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BOOK REVIEW |
Dean and Professor, College of Health Professions Medical University of South Carolina Charleston, South Carolina 29425
Aging, Communication, and Health: Linking Research and Practice for Successful Aging, edited by Mary Lee Hummert and Jon F. Nussbaum. Lawrence Erlbaum Associates, Publishers, Mahwah, NJ, 2000, 317 pp., $69.95 (cloth).
Augmentative and Alternative Communication for Adults With Acquired Neurologic Disorders, edited by David R. Beukelman, Kathryn M. Yorkston, and Joe Reichle. Paul H. Brookes Publishing Co., Baltimore, MD, 2000, 425 pp., no price listed (cloth).
Communication and Aging (2nd ed.), by Jon F. Nussbaum, Loretta L. Pecchioni, James D. Robinson, and Teresa L. Thompson. Lawrence Erlbaum Associates, Publishers, Mahwah, NJ, 2000, 368 pp., $89.95 (cloth), $39.95 (paper).
Communication, Technology and Aging: Opportunities and Challenges for the Future, edited by Neil Charness, Denise C. Parks, and Bernhard A. Sabel. Springer Publishing Company, New York, 2001, 248 pp., $44.95 (cloth).
When I was asked to review four recently published books on topics related to communication and aging, it was as if a lifeline were being thrown to a floundering swimmer. Three years ago I became a Dean and since then I have been keeping my head just above water in a sea of administrative work. I have felt increasingly distanced from my academic grounding and have struggled to continue to publish and attend the occasional scholarly meeting. In addition, it seems that colleagues assume that once one takes an administrative post she leaves her scholarship behind and may even lose some of her cognitive capacity. So, the invitation to review these volumes came as I was feeling a strong need to reconnect with my field of study. These four texts provided me that opportunity. They offer a broad perspective of recent developments in communication and point to the complexity of human communication with elderly persons. I found three themes across these books that appear to be organizing principles for the authors' approaches to the topic. They each show a shift in how researchers are framing questions about communication and aging compared with work from the previous decade.
The first theme that struck me was that there now seems to be a unifying approach to the study of aging and communication. It is important to note that the World Health Organization's (WHO, 1999) model of disablement has become prevalent as a way of structuring the study of communication and aging. This model acknowledges the linkages between physical and psychological impairments and addresses the functional changes that may result from these impairments as well as the social consequences that occur with disabling conditions. It appears that this model has cognitive resonance with researchers and that they have been waiting for just such an organizing schema for their work. In an area as complex as human communication, showing how particular findings support or are supported by the model can serve to validate studies and allow researchers to build on each others' work in ways not available in the past. This model-based approach is more globally integrated than past efforts, both geographically and contextually, and reflects a maturing of the way we attack the study of human interactions.
The second major theme I noted was the importance of accommodation and adaptation by all participants in sustaining communication with elderly persons. While social gerontology has long held that both life situations and individual qualities affect the adaptability of the elderly person, the effects of these factors on communication are only beginning to be addressed. Communication impairments that occur in the elderly person arise from physical limitations, sensory losses, poor social opportunities, lack of technologic literacy, and the consequences of debilitating disease complexes. The ability of professionals to intervene and improve communication in these situations also seems dependent on multiple factors. The willingness of professionals to accommodate an interaction approach, the adaptability of the elderly person to new ways of communication, and the elderly person's access to resources to make necessary accommodations all play roles in improving communication. These critical variables are referred to throughout all four books.
The third and final theme that runs through these texts is an emphasis on retained communication abilities in elderly individuals and how they can underpin successful aging. These books are not written from an impairment perspective; rather, they all stress strategies for maximizing the functional communication abilities that are available to elderly persons. This approach to the issues surrounding communication for older persons is evidence that authors and contributing researchers are taking a "glass half full" rather than a "glass half empty" view. Much of the early work in communication and aging looked at declines in abilities and losses of competency across the life span. These texts signal a positive shift in our orientation to examine adaptability and retained abilities of elderly persons that allow them to be part of constructing improved interactions.
The concept of adaptability is probably nowhere more critical than in the use of technology by elderly persons, especially for those with communication impairments. E-mail allows for social connectivity and relationships that were not possible a decade ago. We are reaching a point where technology is user friendly enough to actually be feasible for independently dwelling older persons to access and use.
Applying Technology
Barriers to use are explored in Communication, Technology and Aging: Opportunities and Challenges for the Future, edited by Neil Charness, Denise C. Parks, and Bernhard A. Sabel. The text is divided into three sections. The first deals with overviews of communication and aging; the second examines broad sociocultural issues; and the third explores design, training, and compensation issues in communication and aging. The book is based on presentations from an international conference linking German and American scientists from industry and academia who are working in the area of communication and technology. However, in reading the volume, it quickly becomes apparent that a major problem with any book on technology applications is the rapid rate at which changes are occurring.
Given the expanding environment in technology and telecommunications, much of what might have been state of the art when the chapters in this volume were being developed may no longer be timely. For example, Internet access and hardware that may have been prohibitively costly 4 years ago when this book was in preparation are now much more affordable for many older persons. The impact of rapid advances in technology is perhaps most noticeable in Chapter 7, where Kara L. Bikson and Tora K. Bikson present an early field experiment that, while offering some insight into how older people process information, has limited applicability. The clunky slow systems employed do not apply for today's Internet users. Much of what is now available for practical use by elderly people (e.g., filing tax returns and accessing medical information and current news) was not readily accessible online at the time this study was conducted.
Susan Kemper presents an interesting chapter, "Over-Accommodations and Under-Accommodations to Aging," that looks at maximizing face-to-face communication and written communication. She offers a general theory of communication and then examines adjustments to aging made by conversational partners. The struggle between over- and under-accommodation to the communication limitations of elderly persons constitutes the "communicative predicament of aging" (Ryan, Giles, Bartolucci, & Henwood, 1986). Kemper relates this challenge of calibrating our face-to-face interactions to that of matching the communication abilities of aging persons with technology so that it is easily used. The discussion is pertinent in the context of designing computer programs for older persons and training them to become technology literate. The final four chapters of the book provide good discussions of compensatory strategies and approaches to computer use.
Neurologic Impairments
Augmentative and Alternative Communication for Adults With Acquired Neurologic Disorders, edited by David R. Beukelman, Kathryn M. Yorkston, and Joe Reichle, broadly views all the communication options that are available for adults with impairments. The book is divided into two parts, with the first section containing six chapters covering severe impairments regardless of etiology. The chapter authors describe communication roles, strategies for messaging, effective augmentative and alternative communication (AAC) strategies for those with residual speech, acceptance of AAC both by users and those they socialize with, and, finally, ways to regain communicative competence and maintain a sense of self for persons with a serious disability. The second section is organized around specific neurologic and neuromuscular conditions and is an excellent resource for professionals exploring communication options for persons with progressive impairments and aphasia. Amyotrophic Lateral Sclerosis, Huntington's disease, Parkinson's disease, traumatic brain injury, primary progressive aphasia, aphasia, and dementia are all examined relative to AAC interventions. The broad exploration of alternative strategies under the umbrella of AAC provides readers with a range of options from high technology systems to caregiver training in discourse strategies.
Beukelman and Yorkston are pioneers in the use of AAC by those with severe impairments. Their chapter on "Decision Making" is particularly enlightening in that it provides a historical perspective on how clinical management has developed in AAC. They argue persuasively that we have moved from subjective, individualized clinical judgments to evidence-based practice decision making in AAC. They contend that we should now apply a data-based approach to intervention that builds on the case studies and research that have been developed over the past 30 years. Clinicians need to hold in mind that much of this work does not deal directly with an older population; however, it can still be made relevant to aging persons with severe impairments.
The influence of the WHO model is particularly apparent throughout this book and the social consequences of neurogenic disabilities are presented in a number of chapters. Using the WHO environmental perspective, in contrast to a biomedical approach, allows clinicians to look at the restrictions in a client's ability to be involved in life situations so that the impact of aging can be factored into the intervention plan. Recognizing the social consequences of disablement and acknowledging the context in which it occurs offers us the best opportunity to improve functional communication. This message is underlined by a number of authors.
The Importance of Social Relationships
The second edition of Communication and Aging, by John F. Nussbaum, Loretta L. Pecchioni, James D. Robinson, and Teresa L. Thompson, is organized in much the same way as the first edition in that each of its 14 chapters deals with an aspect of social relationships and aging. The authors use a model of adaptation to demonstrate how older persons successfully use communication to manage and to maintain the quality of their lives, even in challenging circumstances. I am attracted to this book as an introductory instructional text because it focuses on retained competencies of elderly individuals rather than of lost abilities. This orientation steers students' thinking and gives them a positive perspective for further study. There is a helpful instructional guide that can be purchased with this text.
The book begins by stressing the value of our social exchanges and then examines society's views on aging and the elderly population as demonstrated by stereotypes of aging in our attitudes and the mass media. Work, leisure, and the transition to retirement relationships are reviewed as well as those of family and friends. The effects of relationship roles on communication are well described in chapters 8 and 9. Here the authors look at the impact of divorce, widowhood, and grandparenthood on older people.
The final chapters in this volume concentrate on issues of health, coping with illness and death, and changing cognitive abilities. These are areas where communication is critically important for the older person. The book concludes with a chapter devoted to the importance of relationships in successful aging. As I read this book I was reminded of the saying that "the elderly need so little but they need that little so much." This is a strong underlying theme throughout this book. Two other messages are reiterated across the chapters: (a) old age can be a very satisfying period of life and (b) communication is central to quality of life in later years.
Linking Research and Practice
Linking research and practice for successful aging is the subtitle of Mary Lee Hummert and Jon. F. Nussbaum's text, Aging, Communication, and Health. This book was generated from research presented at the Third International Conference on Communication, Aging, and Health. Although it touches on technology in a chapter devoted to telemedicine, the importance of caregivers in maintaining communication and health is clearly the unifying structure of the other 10 chapters. The initial four chapters look at health care and successful aging and outline programs that support communication in the aging process. The next three chapters examine formal caregiver roles in communicating with ill older individuals and look at the special issues that can involve triangulation between the professional, the family member, and the elderly person. The final four chapters are devoted to issues that family caregivers have in communicating with their elders. The concerns of dependency versus autonomy of the aging person appear central to a number of issues examined in this section. Each chapter concludes by presenting detailed suggestions for future research directions and clinical implications of the findings in the chapter.
Toward a More Systemic Approach
This volume also has an enlightening epilogue to the book by Ellen Bouchard Ryan and Joan E. Norris. Initially they apply Ryan's "Communication Predicament Model" and "Communication Enhancement Model" as frameworks for viewing the work in the other chapters and integrating the authors' various approaches. Then they present what is arguably the most thought-provoking position statement found in any of the four books. They make a persuasive case that both the multidisciplinary nature of the study of gerontology and the dichotomy between the orientations of clinicians and researchers in the study of communication and aging contribute to a paucity of collaborative systemic work in this field.
Although I indicated initially that there are positive shifts in how we are examining communication and aging, our research remains limited by the fractionated nature of much of our current methodology. Work that goes beyond disciplinary boundaries to bring multiple perspectives to bear in a systemic way on the same questions will provide the richest source of new information. This work that occurs at the intersections of our disciplines is our best chance at gaining insight into the complexity of human communication in aging. Multi-authored texts such as these four books can create a layered view of interactions and are currently our best attempts to meet this challenge. The authors in these texts serve to inform us and each other and demonstrate that disparate work can enhance and increase our overall understanding of communication and successful aging.
References
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