Psychometric Analysis of the Emotional Tone Rating Scale: A Measure of Person-Centered Communication.

Psychometric analysis of the Emotional Tone Rating Scale (ETRS) was completed using ratings of naïve listeners who evaluated staff-resident communication in three nursing homes. Interrater consistency was high with ICC (2, 1) for agreement = 0.95 and consistency = 0.95. Factor analysis revealed two factors-person-centered communication and controlling communication-that explained 84.8% of the variance. Person-centered communication included seven descriptors (items) with loadings ranging from 0.84 to 0.98 and a coefficient alpha of 0.98. Controlling communication included five items that loaded from -0.63 to .99 with a coefficient alpha of 0.94. These factors were negatively correlated p = -.64 and demonstrated good ranges, standard deviations, and high item-total correlations. Person-centered communication correlated with higher resident engagement in conversation in contrast to controlling communication. The ETRS provides a measure of person-centered communication that can be used to evaluate interactions between nursing staff and older adults who reside in long term care settings.

Older adults with and without stroke reduce cadence to meet the demands of talking.

PURPOSE: Cognitive tasks performed while walking can be challenging for older adults, especially for those with stroke. Conversational speech requires attention and working memory. The purpose of this study was to examine how older adults with and without stroke meet the demands of walking while talking. METHODS: Community-dwelling older adults, 12 without stroke and 24 with, were videotaped walking an irregular elliptical pathway. Audio recordings were made as subjects discussed topics such as describing a memorable vacation. Each participant performed in single and dual task conditions: speaking, walking, and speaking while walking. Primary measures of interest included cadence and speech rate. Components of language including measures of fluency, grammatical complexity, and semantic content were analyzed to examine additional changes in speech. Paired t-tests were used to compare single and dual task performance for each group. Group differences for dual task effects were examined with independent sample t tests. RESULTS: Cadence decreased with the addition of talking for those without stroke, P < .007, and those with stroke, P < .001. Speech rates did not change with walking for either group; those without stroke did not alter the language components. Participants with stroke reduced the grammatical complexity and semantic content of speech when walking, P's < .013. Those without stroke spent more time doing both tasks at once than those with stroke, P < .023. CONCLUSION: Clinicians can expect older adults to reduce walking speed to meet the demands of walking and talking. Older adults with stroke may use additional strategies to walk and talk simultaneously.

Dual-task demands of hand movements for adults with stroke: a pilot study.

UNLABELLED: For adults with stroke, walking while performing a cognitive task can be challenging, resulting in slower walking, poorer cognitive performance, or decreased performance on both tasks. It is not known if dual-task deficits are also present for upper limb movements for adults with stroke. PURPOSE: To determine if unilateral movements of the affected and less affected hand are compromised when walking or talking. METHODS: Nineteen community-dwelling adults with stroke were video- and audiotaped while performing in single- and dual-task conditions. Tasks included repeated, rhythmic hand movements with the affected and less affected hand, walking a narrow pathway, and speaking. For dual-task conditions, movements of each hand were done while walking and while talking. The rate of hand movement, cadence, and speech rate were analyzed using repeated measures analyses of variance. RESULTS: Affected hand movement rate was the same for single- and dual-task conditions. The rate of less affected hand movement was affected by dual-task conditions; this was due to an increase in hand movement rate while talking. Examination of cadence and speech rates revealed that cadence was decreased when moving the affected hand. Speech rate increased when accompanied by hand movements, but post hoc analyses were not significant. CONCLUSION: For those with stroke, dual-task deficits are seen with slower walking while moving the affected hand. In contrast, hand movements while speaking may have a more complex relationship, with possible faster speech rates in dual-task conditions.

Linking resident behavior to dementia care communication: effects of emotional tone.

Care for older adults with dementia is complicated by behaviors such as verbal and physical aggression and withdrawal that disrupt and increase the costs of providing care. These behaviors, referred to as resistiveness to care (RTC), have been linked to staff elderspeak communication, measured by behaviorally coded explicit behaviors. This study examined videotapes of nursing home (NH) residents with dementia interacting with staff during bathing to explore the relationships between implicit messages communicated by nursing staff and resident RTC behavior. Implicit messages in nursing staff communication were rated using the Emotional Tone Rating Scale by naïve coders. Associations between implicit ratings of care, respect, and control were analyzed in relation to RTC scale scores. Highly controlling communication was significantly correlated with increased resident RTC (r=.49, p<.05). Associations between the care and respect dimensions of communication were not significantly correlated with RTC; however, trends in hypothesized directions were identified. The association between emotional tone and RTC found in this study suggests that it is an important factor in care. Understanding affective messages is a first step in modifying these implicit messages conveyed during staff-resident communication. Research is needed to confirm these findings and to identify and test interventions to teach staff to reduce controlling messages that will to reduce RTC and improve care.

Elderspeak's influence on resistiveness to care: focus on behavioral events.

Resistiveness to care (RTC) in older adults with dementia commonly disrupts nursing care. Research has found that elderspeak (infantilizing communication) use by nursing home (NH) staff increases the probability of RTC in older adults with dementia. The current analysis used general sequential querier (GSEQ) software to analyze behavior sequences of specific behavioral events. We found that older adults with dementia most frequently reacted to elderspeak communication by negative vocalizations (screaming or yelling, negative verbalizations, crying). Because negative vocalizations disrupt nursing care, reduction in elderspeak use by staff may reduce these behaviors thereby increasing the quality of care to these residents. The results clearly demonstrate that sequential analysis of behavioral events is a useful tool in examining complex communicative interactions and targeting specific problem behaviors.

Age differences in memory-load interference effects in syntactic processing.

The effects of a memory load on syntactic processing by younger and older adults were examined. Participants were asked to remember a noun phrase (NP) memory load while they read sentences varying in syntactic complexity. Two types of NPs were used as memory loads: proper names or definite descriptions referring to occupations or roles. The NPs used in the sentence and memory load either matched (e.g., all proper names or all occupations), or they mismatched. Participants read complex sentences more slowly than they did simpler sentences; for young adults, this complexity effect was exacerbated when memory interference was generated by matching NPs in the sentence and memory load, whereas for older adults, memory-load interference did not vary with sentence complexity or memory-load matching. These results suggest that a general reduction in older adults' processing capacity was produced by the memory load, whereas the matching memory loads and sentence NPs produced a more specific form of interference that affected young adults' online processing.

Different effects of dual task demands on the speech of young and older adults.

Young and older adults provided language samples in response to elicitation questions while concurrently performing 3 different tasks. The language samples were scored on three dimensions: fluency, grammatical complexity, and content. Previous research had suggested the hypothesis that the restricted speech register of older adults is buffered from the costs of dual task demands. This hypothesis was tested by comparing language samples collected during a baseline condition with those produced while the participants were performing the concurrent tasks. The results indicate that young and older adults adopt different strategies when confronted with dual task demands. Young adults shift to a restricted speech register when confronted with dual task demands. Older adults, who were already using a restricted speech register, became less fluent although the grammatical complexity and informational content of their speech was preserved. Hence, some but not all aspects of older adults' speech are buffered from dual task demands.

Sentence production by young and older adults in controlled contexts.

In this experiment we compared young and older adults' abilities to produce complex sentences under controlled conditions. We asked participants to memorize sentence stems differing in syntactical complexity and then to produce a complete sentence using the stem. The length, complexity, and content of young adults' responses varied with the syntactical complexity of the stems, whereas older adults' responses did not. These results suggest that working memory processing limitations impose a "ceiling" on older adults' production of complex sentences, limiting their length, complexity, and content.

The costs of doing two things at once for young and older adults: talking while walking, finger tapping, and ignoring speech or noise.

Young and older adults provided language samples in response to questions while walking, finger tapping, and ignoring speech or noise. The language samples were scored on 3 dimensions: fluency, complexity, and content. The hypothesis that working memory limitations affect speech production by older adults was tested by comparing baseline samples with those produced while the participants were performing the concurrent tasks. There were baseline differences: Older adults' speech was less fluent and less complex than young adults' speech. Young adults adopted a different strategy in response to the dual-task demands than older adults: They reduced sentence length and grammatical complexity. In contrast, older adults shifted to a reduced speech rate in the dual-task conditions.