
Meyerhoff, W. L „ 85, 103 159,182, 2 0 6 , 2 1 2 , 2 1 5 , 2 1 7 , 2 1 8 , 2 2 4
Michaels, L „ 85, 105, 250
Milberg, W„ 66, 68, 79
Millar, E E . , 91, 104 Ober, Β. Α., 6 2 , 6 7 , 81
Miller, G. R„ 136, 159 Obler, L. K „ 7 3 , 8 1 , 118-120, 129
Milner, B „ 121, 129 O'Brien, K „ 3, 4, 13, 118, 128
Mishler, E., 226 O ' K e e f e , B. J., 8, 12, 173, 183
Moller, Μ. B „ 86, 104 O ' K e e f e , D. J., 8, 12
Montepare, J. M „ 5, 13,149, 150, 159, 174 Oldham, J. M „ 147, 159
Moody, J., 135, 159 Olsen, W. O. 85, 105
Moore, M., 4, 13 Olsho, L. W„ 30, 38
Morgan, G „ 157, 188, 206 Orange, J. B., 58, 81
Morgan, M „ 152, 157 Orbach, H. L „ 188, 192, 204
Morgan, W. L „ 239, 245, 250
Morris, P. E „ 54, 57
Moscicki, C. D„ 85, 104 Palmerino, M., 151, 160
Moscovitch, M „ 120, 121, 129 Paoletti, I., 192, 197, 207
Paparella, Μ. M „ 83, 84, 104 Rodin, J., 18, 19, 2 0 , 3 1 , 3 9

Parsons, T„ 229, 250 Rogers, E„ 231, 250
Patterson, B. R., 218, 224 Rogers, L. E„ 87, 91, 103, 104, 227, 249
Pearce, W. B„ 202, 207 Rook, K. S„ 6, 13, 130, 160, 214, 224
Perse, Ε. M „ 6, 12, 155, 156 Rose-Colley, M „ 173, 183
Petronio, S., 150, 160 Rosenbaum, W. Α., 155, 160
Phelps, Μ. E„ 77, 79 Rosenberg, B„ 5, 13, 149, 150, 159
Pierson, H. D., 145, 146, 158 Rosenwasser, H „ 84, 105
Pikus, Α., 86, 103 Ross, M „ 20, 39
Poon, L. W„ 16. 17, 49, 56 Roth, M „ 59, 82
Potter, J. 148, 160 Rothbcrg, S. T.. 20, 37
Powers, Ε. Α., 215, 224 Rozema, H„ 87, 103
Pratt, M. W., 19, 38 Rubenstein, R. L., 195, 203, 207
Premo, T„ 190, 199, 205 Rubin, K„ 112, 129, 183
Pryor, B„ 87, 103 Rubin, Κ. H., 20, 39, 162, 183
Putnam, L. L„ 188, 207 Rubinstein, E„ 152, 159
Rudich, P. J., 116, 128
Ruff, C. D., 20, 39
Rabbit, P . M . Α., 41, 54, 57 Ryan, E. B„ 3, 4, 5, 8, 10, 13, 16, 17, 19-
Rader, V„ 148, 160 22, 31, 34-36, 54, 76, 81, 83, 86,
Radvansky, G., 120, 128 102, 105, 132, 134, 138, 142, 144,
Ragan, S . , 9 1 , 105 150, 158, 160, 162. 163, 165, 167-
Rainford, Β. Α., 119, 129 169, 171, 172, 174, 175, 179, 180,
Ramsey, R. G., 77, 80 183, 188, 208
Rapoport, S„ 86, 103
Rash, S„ 3 , 4 , 13, 19, 38, 118, 128
Rau,M. T.,58,81 Saffran, Ε. M „ 70. 82
Rawlins, W. K„ 209, 217, 218, 222, 224 Salmon, D. P., 62, 69, 80, 82
Read, D „ 121, 129 Salthouse, Τ. Α., 34, 49, 57, 162, 183
Reason, J. T„ 43, 57 Sampson, Ε. E„ 191, 207
Reddy, M. J., 87, 105 Sankar, Α., 187, 190,206
Redfoot, D „ 192, 204 Santo Pietro, M. J., 6 1 , 8 2
R e i d , T „ 83, 89,91-93, 105 Scarry, E.. 200, 207
Reitan, R„ 121, 129 Schaie, K. W„ 7, 13
Revenson, Τ. Α., 130, 160 Schalman, Μ. E„ 84, 104
Ribeau, S. 141, 158 Schmidt, D. F„ 163, 164, 175, 183
Richardson, D „ 83, 89-93, 105 Schneider, W., 72, 82
R i g o . T . G „ 89, 104 Schoenberg, B. S„ 58, 82
Rintlemann, W. F., 85, 104 Schonfeld, D„ 116, 129
Risenberg, D „ 228, 249 Schuknecht, H. F.. 85, 105
Rizzo, C . , 7 , 1 1 , 2 3 1 , 2 5 0 Schultze, W. Α., 155, 158
Robb, S S „ 173, 183 Schvaneveldt, R. W„ 66, 81
Roberts, P. M., 118, 129 Schwartz, M „ 86, 103
Robertson, J. F„ 212, 224 Schwartz, M. F„ 70, 82
Robins, S. L., 19, 38 Schwartzman, Α., 26, 37, 107, 109, 110,
Robinson, J. D., 86, 104, 132, 152, 159, 113-116, 118, 124, 128
160,212, 2 1 5 , 2 1 7 , 2 1 8 , 224 Secord, P. F„ 174, 183
Robinson, P. K., 86, 104 Seidenberg, M., 63, 79
AUTHOR INDEX 259
Seleswick, S. T„ 59, 79 Suczek, B„ 187, 189, 207

Semenza, C „ 49, 57 Sugar, J. Α., 186, 187, 196
Shadden, Β. Α., 22, 39 Sullivan, L. Α., 34, 38
Shaner, J. L „ 163-165, 171, 174, 175, 179, Sundel, M „ 147, 159
180, 182 Sunderland, Α., 4 1 , 5 7
Shantz, G. B„ 144, 160, 167, 168, 183 Sunderland, T. 64, 80
Shatz, M „ 150, 160 Szuchman, L. T„ 20, 37
Shenaut. G. K„ 67, 81
Shepard, M „ 228, 249
Shepherd, G. J., 173, 183 Taber, Μ. Α., 188, 207
Sherman, F„ 228, 250 Tajfel, Η., 175, 184
Shewan, C. M., 105, 157 Tannen, D., 87, 105
Shiffrin, R., 72, 82 Taylor, B. C., 5, 6, 11, 14, 153, 155, 160,
Shindler, A. G . , 6 1 , 7 3 , 80 207
Signorelli, N„ 152 Teng, E. L „ 59, 79
Silva, Μ. N., 150, 159 Thomas, L. E„ 189, 193, 207
Slauson, T., 73, 79 Thompson, K„ 64, 80
Slocum, Η. E., 163, 183 Thompson, T„ 86, 104, 105,132, 159 ,
Smith, E„ 142,158 217, 224
Smith, P. M „ 88, 103 Tien-Hyatt, J. L „ 145, 161
Smyth, Κ. Α., 72, 81 Tilson, D „ 186, 187, 199, 203, 207
Sobkowska-Ashcroft, I., 152, 156 Tomb, D. Α., 86, 87, 105
Soucek, S „ 85, 105 Tomlinson, Β. E., 59, 82
Spence, D. L„ 189, 192, 207 Tomoeda, C. K„ 31, 37, 58, 63, 69, 73, 79
Spirduso, W. W„ 187, 199, 207 Topel, J. R„ 77, 80
Spretnjak, M. L., 85, 105 Trosset, M. W„ 63, 69, 79
Sprott, R „ 3 , 4 , 118, 128 Troster, A. I., 62, 82
Stach, Β. Α., 85, 105 Trovato, D„ 4, 8, 10, 13, 17, 39, 54, 83,
Stanhope, 52, 57 134, 150, 160, 176, 188
Stanovich, Ε. E„ 68, 82 Tsai, S. Y., 77, 79
Starr, J. M „ 192, 207 Turner, B. S„ 197, 207
Steinberg, J., 5, 13, 149, 150, 159 Turner, J. C „ 142, 155, 161, 175, 184
Stephens, S. D. G „ 87, 105 Tyler, S. A„ 202, 208
Sternberg, R. J., 20, 35, 37
Stewart, Μ. Α., 132,160
Stine, E. A. L., 16, 17, 39, 89, 91, 100, Ulatowska, Η. K., 36, 39, 73, 82
105, 106 Urwin, C., 191,206
Stokes, R., 9 3 , 1 0 5
Stoltzfus, E. R., 120, 128
Stones, M . J . , 116, 128 Van Dijk, Τ. Α., 148, 161
Storandt, M., 71, 72 Vaughan, G., 150, 161
Strahm, S„ 163-165, 171, 174, 175, 182 Venn, C „ 1 9 1 , 2 0 6
Strauss, Α., 187, 189, 207 Villaume, W. Α., 10, 83, 8 9 , 9 3 , 115
Street, R. L . , 7 , 13
Streib, G. F„ 186, 192, 203, 207
Strenta, A. C., 142, 160 Wade, E „ 34, 37, 43, 45-48, 52, 56
Strine, M. S„ 190 Walker, V. G., 118, 129
Suchman, Α., 247, 249 Walkerdine, V., 1 9 1 , 2 0 6
Walsh, J., 228, 249 Williams, S. E„ 22, 39

Ward, A . M . , 155, 161 Williamson, J. B„ 131, 156
Watson, J, B„ 22, 39 Wills, K. J., 168, 184
Watson, K. W„ 89, 90, 105 Wingfield, Α., 16, 17, 89, 91, 100, 105,
Watts, K., 41, 57 106
Watzlawick, P., 87, 105 Winocur, G„ 120, 121, 129
Wayland, S. C„ 89, 100, 106 Winthorpe, C., 4 1 , 5 7
Weagant, R. Α., 188, 207 Wober, M „ 152, 161
Wechsler, D„ 121 Wood, L . A . , 188, 208
Weiler, E„ 85, 89, 90, 104 Wood, V., 212, 224
Weiner, C. L., 187, 189, 207 Woodward, K„ 200, 201, 208
Weingartner, H., 64, 80 Worthley, J. S„ 34, 37, 43, 45-48, 52,
Welsh, J. J., 85, 105 56
Welsh, L. W., 85, 105 Wortman, C. B„ 130, 159
West, R. L., 47, 48, 56 Wright, P. H„ 216, 224
West, R. T„ 68, 82
Wetherell, M , 148, 160
Whitaker. H„ 70. 82 Young, A. W„ 49-50, 52, 56
Whitaker, Η. Α., 82
Whitbourne, S. K„ 168, 184
Whitehouse, P. J., 72, 81 Zacks, R. T„ 16, 17, 37, 119, 120, 123,
Wicclair, M. R„ 187, 208 127, 128
Wiemann, J, M„ 4, 6, 7, 12-14, 22, 36, 37, Zelinski, Ε. M., 4, 1 3 , 3 1 , 3 7
87, 103, 136, 137, 139, 156, 157, Zettin, M „ 49, 57
158, 190, 194, 205, 222-224, 230, Zieren, C„ 108, 110, 113, 116, 117, 124,
231, 233, 243, 249, 250 127, 128
Wiemann, M. C„ 6, 7, 233, 250 Zimmerman, L„ 228, 249
Wiener, M., 92, 106 Zucker, H„ 229, 250
Williams, A. M„ 6, 10, 22, 34, 36, Zuckerman, D„ 152, 159
45,76,131,141,143, 149, 15, 154, 158, Zukow, P. G„ 150, 161
161,163,170, 171, 182, 192,205 Zwaardemaker, 83
Subject Index
Acceptance, 218 disruption of communication in, 72-77

Activation: preservation of grammar in, 70-72
concept, 60, 66, 69 semantic memory impairment in, 60-69
name, 44, 46, 49, 50, 52, 66 spouses communication ability in, 76
script, 6 6 Anaphoric reference, 41
spreading, 60 Aphasia, 7 0 , 7 8 , 119
stereotype, 170 Asymmetrical relationships, 230
Activity ratings, 111 Attention deficit, 61, 76, 119
Activity theories, 8 Attitudes, 18
Affection, 217 Auditory cortex, 84-85
Age: Auricular cartilage, 84
bias, 19, 21. See also Ageism; Pro-aged Autonomous syntactic module, 72
bias Avoidance of talk, 27
chronological, 192, 194
identities, 156, 198
self definitions of, 155 Baby talk, 19, 167, 176
Age-adapted speech, 76, 170-172, 177. secondary, 167-168
See also Baby talk; Elderspeak; See also Age-adapted speech; Elder-
Overaccommodation; Patronizing speak; Overaccommodation; Patron
speech; Speech accommodation; Un izing speech; Speech accommodation
deraccommodation Beliefs, 15, 18, 54, 131, 135-137, 179
Ageism/Ageist, 132, 154, 156, 194, 232, Biomedical agenda, 239
249
Agrammatism, 70
Aligning actions, 91 Canadian Study of Health and Aging, 32,
Alzheimer's dementia, 9-10, 58-79 36n
261
Caregivers, 75, 78, 167, 187, 195, 231 Cooperative principle, 123
Care, psychosocial dimensions of, 232 Critical:
Caretaker, 176 perspective, 188, 196
Cartesian self, 188 research, 190-191, 197-204, 203
Category knowledge, 62-63, 65
Chronic illness, 186, 234
Clarification strategies, 162 Deconstruction, 190, 196-197, 202-203
Cochlea, 85 Defective output monitoring, 41
Cognition, 4, 192. See also Attitudes; Be Dementia, 32, 78
liefs sociogenic perspective of, 78-79
Cognitive: See also Alzheimer's dementia
complexity, 173 Demographics, 2
decline, 165, 174 Dependence, 186, 196,217-218
impairment, 54, 232 Developmental Sentence Scoring (DSS),
systems, 170 72
tasks, 20 Devotion, 219, 223
Commonality, 220, 223 Dialectic:
Communication accommodation theory, 8, of frailty, 195-197
169. See also Age-adapted speech; of friendship, 218
Overaccommodation; Speech accom process of aging, 8
modation; Underaccommodation Diary studies in retrieval of proper names,
Communication: 43-47
competence, 4, 35, 40, 222. See also Discourse analysis, 189, 191, 192, 194
Competence Discrimination, 216
efficiency, 46 Diseases, degenerative, 59
motives, 6 Disengagement theories, 8
pro-active strategies, 83
See also Intergenerational communication
Companionship, 213, 215 Ecological theories, 8
Competence, 20, 54, 132, 134, 138 Egocentrism, 116, 122-123, 133, 136, 140
mental, 135 Elderspeak, 5, 75-76. See also Age-
See also Communication competence adapted speech; Baby talk; Overac
Compliance gaining, 136-137 commodation; Patronizing speech;
Conflict, 116, 196 Speech accommodation
Confrontation naming, 42, 61, 63. See also Emotional support, 211
Names; Retrieval blocks Empowerment, 194
Constructivism, 8. See also Social con Empty speech, 77, 119
struction, of reality Epistemology, 189, 192
Contact with the elderly, 35, 173. See also Equality, 210
Intergenerational contact Escapist strategy, 87
Content message, 87, 91 Ethnic group membership, 145
Context effect, 66, 68 Ethnicity, 246. See also Race
Continuers, 93, 97 Ethnography, 191
Control, 6-7 Ethnomethodology, 189
Conversational: Etiology, 59
dominance, 26 Existentialism, 189
skill, 17, 28, 35 Experimental studies in the retrieval of
style, restricted, 101-102 proper names, 44-47
SUBJECT INDEX 263
Expressive skills, 25, 29 impairment, 84

Expressiveness, 218 sensitivity, 84
Extraversion, 112, 115, 118, 122-123, 126 Hermeneutics, 189
Face, 227 Imagery mnemonics, 54. See also Mne

Facial wrinkling, 174 monic strategies
Familial comparison, 221 Immigrant acculturation, 154
Family network, 212 Impression management, 98
Frailty, 5, 11, 132, 185-204 Income, 187
dialectic of problems and productivity, Independence, 118, 217, 218
195-197 Inductive reasoning, 21
physical, 186 Inference strategies, 87
poetic narratives, 201 Information-processing, 9, 16-17, 21, 30
symbolic constructs, 197-200 Instant aging, 151, 155
Free association, 60 Instrumentality, 217
Freudian psychoanalytic theory, 200 Intelligence, 34
Friendship, 11,209-223 Intercultural communication, 154
definitions of, 210 Interculturing mechanisms, 131
dialectics of, 218 Intergenerational:
egalitarian quality of, 213 behavior, 30
external structure of, 214-215 boundaries, 148
intergenerational, 219 communication, 6, 23,35, 131, 137,141,
internal structure, 214 146-151,170,177,191,203,246
lifespan nature of, 211 conflict, 131
secondary networks of, 215 contact, 141, 149, 151
structural characteristics of, 210-211 conversations, 15, 132, 152
Frontal lobe functions, 59,77, 120-122, 126 ethics, 190, 192
Functional ability, 177 pragmatics, 190
Functionalism, 188, 196, 202 processes, 150
Functionalist research, 193, 202 relations, 197
talk, 6, 28, 194
Intergroup communication, 146-148, 155
Gender, 215 Internal locus of control, 130
differences, 216 Interpersonal:
socialization, 196 contact, 152
Generation gap, 131 factors, 18
Generativity, 20 interaction, 168
Geriatric: Interpretive research, 189-197, 203
evaluation, 228 Interpretivist perspective, 188
medicine, 228 Intersubjective reality, 189
Grammatical structures, 10, 66 Intimacy, 211, 216, 220, 236, 238-239,
243, 245
Intragenerational communication, 23, 170,
Health care, 187 177
bureaucracies, 187
Health, physical, 175
Hearing, 17, 25, 30, 34 Judgment, 217
Knowledge, 20 Mortality, 186

script, 64-65 Multi-Dimensional Interaction Analysis
(MDIA), 235
Multiculturalism, 153
Lacanian psychoanalytic theory, 200-201 Multilingualism, 153
Language:
and identity crisis, 201
performance, 9, 15, 19, 21, 33 Names:
production, 41, 52 age and memory problems with, 43-48
skills, 5 confusions, 45
Lexical: functions of, 42
decision, 66-68 retrieval models, 49-52
naming, 66 Naming, referring, 42
nodes, 52 National Health Interview Survey, 84
Lexicon, 60 National Institute on Aging (ΝΙΑ), In, 2,182n
Life: Neurological degeneration, 59
histories, 29 Neuropathology, 77
previews, 247 Nonverbal communication, 35
reviews, 247 Nursing homes, 165, 187, 218
Lifespan:
adaptation, 154
developmental perspective, 3-7 Obligation, 2 1 1 , 2 1 3
Linguistic: familial, 214
performance, 16, 18, 41 Off-target verbosity (OTV), 18, 107-127
preprocessors, 88 cognitive factors of, 118-122
Lip reading, 87 demographic correlates of, 113-115
Listening ability, 92 extant, 110
psychosocial variables of, 115-118
quantitative items of, 110
Masculine sex role, 215 Ontology, 189, 194
Mediated contact with older adults, 151-142 Outer ear, 84
Medicare, 232 Overaccommodation, 142, 144, 148, 150,
Memory, 20-21, 25, 30-31, 34, 41 169. See also Age-adapted speech;
capacity, 4, 7 Baby talk; Elderspeak; Patronizing
name, 43-52 speech; Speech accommodation
recognition, 120
semantic, 10, 60, 64, 66, 68-69, 73
semantic impairments, 60-70, 77 Painful self disclosure, 6, 139, 142, 149,
spreading activation model, 60 194. See also Self disclosure
verbal, 121 Paradigmatic associations, 61
visual, 121 Paralanguage, 88-89
working, 41 Paralinguistic cues, 88, 100
Metamessage, 87 Paraphasia, 119
Methodologies, 7-8, 187-189, 191-193, 203 Participant observation, 192
Mnemonic strategies, 55. See also Imagery Patient:
mnemonics disclosures, 229-231
Mobility, 213-214 presentation of self, 226-249
Modularity theory, 72, 77 See also Self disclosure
SUBJECT INDEX 265
Patronizing: Reaction time, 50, 135

behaviors, 19 Reasoning, 41
language, 142-146 Recall, 25, 40. See also Memory
speech, 5, 10, 102, 131, 162-163, 165 Receptive skills, 25, 29. See also Expres
169, 173, 176, 181 sive skills; Hearing, Information
See also Age-adapted speech; Baby processing; Memory; Vocabulary
talk; Elderspeak; Overaccommoda Reciprocal relationships, 220, 223
tion; Speech accommodation Reciprocity, 223
Perception, 41 Recognition memory, 120
Personal: Relational:
adjustment, 116 perspective, 217
appearance, 174 stratification, 220
histories, 19 Relationships, 5
identity, 153, 190, 215, 228, 231 asymmetrical, 230
identity node (PIN), 49 relational control in, 91
Phenomenology, 189 relational distance in, 9 2
Phonemes, 84, 87, 90 relational intensity in, 91
Physical decline, 1 6 5 , 1 7 4 relational messages in, 8 7 , 9 1
Physician: See also Physician-patient relationship
interactional strategies, 239, 243 Reminiscence, 107, 116, 190
responsiveness, 238-239, 248 Retrieval:
Physician-patient relationships, 6, 10, 227 blocks, 43, 45, 48
Physiognomic cues, 170, 174 failures, 47
Physique, 174 Rituals, 196
Political budgeting, 2
Pop-up resolutions, 46, 54
Positive impact, 221 Satisfaction:
Positive regard, 220 life and friendships, 218
Positivist research, 192 patient with physician communication,
Postmodernist theories, 191 246
Poststructuralist theories, 191, 197 with intergenerational communication,
Power, 6, 191, 229 141
Pragmatics, 35 with social support, 117
Presbycusis, 10, 83-102 Selective anomia, 49
content, 10 Self disclosure, 132, 216, 227, 233, 241
relational, 10, 89-92, 100 242, 248
Primordial memories, 200 Self esteem 130, 173, 215
Pro-aged bias, 23. See also Age bias; Age Self relations, 117-118
ism Self-affirmation, 112
Prosody, 100 Self-concept, 168
Protectiveness, 218 Self-confidence, 26
Psychomotor speed, 20 Self-efficacy, 19, 36
Psychosocial: Self-perceptions, 9, 15, 19, 22, 30-33
issues, 230 Self-preoccupation, 112. See also Egocen
topics, 230 trism
Self-presentation, 115
Self-sufficiency, 187
Race, 246. See also Ethnicity Self-systems, 170, 173
Semantic: constructions, 191, 197

discourse content, 73 interaction, 184
lexical module, 72 Syntactic:
memory, 10, 60, 64, 66, 68-69, 73 complexity, 119
network, 6 0 , 6 2 , 65, 68 production errors, 119
nodes, 68-69 structures, 4, 16, 41
priming, 65-70 Syntagmatic associations, 61
Simplification strategies, 162 Syntax content, 73
Sincerity in conversation, 26, 34
Sociability traits, 19
Social construction: Task demands, 18
of frailty and aging, 194-195 Television representation, 152-153
of reality, 148, 155, 188, 196 Terminal node, 50
Social: Theories of aging, 8
contact, 215 Time orientation, 237
identity, 151 Tip of the tongue, 25, 27, 34, 43
networks, 221 Topic:
perceptions, 33-36 shading, 93
resilience, 130 shifts, 93
security, 199 Transactional redundancy, 91
support, 117-118, 122, 187,212-213 Transmission deficit hypothesis, 47-48
workers, 187 Triadic medical visits, 232-233
Sociocultural environment, 26 Trust, 211
Sociodemographic homophily, 232 Tympanic membrane, 84
Sociolinguistic behaviors, 134
Solidarity, 132, 214
Speech: Underaccommodation, 141, 169-170. See
accommodation, 75,77,88 also Overaccommodation; Speech
style, 180 accommodation
See also Age adapted speech: Baby Understanding, 221
talk; Elderspeak; Overaccotnmoda
tion; Patronizing speech; Underac
commodation Values history, 247
Speed of talk, 25 Verbal:
Status, 194,210 fluency, 62
Stereotype, 3-4, 10, 54, 76, 83, 131, 134, immediacy, 92
138, 145, 148, 151, 162-165, 166 intelligence, 20
(table), 167-180, 230, 231, 237, 249 Verbosity, 10, 26, 107-127. See also Off-
activation model, 178 target verbosity
choice of speech style, 75-76, 134-135, Vocabulary, 19, 25
176-177
multiple stereotypes of the elderly, 163-185
situations, 175-179 Well-being, 116, 212
Stimulus onset asynchrony (SOA), 67 Wisdom, 20
Storytelling, 19, 26, 34, 73 Word:
Stress, 117-118, 122 association, 65
Stress-adaptation-growth model, 154 retrieval, 4
Symbolic: See also Memory; Names; Retrieval
About the Authors
Ronald D. Adelman, M.D., an internist and geriatrician, is the Chief of

the Division of Geriatrics at Winthrop-University Hospital in Mineola,
New York. His major research interests include the physician-older pa
tient relationship, elder mistreatment, healing and compassion in medicine,
and geriatric education and training. He has published in the Journal of
the American Geriatrics Society, The Gerontologist, Ageing and Society,
Language and Communication, and Communication Research. He is
coauthor of Strategies for Helping Victims of Elder Mistreatment.
David Andres, a social psychologist, is an Associate Member of the

Centre for Research in Human Development and an Associate Professor
in the Department of Psychology, Concordia University. His research inter
ests include the areas of social and personality factors in aging and the
application of multivariate statistics to research in social gerontology.
Tannis Y. Arbuckle is a Professor in the Psychology Department at

Concordia University. She is also Associate Director of Concordia's
Centre for Research in Human Development and a researcher in the
Canadian Aging Research Network (CARNET). Her research focuses on
age-related changes in cognition and language and psychosocial media
tors of those changes.
267
Mary Helen Brown (Ph.D., The University of Texas at Austin, 1982) is

an Associate Professor of Communication at Auburn University. Her
research interests include communication and aging, informal organiza
tional communication, and tabloid journalism.
Gillian Cohen is Professor of Psychology at the Open University in the

United Kingdom and a Fellow of the British Psychological Society. She
is a cognitive psychologist working in the Human Cognition Research
Laboratory, a group of psychologists and cognitive scientists. Her re
search has been concerned with cognitive aspects of aging, focusing on
the effects of aging on language and on memory. She is particularly
interested in everyday memory and favors an approach that combines
laboratory experiments with more naturalistic research. Her interest in the
topic of memory for proper names arises directly out of conversations
with elderly people who cite this as one of their main problems. She is
also interested in the long-term retention of knowledge acquired through
formal education. She is the author of Memory in the Real World (1989).
Rieko Darling (Ph.D., Florida State University, 1987) was Director of

Audiology and Speech Pathology Services at the Methodist Hospital in
* Houston, Texas , and Assistant Professor of Otorhinolaryngology and
Communicative Sciences, Baylor College of Medicine. Her research
interests include auditory-evoked potential, central auditory processing,
and geriatric audiology.
Susan Fox is Assistant Professor in the Department of Communication

at Western Michigan University, Kalamazoo. She has published a number
of papers on reactions to patronizing language, intergenerational contact
theory, and age stereotypes. The focus of her doctoral research is on
"interability" communication, that is, talk between persons with disabili
ties and able-bodied communicators.
Erika Friedmann, Ph.D., is Professor and Chair of the Department of

Health and Nutrition Sciences at Brooklyn College, City University of
New York. She conducts research on the interaction of social, psychologi
cal, and physiological factors on health, with a particular emphasis on
cardiovascular health. She has published in Heart and Lung, Anthrozoos,
Journal of Nervous and Mental Disease, and Public Health Reports. She
is currently President of the International Society for Anthrozoology.
A B O U T THE A U T H O R S 269
Howard Giles is Professor and Chair of Communication at the University

of California, Santa Barbara. He was founding editor of the Journal of
Language and Social Psychology and founding coeditor of the Journal of
Asian Pacific Communication and is currently editor of Human Commu
nication Research. Although his present work revolves around intergen
erational issues and aging, he also has long-standing projects under way
in language effects, intercultural communication, and bilingualism.
Dolores Pushkar Gold, a social psychologist, is the Director of the

Centre for Research in Human Development and a Professor in the
Department of Psychology at Concordia University. She is a member of
the Canadian Aging Research Network (CARNET) and conducts research
examining the influence of individual and social factors on well-being
and competence in the elderly.
Michele G. Greene, Dr.P.H., is Associate Professor in the Department of

Health and Nutrition Sciences, Brooklyn College, City University of N e w
York. She is also Senior Research Investigator, Division of Geriatrics,
Winthrop-University Hospital, Mineola, New York. She has been con
ducting research on the physician-patient relationship for more than 15
years. In particular, she has studied the determinants, outcomes, and
interactional dynamics of communication between primary care physi
cians and older patients. She is currently studying a longitudinal series of
visits between physicians and older patients to determine how the physi
cian-patient relationship develops and changes over time. Her work has
appeared in such journals as Language and Communication, The Geron
tologist, Social Science and Medicine, and Communication Research. Her
other research interests include women's health issues; medical education
and training; and the social, psychological, and cultural determinants of
health attitudes and behaviors.
Jake Harwood is Assistant Professor in Communcation Studies at the

University of Kansas, Lawrence. He has published widely on many facets
of intergenerational issues, including media representations of the elderly,
middle age and communication, and cross-cultural aspects of ageist
language.
Mary Lee Hummert (Ph.D., University of Kansas) is an Assistant Pro

fessor in the Communication Studies Department at the University of
Kansas and an Assistant Scientist in the university's Gerontology Center.
Her research centers on the relationship between stereotypes of the

elderly and communication with the elderly, for which she has received
a 5-year grant from the National Institute on Aging. Her work has
appeared in Psychology and Aging, Journal of Personality and Social
Psychology, Annual Review of Gerontology and Geriatrics, and the Inter
national Journal of Aging and Human Development. She has also coedited
a special issue of the journal Communication Research on the topic of
communication and aging.
Susan Kemper is Professor of Psychology at the University of Kansas.

Through her involvement with the Child Language Ph.D. program and
the Gerontology Center at the university, she has promoted a "life-span"
approach to the study of psycholinguistics. She has published extensively
in the area of geriatric psycholinguistics, documenting a wide range of
changes to older adults' speech production and comprehension. She has
also investigated how Alzheimer's dementia affects language production.
Currently, she is evaluating the effectiveness of speech accommodations
for facilitating older adults' comprehension.
Sheree Kwong See is a Ph.D. candidate in the Department of Psychology

at McMaster University. Her research focuses upon cognitive processes
in later life, as well as social psychological influences upon these pro
cesses. She has presented her work at the annual conferences of the
Canadian Psychological Association and the Canadian Association on
Gerontology.
Kelly Lyons completed her Ph.D. in experimental psychology at the

University of Kansas in 1993. Her research focused on the effects of
normal aging and Alzheimer's dementia on semantic memory. She has
also examined the effects of Alzheimer's dementia on language, including
wording-Finding problems during spontaneous speech and linguistic sim
plifications arising from neuropsychological impairments. Currently, she
is investigating how spouses and other companions learn to accommodate
to the disruptions of language that result from Alzheimer's dementia.
W. Bryan Meneer recently completed requirements for his honors psy

chology degree from McMaster University.
Jon F. Nussbaum (Ph.D., Purdue University) is a Professor at the Uni

versity of Oklahoma in the Department of Communication and is a Senior
ABOUT THE AUTHORS 271
Fellow at the Oklahoma Center on Aging. He is coauthor of Communica

tion and Aging and editor of Life-Span Communication: Normative Proc
esses. H e has contributed several recent articles to such publications as
Ageing and Society, International Journal of Aging and Human Develop
ment, and Communication Education. He has been a Fulbright research
scholar at the University of Wales in Cardiff.
Connie Rizzo, M.D., is an Adjunct Assistant Professor in the Department

of Biology at Pace University in New York. Upon graduating f r o m
medical school, she temporarily has set aside her clinical training to
pursue a lifelong interest in teaching undergraduate science. Her principal
interests lie in reforms needed in premedical and medical education, and
the role literature and the humanities must play in that process, both in
shaping the student and in physicians' dealings with bioethical decisions.
She has done a considerable amount of work with troubled adolescents,
and hopes to resume her postgraduate medical training in psychiatry,
specifically, child and adolescent psychiatry.
Ellen Bouchard Ryan is Professor of Psychology in the Department of

Psychiatry and Director of Gerontological Studies at McMaster Univer
sity. She has contributed recent articles to the Journal of Gerontology:
Psychological Sciences, Psychology and Aging, and the International
Journal of Aging and Human Development. Her research focuses upon
social psychological and cognitive aspects of language across the life span
as well as intergroup attitudes.
Bryan C . Taylor is an Assistant Professor in the Department of Speech

Communication and Theatre Arts, Texas A & M University. His research
interests include the use of critical theory and interpretive methods to
study the relations among language, subjectivity, institutions, and power.
His recent publications have appeared in the Western Journal of Speech
Communication, Communication Research, Quarterly Journal of Speech,
and Journal of Applied Communication Research.
Diane Trovato recently completed the requirements for her honors psy
chology degree from McMaster University.
William A. Villaume (Ph.D., The Ohio State University, 1984) is an

Associate Professor of Communication at Auburn University. His re
search interests include communication and aging, interaction involvement,
and the use of verbal aspect in the characterization of communicative

action.
John M . Wiemann (Ph.D., Purdue University) is Professor of C o m m u

nication at the University of California, Santa Barbara. His research
interests include communicative competence, cross-cultural influences
on beliefs about talk, nonverbal communication, and communication,
health, and aging. He coedits the Sage Annual Reviews of Communica
tion Research series and has recently coedited special issues of Communi
cation Research (on communication and aging) and American Behavioral
Scientist (on the social psychology of language). His recent books include
Communication, Health and the Elderly and "Miscommunication" and
Problematic Talk (both with H. Giles and N. Coupland) and Strategic
Communication (with J. Daly). He has been a W. K. Kellogg Foundation
National Fellow and a Fulbright-Hays Senior Research Scholar at the
University of Bristol, England.
Angie Williams completed her doctoral research at the University of

California, Santa Barbara, and thereafter was appointed Research Fellow
in Sociolinguistics at the University of Wales College of Cardiff. She is
now Assistant Professor of Communication at the University of Okla
homa, Norman, and has published on issues of intergroup accommodation,
especially as they relate to intergenerational satisfaction and dissatisfaction.
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INTERPERSONAL

8 Controversy ( Third Edition) 152. Researching Sensitive Topics

Mary Lee Hummert

All rights reserved. No part of this book may be reproduced or utilized

For information address:

S A G E Publications India Pvt. Ltd.

Printed in the United States of America

Library of Congress Cataloging-in-Publication D a t a

Main entry under title:

Interpersonal communication in older adulthood: Interdisciplinary

Sage Production Editor: Astrid Virding

1. Interpersona l Communication and Older Adulthood:

Social scientists from a variety of academic disciplines have energeti­

Why Study Interpersonal Communication

According to the most recent statistics compiled by the American

Cognition, Language, and

Although it is quite common to classify elderly adults as neatly fitting

well as negative effects of the aging process on language production,

Evidence gathered by cognitive psychologists suggests that a decline

younger participants in intergenerational interactions can lead to in ­

Although older adults are heterogeneous in their language skills, they

Our relationships with others are accomplished through a complex

of these relationships in terms of mutual influence (control) and affiliation

Methodologies for the Study of

As exemplified by the chapters in this book, we believe that a variety

In addition, it is important for researchers as well as readers to be open

Theories of Aging and Interpersonal Communication

not only that interpersonal communication research can provide the

The chapters in this book address the interrelationships among cogni­

of Alzheimer's dementia on language and communication. They include

Taylor, B. C. (1992). Elderly identity in conversation: Producing frailty. Communication

Difficulties encountered in intergenerational conversations may fre-

introduce a multidimensional model for understanding language in later

Beliefs About Age-Based Changes in Competence

Multiple Influences on Language Performance

Although linguistic knowledge appears to remain stable among healthy

Figure 2.1. Multiple Influences on Language Performance in Later Life

The multiple factors contributing to variability in conversational skill

The advantage of this model is that it highlights the potential influences

Perceptions of Later-Life Competence

Implicit theories of life-span development have become the focus of

Ross, 1989). Repeated-measures paradigms have revealed adults' implicit

Kwong See, 1993) has adapted well-known self-report questionnaires

Purpose of the Study

hood questionnaire (LIA) was developed concerning receptive and ex­

In order to measure the language-relevant self-perceptions and social

1. Self-perceptions of both receptive and expressive language performance

in Adulthood, Dixon & Hultsch, 1983). The LIA consists of 20 items: 10

Intratest reliabilities of the three versions of the Language in Adulthood

high. However, because the reliabilities of the Expressive subscale were

For Receptive self-perceptions, the respondent age group comparison

The significant multivariate effect for self-perceptions on the Expres­

Table 2.1 Mean Self-Perceptions of Receptive Language

Respondent Age Group

People speak too softly 3.73 4.45*

*p < 0.05; **p < 0.01 ;***/) < 0.001.

Table 2.2 Mean Social Perceptions of Younger and Older Adult

Respondent Age Group

People speak too softly 3.26 5.66 3.78 4.75 ***

Hard to understand when noisy 4.48 6.17 4.09 5.68 ***

Frustrated when do not hear 3.06 5.41 3.22 5.14 ***

People use long sentences 3.26 4.21 3.41 3.75 *

People speak too fast 3.16 4.90 3.09 4.50 ***

Social scientists from a variety of academic disciplines have energeti

younger participants in intergenerational interactions can lead to in

The chapters in this book address the interrelationships among cogni

hood questionnaire (LIA) was developed concerning receptive and ex

The significant multivariate effect for self-perceptions on the Expres

p < 0.05; p < 0.01 ;/) < 0.001.

persons' interactions with their environments, influencing their motiva

As anticipated, the younger adults perceived their language perform

of a self-report instrument about language and communication in every

Based on perceptions of older target persons in other cognitive do

associations that other words possess, so that instead of recruiting activa

Although there is little disagreement regarding the presence of seman

Semantic memory also contains script information. A script is a tem

Studies examining word associations, confrontation naming, and cate

The semantic priming paradigm offers another way to examine seman