Aging, Communication, and Health

Linking Research and Practice for Successful Aging

Mary Lee Hummert, Jon F. Nussbaum

• Publisher: Routledge
• Year: 2001
• eBook ISBN: 9781135665500
• Topic: Languages & Linguistics
• Subtopic: Communication Studies
• Index: Languages & Linguistics

This collection highlights the current efforts by scholars and researchers to understand the aging process as it relates to the health of older adults. With contributions from international scholars in communication, psychology, public health, medicine, nursing, and other areas, this volume emphasizes communication as a critical research, education, policy, and practice issue for the design, provision, and evaluation of health and social services for older adults. Organized into sections addressing communication developments in the healthcare arena, issues in provider-patient communication, and the relationships between family communication and health. The chapters cover critical topics related to successful aging, such as Alzheimer's disease, managed care and older adults, communication issues of severe dementia, and healthcare decision-making within families.

The editors have designed this volume to be accessible to a broad audience, including scholars and students of aging and communication, healthcare practitioners with older clients, and aging individuals and their families who are pursuing strategies for successful aging. The chapters represent the highest levels of current scholarship on communication, aging, and health, providing a strong foundation for future research. Each contribution also addresses the applied implications of this research, offering practical guidance to readers dealing with these issues in their own lives. As a whole, Aging, Communication, and Health represents a major advance toward understanding the importance and application of communication for successful aging.

III
FAMILY COMMUNICATION AND SUCCESSFUL AGING

8
Negotiating Decisions in the Aging Family

Mary Lee Hummert

University of Kansas

Melanie Morgan

University of Louisville

One of the most important relationships in the aging family and one for which communication becomes especially critical is that between an adult child and an older parent. In fact, Mancini (1989) wrote that, “perhaps the most enduring of all bonds is the parent–child bond” (See Page). No other relationship lasts as long or has the same capacity for mutual influence as that of parent and child (Mancini & Blieszner, 1989). Throughout the life span, the parent-child relationship experiences many changes as its members shift between states of dependence, independence, and interdependence (Horowitz, Silverstone, & Reinhardt, 1991). This negotiation between independence and dependence is an area of particular interest to aging families as older parents are faced with a growing number of situations in which they find themselves dependent on others, often their children (Cicirelli, 1992). How families approach the decision making required by these situations can have profound implications for the psychological and physical health of the parents as well as the quality of the relationships among family members (Lieberman & Fisher, 1999).

In this chapter we consider how families handle this decisionmaking process. We begin with an overview of the research on adult child-older parent relationships and communication within those relationships. Next we discuss the special challenges to parent-child communication of making decisions with implications for the independence/dependence of the parent (e.g., to drive or not to drive, to remain in one’s own home or move to assisted living). We conclude with some ideas on how family members can best negotiate such decisions so that the parent’s simultaneous needs for help (dependence) and a sense of personal control (independence) can be met, and with some suggestions for future research on this topic.

ADULT CHILD–OLDER PARENT RELATIONSHIPS

A prominent myth regarding older adulthood is that it is a time of isolation where one can expect little assistance from family members (Cicirelli, 1992; Mancini, 1989; Mancini & Blieszner, 1989; Nussbaum, Thompson, & Robinson, 1989). Research has negated this myth, showing that adult children have frequent contact with their parents and provide help to their parents when needed (Cicirelli, 1981, 1989; Lye, 1996; Norris & Tindale, 1994; Rossi & Rossi, 1990). Frequent contact is maintained even when large geographical distances separate children and parents. Lawton, Silverstein, and Bengston (1994), for example, found that 60% of adult children have weekly contact with their mothers while 20% have daily contact. Similarly, Troll, Miller, and Atchley (1979) reported that approximately 75% of the older parents in their study had face-to-face contact with their children on a weekly or semiweekly basis. This contact is often associated with some type of assistance to the parent, particularly in terms of instrumental aid (e.g., driving, shopping) and emotional support (Mancini & Blieszner, 1989). According to Cicirelli (1992), “the majority of elderly depend on help from adult children and other family members more than help from any other source” (See Page).

Another myth is that parents and adult children have low quality relationships with the result that the contact they have is dissatisfying for both parties. Again, research shows otherwise. Quality of relationship between adult children and their parents has been assessed in a variety of ways: using a single item measure (Aguilino, 1994) and using scale measures (Amato & Booth, 1991); assessing feeling of closeness and attachment (Cicirelli, 1983; Rossi & Rossi, 1990) and assessing amount of disagreement, strain, and dissatisfaction (Aldous, 1987; Umberson, 1992). Regardless of the type of instrument used or approach taken, results show that the majority of adult children and parents report close relationships and are satisfied with the quality of the relationship (Lye, 1996; Mancini & Blieszner, 1989).

Communication in Adult Child–Older Parent Dyads

Few studies have explored communication within the context of the aging family (Weigel & Weigel, 1993; Norris, Powell, & Ryan, 1996). Gerontological studies reveal how frequently parents and their adult children interact, but tell us very little about the messages that are exchanged within these dyads. In the family communication literature, the adult child–older parent dyad has been neglected as a focus of study. For instance, communication within the aging family is not addressed in a recent review of the family communication literature (Fitzpatrick & Badzinski, 1994), even as a direction for future research. The exception to this pattern is in the study of family communication with persons with dementia (see Orange, chap. 10, this volume), where the emphasis is on how families meet the challenges of communicating with individuals whose language skills are declining. Recent studies (Hummert & Morgan, 1999; Morgan & Hummert, 2000; Norris et al., 1996; Pecchioni, 1999; Weigel & Weigel, 1993), however, have considered communication between older parents and adult children in more general terms.

Weigel and Weigel (1993) surveyed 71 intergenerational farm families. Each family consisted of an older father, mother, son, and daughterin-law. Each family member was given the family communication satisfaction scale, which was adapted from Olson and Wilson’s (1982) Family Satisfaction Scale. The scale measures family members’ satisfaction with the communication within their intergenerational family system. Perceptions of communication problems were measured using an 8-item subscale of the Farm Family Strain Scale (Weigel, Weigel, & Blundall, 1987).

Weigel and Weigel (1993) found that the older parents had much more favorable perceptions of the communication that occurred in the family than did their sons and daughter-in-laws. The parents were also more satisfied overall with the communication that occurred between family members. Adult sons and their spouses perceived more communication problems within the intergenerational family context and had lower communication satisfaction than did parents. Problems identified involved influence attempts, conflicts, and negative criticism.

Norris et al. (1996) explored family communication patterns by manipulating filial anxiety through two scenarios in which older women were depicted in critical situations of dependency. One situation concerned a 75-year-old mother who had recently suffered a ministroke from which she had completely recovered, and the struggle the family members felt regarding their mother’s autonomy and independence and their desire to protect her from harm. The second scenario described a 75-yearold mother who provides care to her husband who suffers from mild dementia. The mother in this scenario insists on cooking the family Christmas dinner, although her children feel that it is too much for her to handle with the burden of caring for their father.

Participants were presented with both of the scenarios and asked to describe how they thought the situations would be realistically resolved. Participants reported that they would expect disagreement in these discussions, with the children controlling decision making and using a communication style that conveyed low levels of respect to their mother. The authors concluded that the participants’ responses are evidence for a familybased example of the Communication Predicament of Aging Model (Ryan, Giles, Bartolucci & Henwood, 1986).

The Communication Predicament of Aging Model (Ryan et al., 1986; Ryan & Norris, this volume) is grounded in Communication Accommodation Theory (Giles, Coupland, & Coupland, 1991), which seeks to explain conversational behaviors as accommodations or adaptations to other interactants’ styles and particular communication needs. According to Ryan et al., a predicament occurs in communication with older individuals when the accommodations are based on negative stereotypes of aging rather than the actual communicative competence of those individuals. These accommodations to the stereotype rather than to the person have been termed overaccommodations. In communication with older individuals, overaccommodations to negative stereotypes have been associated with patronizing talk (Ryan et al., 1986; Ryan, Hummert, & Boich, 1995; Hummert, Shaner, Garstka, & Henry, 1998; Hummert & Ryan, in press). Patronizing talk to older persons is characterized by such linguistic adaptations as the use of simple clauses, short sentences, and diminutives, as well as by such paralinguistic adaptations as speaking loudly, speaking slowly, and using exaggerated intonation (Ryan et al., 1995). It may also involve restricted communication topics and attempts to assume control over the older person (Ryan et al., 1995; Hummert & Ryan, 1996). In the Norris et al. (1996) study, family members expected to overaccommodate to negative age stereotypes by being overly directive and discouraging joint decision making. This family communication predicament of aging is driven, we believe, by the interplay between the older parent’s simultaneous needs for independence and assistance and the adult child’s desire to help/protect the parent by adopting a paternalistic role (Hummert & Morgan, 1999; Morgan & Hummert, 2000).

DEPENDENCY IN OLDER ADULTHOOD AND ITS CHALLENGES TO FAMILY COMMUNICATION

The family is essential in the negotiations of dependency described by Norris et al. (1996), as this is where we first learn to become independent. Independence is one of the most important skills a family can teach its young members. As Clark (1969) argued, “only by being independent can an American be truly a person, self-respecting, worthy of concern, and the esteem of others” (See Page). According to Baltes (1996), Western cultures value independence and self-reliance to such a degree that they become the “imperative” (See Page). Dependency is something to be outgrown and is not sanctioned. She asserts, however, that there are situations in which a society will tolerate dependency and in some cases elect to relieve certain individuals of the burdens of independence. One of these situations is older adulthood.

Aging is viewed as a time of decline and disability both physically and mentally. Because of this negative view of aging, we, as a society, tolerate dependency in older adulthood and often relieve our older family members from some of the burdens related to independence. Just as young adults negotiate the move from dependence to independence within the family, it is also within the family that older adults begin to re-negotiate their level of independence and to make decisions in response to the challenges of aging (Cicirelli, 1992). Adult children play a significant role in that re-negotiation. Consider the following excerpt from an interview with a married couple aged 79 and 75 who have three middle-aged daughters living in another city (Hummert & Morgan, 1999). The interviewer has asked whether the couple does their own yardwork. Transcription conventions used in this and subsequent excerpts are: (()) double parentheses for pauses, laughter, etc.; [[two left brackets to indicate that speakers began to talk simultaneously; [] closed brackets around text of completely overlapping utterances; and () single parentheses around comments inserted by authors.

Interview 2, Excerpt 1

1 Wife: Part of it. Our children wanted us to hire some help. We need, we need to keep moving. If we sit down we’ll get so we can’t move. We have so much shrubbery. That’s one of our big jobs during the spring years—is to get out there and trim all that shrubbery. Forty some bushes. Big ones, ((laughter)) And then the leaves collect. We have to rake them out at least twice a year. And ah, it gets to be quite a job. We can only do so much every time but we keep plugging at it.

2 Interviewer: So, they’re concerned about you doing all the yardwork?

3 Wife: They think we try to do too much. Yeah, they…

4 Interviewer: How do you know that?

5 Husband: [We have a boy…]

6 Wife: [They said so.]

7 Husband: They said so.

8 Interviewer: Who said so?

9 Wife: Ummm… Both L. and B. (two of the couple’s daughters) said we should hire somebody to come in and help us, but we said as long as we could do it we wanted to try and keep doing it ourselves.

In this excerpt, the wife’s comments reveal how her daughters encouraged their parents to give up the physically demanding task of caring for their yard. She notes (turn 3) that the daughters are concerned about their parents “doing too much,” a concern which seems warranted when the couple reveals later in the interview that the husband has a heart condition. However, to this couple, doing the yardwork is important to their physical health because it keeps them “moving” (turn 1). The wife’s comments detailing the extent of the care required to maintain their yard (turn 1) also display pride in their accomplishments. Although this is “quite a job,” they “keep plugging at it” until it’s finished. Doing the yardwork also seems to contribute to their psychological health by reinforcing their personal sense of competence. By qualifying her assertion about their desire to do the yardwork alone with the phrase “as long as we could do it” (turn 9) the wife does acknowledge that they may need help at some time in the future.

While relief from a time-consuming and tiring task such as yardwork is inviting, this couple seems aware that such relief has its costs. As Baltes (1996) stated, “such protection often results also in disempowerment and paternalism, consequences at the root of the conflict between dependency and personal control, autonomy, and competence” (See Page). The difficulty for many older individuals and their families is that the vagaries of life and health place them at the center of this conflict between dependency and autonomy.

The Paradoxical Relationship Between Dependence and Independence in Aging Families

Cicirelli (1992) defined dependency in older adulthood as no longer being able to satisfy one’s needs or wants by him or herself. Using psychological terms, dependency can also be seen as the loss of primary control strategies (Heckhausen & Schultz, 1995; Schultz & Heckhausen, 1999). Blenkner (1965) divided these dependencies into four areas: economic, physical, mental, and social. Economic dependency occurs because of a lack of finances and is usually related to retirement. Physical dependencies are characterized by diminished energy, poor health and slowed reflexes. Mental dependencies are related to deterioration in memory and loss of orientation while social dependencies are related to loss of roles, status, and power. As dependency in one of these areas increases, it creates a paradoxical situation for older parents and their children: Maintaining the parent’s independence in other areas requires assistance from the children.

As mentioned earlier in this chapter, adult children have frequent contact with their parents and provide help to their parents when needed (e.g., Rossi & Rossi, 1990). Our research (Hummert & Morgan, 1999) suggests that much of this support is directed towards maintaining the independence of a parent with chronic health problems. For instance, one woman described the extensive help that she, her immediate family, and her siblings were providing to their mother, aged 82, who had suffered a stroke. This help included a sister coming to the mother’s home daily to arrange medications, do wash, and so forth; a brother doing finances; and the interviewee’s husband and college-age daughter spending their spring break vacations caring for their mother-in-law/grandmother. The interviewer responded:

Interview 6, Excerpt 1

1 Interviewer: So it’s almost like um you’re trying to help her maintain the lifestyle she had before.

2 Daughter: [[we’re trying

3 Interviewer: [[and she wants to maintain that lifestyle.

4 Daughter: Yeah, we’re trying to let her be as independent as she possibly can. Um, And, you know, feel worthwhile and be happy…

The extensive aid provided to the mother by this daughter and her siblings were designed to maintain the mother’s “independence.” Another interviewee (Hummert & Morgan, 1999) commented directly on how her 94-year-old mother is independent, yet also dependent on her daughter for transportation.

Interview 1, Excerpt 1

1 Interviewer: She’s 94?

2 Daughter: Um Hum. She’s a very independent lady. She makes all her own decisions.

3 Interviewer: ((laughs))

4 Daughter: Except, ah, she calls on us ((laughs)) when she gets a little stuck, but ah, she did have to give up her car so she doesn’t drive anymore, which sort of took some of her freedoms away…

Later in the ...

Table of contents

• Cover Page
• Title Page
• Copyright Page
• Acknowledgments
• Introduction: Successful Aging, Communication, and Health
• I: Developments in Health Care and Successful Aging
• II: Provider–Patient Communication and Successful Aging
• III: Family Communication and Successful Aging
• Epilogue: Communication, Aging, and Health: The Interface Between Research and Practice