Boyd Davis

The older adult population is growing in epic proportions. With this growth, chronic disease is also increasing, especially the chronic disease of diabetes. Older adults often have difficulty communicating with health care professionals about their illnesses and often have low health literacy and poor understanding of their illness processes. Advanced Practice Registered Nurses (APRNs) serve a vital role in not only caring for this burgeoning population of older adults with diabetes, but also are the key to ensuring good communication and understanding of the disease process with their patients. This article discusses the importance of the lifeworld in older adults with chronic diseases such as diabetes and presents multiple qualitative analytic approaches utilized to better understand the intricacies of these conversations with older adults with diabetes. The key conversation points are then discussed to assist APRNs on how to cue into certain words within the conversation that wil...

... 19 Boyd H. Davis & Margaret Maclagan words to signaling problems in finding key components in the thread of the story (Davis ... Formulaic phrases often act as discourse-level fillers; they may, in that sense, aid the unimpaired speakers' inferences (Bezuidenhout & Morris 2004 ...

Videos and multimedia are increasingly used to stimulate reminiscence in dementia care. However, they are also valuable in eliciting a wide range of language patterns that are not necessarily keyed to reminiscence about self. Low-technology, home-made generic and personalized videos were tested with 2 samples of persons with dementia, to increase engagement and support the retention of identity. Participants showed a slight, though not significant, preference for looking first at personalized videos and produced a wider range of conversational language topics and phrasal patterns in response to the generic videos.

People with cognitive language impairments such as Traumatic Brain Injury (TBI) are often reported to manifest difficulties within the domain of pragmatics (Togher, 1998; 2013). In particular they may struggle with subtle aspects of communication that have been noted in politeness theory (Brown and Levinson, 1987), such as the appropriate recognition and use of politeness strategies for speech acts including apologies or requests. In this report, we analyze responses by unimpaired adults to prompted production of specific directives and requests specified by the Assessment Battery for Communication (ABaCO), finding they identify lay expectations for conversational politeness strategies. This preliminary study allows us to contribute to establishing a finegrained set of expectations for correct answers by future American subjects as clinicians working with cognitive language impairment may not always have training in or experience with regionally-cued expectations contextualizing pragmatic subtleties in interactions with persons having impairments such as cerebral lesions.IntroductionPragmatics is that field of language study that looks at usage to see how people manage to interact without alienating each other. It includes knowing who can and cannot speak in certain locations, situations, or circumstances, and what they can or cannot talk about appropriately, all of which is part of the knowledge that speakers gain from participating in language socialization practices over time (Schieffelin and Ochs, 1986). People generally don't think consciously about the pragmatics or the linguistic features used in social situations: we have been socialized into their selection and sanction since childhood, and we 'know' them - unless they are, quite literally, knocked out of our heads. Lacking pragmatic competence is to lack access to one's culturally-appropriate linguistic repertoire of speech acts, and thus to one's full participation in the social aspects of daily life. For adults, this shrunken repertoire can mean difficulty in maintaining relationships, employment, even ordinary conversation in which they may be seen as anywhere from tactless to cold to offensive. For example, persons learning a second language face multiple difficulties in learning culturally and linguistically appropriate ways of talking, whether it be learning register, illocutionary force, or specific sanctions surrounding speech acts such as compliments (Rose and Kasper, 2001. Recovering competence in the appropriate use of speech acts in a language one already speaks can be difficult for persons with acquired neurological disorders (Cummings, 2009), such as right or left hemisphere injury, or traumatic brain injury (TBI). This discussion focuses on lay expectations for adult use of politeness formulas or routines in response to an initial American adaptation of an Italian inventory of pragmatics affected by such acquired disorders. Its aim is to test the applicability of ABaCo for an American audience, and to screen for regional differences.The Assessment Battery of Communication (ABaCO) was developed as a new protocol to conduct pragmatic assessments of persons with cognitive impairments at the Center for Cognitive Science at the University of Turin; its contents are detailed below. The Battery which has been trialed with Italian TBI patients (Angeleri et al., 2008); Italian children with SLI (Bosco et al., 2013), and Italians with schizophrenia (Colle et al., 2013). Sacco (2008) provides information on its initial validation. It has also provided researchers with normative data stratified for sex, age and education, from 300 persons 15-75 years old (Angeleri et al., 2012) and with the results of testing two equivalent forms. It has also been used to evaluate 30 children with TBI (Bosco et al., 2012; Colle et al., 2013), to provide before- and after-testing. Recently, their team has tested the efficacy of the Battery with 17 persons having schizophrenia against 17 without it. …

AIM This pilot study was designed to examine the feasibility of using telemedicine to deliver a fall prevention program, a modified Otago exercise program, to low-income older adults living independently in affordable housing apartments. METHODS A mixed-methods feasibility study. Participants were divided into two groups: one group participated in a 12-week modified Otago fall prevention program via telehealth, while the other group participated in the program with an on-site instructor. Performance-based measures of physical function and self-report measures for self-efficacy for exercise and social connectedness were collected pre- and post-intervention and 1 year later. RESULTS All participants completed the 12-week intervention and expressed satisfaction with both the telehealth program and the on-site instructor-led program. There were no major differences in performance or self-report measures between the two groups, showing that telehealth-delivered applications can be effect...

The COVID-19 pandemic challenges us to think outside of the box to respond to this unprecedented global crisis. In this letter, we propose a pilot study to use a socially assistive robot to help meet social needs for older adults with cognitive impairment residing in long-term care facilities.

... be elaborated along an assortment of divergent paths, each path being the product of the ... that is filled with such analytic procedures as phonology, morphology, syntax, discourse, semantics, prag-matics ... good that can be said about this, for specialization can also create progress ...

Older adults often draw on memories to construct stories about themselves that help them to retain and validate their self-identities, doing this within the cultural contexts that have shaped their lives. In this paper, we examine the life history narratives of two working class, rural ...

Due to the increasing use of Internet by older adults and their low computer and Internet security literacy, their susceptibility to online fraud has also increased. This suggests in turn that there are still too few Internet education materials targeting seniors. We take a first step towards developing interactive security information materials for seniors by determining which media they prefer and can easily comprehend. We studied the reception of two media, text and audio, as they communicated information about email-based phishing attacks. Our preliminary study of 34 seniors shows that the participants personally preferred the text over the audio. However, the comprehension score was not significantly different for participants who read the phishing training text script as compared to the participants who listened to the phishing training audio script.

The measurement of guest satisfaction and delight is the focus of this article. An application of a quantitative methodology known as stance-shift analysis is proposed and demonstrated on data composed of Internet blog narratives. The authors argue that the method provides both an efficient and effective means to determine a firm’s competitive position in produc-ing satisfied guests who will not only come back but also recommend the firm to others. Specifically, the method produces relatively detailed evaluations to determine the following: How satisfied are my guests? What are they telling others about their experiences? How is my property performing in creating satisfying guest experiences when compared with the com-petition? What are my property’s strengths and weaknesses in its competitive environment?

We describe a proposed assistive conversational skills training system using artificial intelligence and natural language generation techniques to simulate spoken dialogue between two embodied agents, one character representing a caregiver and the other character a person with Alzheimer's Disease (AD). The type of dialogue simulated is social conversation in which the caregiver encourages the person with AD to tell autobiographical stories. Intervention by the caregiver may be required at times to keep the conversation going due to linguistic or cognitive problems experienced by the storyteller. In our proposal, turn and topic management behavior for the storyteller character is implemented by combining rules representing normal pragmatic routines with linguistically-motivated rules representing coping strategies.

The authors provide guidance for interactional research design involving persons with dementia. This guidance includes gaining institutional approval to best guarantee the ethical treatment of persons within this vulnerable population. In particular, the protection of such persons’ identities and personal information are key. Also essential is identifying clear purposes for collecting discourse data, which will then set the types of activities that serve those goals and the agenda. Since collecting data can be complicated, we present ways by which speakers who have dementia may be located. They walk researchers through the steps to gain consent from guardians and permission from residential centers, to include agreement for the use of equipment such as recorders, cameras, or cell phones. This chapter, overall, provides guidance for productive and practical research outcomes by ensuring, first, that the best interest of the study participants is part of the research design.

Due to the increasing use of Internet by older adults and their low computer and Internet security literacy, their susceptibility to online fraud has also increased. This suggests in turn that there are still too few Internet education materials targeting seniors. We take a first step towards developing interactive security information materials for seniors by determining which media they prefer and can easily comprehend. We studied the reception of two media, text and audio, as they communicated information about email-based phishing attacks. Our preliminary study of 34 seniors shows that the participants personally preferred the text over the audio. However, the comprehension score was not significantly different for participants who read the phishing training text script as compared to the participants who listened to the phishing training audio script.

This study examines the benefits of introducing autoethnographic writing as part of an ageism intervention to familiarize students with the life course. In this mixed-methods study, 186 graduate and undergraduate students conducted interviews with a grandparent or older adult and subsequently assumed the identity of the grandparent to write introductions of themselves as if they were that grandparent, using “I” statements in an online discussion forum. Most assumed grandparents were women (78.0%), and White (63.8%) with an average age of 77.3 ( SD = 12.3). Emerging themes were categorized into three levels: structural, familial, and individual. The number of times a certain theme was mentioned was counted and major themes were analyzed. Findings indicated how autoethnographic reflections can promote student examination of self-awareness, cultural heritages, and personal growth. This technique is encouraging as an educational ageism intervention and warrants further adaptation and te...

Abstract In this paper we draw from variationist analysis and ethnographic and sociopragmatic approaches to examine conversations with Maureen Littlejohn who moved from mild into moderate Alzheimer's disease over the six years of the study. As dementia increases, people often find it difficult to use pragmatic particles such as well, so or you know. We explore how Ms Littlejohn used UH, often dismissed by researchers as only marking hesitations, as a pragmatic particle in conversations with students and with the first author. In our analysis we adopt categories used by Gonzalez (2004) in her exploration of the pragmatic force of markers such as well, so, then, and anyway in both English and Catalan. We demonstrate that, even in her last conversations, Ms Littlejohn was able to use UH in a variety of pragmatically meaningful ways to express many of the categories identified by Gonzalez.

Differences in power are frequent in institutional care settings and provide contexts in which conflict can occur. In order to examine the power imbalance between residents and caregivers and the consequent potential for verbal conflict we first discuss the situations in which persons with dementia (PWD) find themselves within long-term residential care institutions and the interactions they commonly experience with those who care for them. We then examine strategies commonly used by conversational partners that either support or hinder the attempts by PWD to interact competently. The strategies may lead to cooperative conversations or verbal conflicts. They include caregiver marginalization as well as joking and teasing, both of which may serve to positively support PWD or can minimize conflict (Offord et al. 2006; Schnurr and Chan 201l) and can be initiated by both residents and caregivers. The final section contains case studies of interactions with two PWD, “Madge” and “Maureen”...

Among Veterans, heart failure (HF) contributes to frequent emergency department visits and hospitalization. Dual health care system use (dual use) occurs when Veterans Health Administration (VA) enrollees also receive care from non-VA sources. Mounting evidence suggests that dual use decreases efficiency and patient safety. This qualitative study used constructivist grounded theory and content analysis to examine decision making among 25 Veterans with HF, for similarities and differences between all-VA users and dual users. In general, all-VA users praised specific VA providers, called services helpful, and expressed positive capacity for managing HF. In addition, several Veterans who described inadvertent one-time non-VA health care utilization in emergent situations more closely mirrored all-VA users. By contrast, committed dual users more often reported unmet needs, nonresponse to VA requests, and faster services in non-VA facilities. However, a primary trigger for dual use was V...

Direct-to-adolescent text messaging may be a consideration for vaccine reminders, including human papilloma virus (HPV), but no studies have explored the minimum age at which parents would allow adolescents to receive a text message. We distributed a survey to parents of 10-17 year olds during any office visit in two practice based research networks in South Carolina and Oklahoma. We asked about parental preference for receiving vaccine reminders for their adolescent, whether they would allow the healthcare provider to directly message their adolescent, and if so, what would be the acceptable minimum age. In 546 surveys from 11 practices, parents of females were more supportive of direct-to-teen text message reminders than were parents of males, (75% v. 60%, p < .001). The median age at which parents would allow direct text messages from physicians' offices was 14 in females compared to 15 in males, p = .049. We found a correlation between the child's age and the youngest...

Ageing in place (AIP) is the ability to live in one's home and community independently, despite age, ability level or income. To elicit knowledge and feelings about AIP from low-income older adults relocated to low-income housing. Nursing students, supervised by nursing faculty trained in research, conducted semi-structured interviews about AIP with volunteer residents living in a low-income apartment complex in the southern US. Seven participants discussed common fears and worries as well as needs for AIP in low-income housing. Mental health issues were prominent. Mental health warrants consideration along with physical, social and emotional well-being in beginning to identify and address the needs of older people ageing anywhere, perhaps especially in relocated low-income older adults. This information could inform future interventions to encourage AIP in the US and potentially in other countries.

Elderly diagnosed with dementia are three times more likely to fall and over three times more likely to have severe injury compared to cognitively unimpaired elderly. Consequently, there is a need to identify biomarkers that can facilitate early detection, diagnosis, and progression of dementia. One of the characteristics of dementia is the inability to allocate attentional resources to concurrent tasks. Consequently, recent studies have used walking gait in conjunction with another cognitive or motor task to identify biomarkers related to the disease. However, in every study all temporal-spatial gait descriptors are being evaluated and, typically, the nonspecific velocity, double limb support, and stride variability are reported as significant. The purpose, therefore, of this investigation was to use a computational approach to first establish a dementia-specific gait profile irrespective of walking condition (talking, without talking) using the minimum number of temporal-spatial g...

Objectives This study explores perceptions of US Veterans Affairs (VA) and non-VA healthcare providers caring for Veterans with heart failure (HF) regarding Veteran knowledge and motivations for dual use, provider roles in recommending and coordinating dual use, systems barriers and facilitators, and suggestions for improving cross-system care. Methods Twenty VA and 11 non-VA providers participated in semi-structured interviews, which were analyzed using parallel qualitative content and discourse analysis. Results VA and non-VA providers described variable HF knowledge and self-management among Veterans, and both groups described the need for improved education addressing medication adherence, self-care, and management of acute symptoms. Both groups described highly limited roles for providers in shaping choices surrounding dual use. VA and non-VA providers had significantly different perceptions regarding the availability, quality, and effectiveness of VA HF services. Multiple non-...

Naturally occurring conversation with Alzheimer’s speakers, including embedded or co-constructed narrative, can be used to support or augment clinical findings on features of Alzheimer’s discourse, which are as highly variable as is the disease. For example, not only can speakers with moderate to moderately severe Alzheimer’s disease maintain some level of politeness (Sabat & Collins 1999; Temple et al. 1999; Rhys et al. 2000); and interaction (Hamilton 1994a, 1994b; Ramanathan 1997), their pragmatic skills can sustain more fine-tuned analysis, particularly as those skills sustain or simulate fluency. Ellis (1996) comments that problems Alzheimer’s speakers have in organizing and concentrating information are both communicative and cognitive. In the early stages, as grammatical modes of processing deteriorate for whatever reason, those “cohesion ties that structure topicality will begin to fade”; in later stages, more severe problems with maintaining topic will surface (see for example, Kempler 1995). Alzheimer’s speakers typically depend on lexical cohesion, or word-based means of holding the elements of a sentence together, as opposed to grammatical because, adds Ellis, lexical cohesion relies on “meaning,” not on grammatical structures. They lose the ability to “ground” the discourse for the hearer, or to organize meaning with thematic information via pronouns (see Almor et al. 1999)

We first met “Larry Wilcox” in December, 1999, and learned something of him throughout 2000 and 2001, the two years during which we conversed with him, and on which we base this case study of reference and politeness in Alzheimer conversation. Some of our conversations were short and some were shorter — Wilcox was not loquacious. Indeed, staff in the Alzheimer’s unit at Pleasant Meadows, a private retirement and assisted living facility in Charlotte, NC, had initially wondered whether he could be sufficiently talkative with strangers to be a conversation partner. We were told that he was in his early 80s, diagnosed with probable Alzheimer’s Disease, no longer formally assessed, but in the process of moving from moderately severe to severe cognitive decline. We attempted to get a baseline for cognition by administering the Seven-Minute Screen (Solomon et al. 1998), but he stopped the test two-thirds of the way through, and refused for the rest of our acquaintance to participate in any interaction where the conversation partner carried notebooks or picture cards or asked content-seeking questions.