A Socio-Cultural Approach to Eldercare Communication: Ethnographic Insights from Adult Day Centers in Taiwan

Background and Purpose

Research on eldercare communication has yielded valuable insights into communicative features between care participants, characterized by the predominance of task talk (e.g. “Raise your feet.” “Would you like some water?”) and prevalence of elderspeak or infantilizing speech. These features of communication have been found to reflect asymmetry of power between caregivers and older adults, with the caregivers positioning themselves, and being positioned as those with the institutional power and knowledge to control care as well as communication. To date, the majority of this research has focused on the Western context. Little information about eldercare communication is yet available from the Asian contexts. Also, while non-verbal communication plays a key role in eldercare communication, few researchers have included video-recorded interactional data in their studies. This study helped to fill these gaps by examining care communication in two adult day centers (ADCs) in Taiwan. Through analyzing longitudinal, ethnographic, and video-recorded data, this study aimed to provide a socio-culturally informed interpretation of care communication.

Methods

This study is drawn from my two years of ethnographic fieldwork in two ADCs (Banyan ADC and Sunrise ADC) in a city in northern Taiwan to examine communication in eldercare. Approximately half of the older adults in each facility had dementia, and one-fifth of them were wheelchair bound. Also, 40% of the older adults in the ADCs received elementary or no schooling, reflecting the overall educational level of the cohort of older adults in Taiwan today due to Taiwan’s complicated sociopolitical history. Data collection included participant observation (2–3 times a month, each lasting 4–8 hours), video-recordings of naturally-occurring interactions between caregivers and older adults, and interviews with caregivers and older adults. Altogether, I collected 255 hours of video-recorded interactions, 300 typed pages of field notes, and 108 hours of audio-recorded interviews about caregivers’ beliefs and practices of eldercare and about older adults’ life stories and their experiences in the centers.

Findings

The ADCs were framed as a school (Goffman, 1974), with the caregivers and older adults positioning themselves and being positioned as teachers and students respectively. Older adults, especially those who were little educated, appreciated the opportunity to be “educated” when old. What had previously been labelled as elderspeak in the literature was not taken up as demeaning, but as a form of care.

Furthermore, caregivers initiated what I term “task-plus” communication, engaging older adults in social and even therapeutic interactions while performing care tasks. Such task-plus communication shows how the caregivers skillfully laminated the school frame of interaction with other frame(s) of interaction – including social frame, therapy frame, and personal frame, to reach a personally-tailored, meaningful interactions with the older adults.

Conclusion and implications

This study contributes to research on eldercare communication by demonstrating a cultural case from Taiwan which has similar communicative features (e.g. elderspeak) found in the Western contexts and yet those features are interpreted differently by the local participants. This study provided important implications for culturally appropriate care, as well as socially and personally engaging communication in eldercare.