‘I LIKE 88.’ ‘DO YOU MEAN YOU LIKE RICE?’

INTRA- AND INTERGENERATIONAL TALK IN A JAPANESE GERIATRIC HOSPITAL

TOSHI HAMAGUCHI, PH.D.UNIVERSITY OF THE SACRED HEART, TOKYO

Social motivation of studying language and aging

Cultural influences on discourse of and with the elderly

Scholarly implications for further research

JAPAN: SUPER-AGING SOCIETY

Okinawa, the southernmost part of Japan, is one of the 5 “blue zones” in the world where people live the longest. (Dan Buettner, GSA 2011 plenary speaker)

http://www.bluezones.com/2011/09/5-rules-for-building-true-friendships/

OKINAWA: BLUE ZONE“Okinawa’s Ushi Okushima still gardening at age 109”

http://www.bluezones.com/live-longer/

OLDEST PERSON TO SCALE MT. EVEREST

Alpinist and professional skier Yuichiro Miura climbed Mt. Everest in May 2013 at the age of 80. This was his 3rd time to climb Mt. Everest (the 2nd time was only 5 years ago, when he was 75).

HOW OLD IS OLD?(Finishing a phone conversation with a jeweler) “It was Mr. Aida. He says he’s retiring at the end of this month. He’s still 82.”

JAPAN AS SUPER-AGING SOCIETYLife expectancy (2012): Men 79.44 yrs old

Women 85.90 yrs oldIn 2012, 30,740,000 people were over 65. This is about 1 in 4 people (24.1%) of total population. Moreover, 15% have dementia (4,620,000). It is estimated that by 2025, 30.5% of the population will be over 65, and 25% will be over 75.Centenarians reached at 51,376 people in 2012, of which 87.3% were women.

(Source: Asahi Shimbun June 1st, 2013, Ministry of Health, Labor, and Welfare)

POPULATION BY AGE: DECLINING BIRTHRATE & AGING GROWTH

0- 4

10-14

20-24

30-34

40-44

50-54

60-64

70-74

80-84

90-

0 1000 2000 3000 4000 5000 6000 7000 8000 9000 100005323

563959026001

66777272

83949535

842477037651

90619356

83426879

57914221

23231326

1,326,000

Roughly one in 4 is over 65.

(1000)

Statistics Japan

ELDERLY POPULATION GROWTH 　(1990-2012)

1990 2000 20120

1000

2000

3000

4000

5000

6000

85+80+75+70+

10,0

00

Ministry of Health, Labor and Welfare

CENTENARIANS IN JAPAN (1991-2010)

1991

1993

1995

1997

1999

2001

2003

2005

2007

2009

0 5,000

10,000 15,000 20,000 25,000 30,000 35,000 40,000 45,000 50,000

Women Men

Ministry of Health, Labor and Welfare

JAPAN AS “AGED” SOCIETYWHO’s definition of ‘aging’ vs ‘aged’ society65+ < →7% of population = ‘aging society’65+< →14% of population = ‘aged society’

Japan: Aged society in 1994 (24 years after Japan had become an ‘aging’ society)“In most Western countries this process takes 60-120 years” (Takeda et al. 2010: 10).

# OF PEOPLE WITH DEMENTIA Dementia: 4,620,000 (15% of age over 65)MCI: 4,000,00040% of age over 85 suffer from some kind of dementia

DAT: 67.6%CVD (Cerebral Vasucular Disorder): 19.5%DLB (Dementia with Lewy Bodies): 4.3%

(Asahi Shimbun June 1st, 2013)

“Considerable disruption to patients’ daily lives, the burden to caregivers, and the long duration of the disease make dementia, especially Alzheimer’s disease (AD), the most malignant disease of our time.”

(Takeda et al. 2010: 11)

OBSERVATION

Geriatric hospital in the outskirts of TokyoFounded by a psychiatrist in 2005240 bedsFull-time medical staff MD (8), RN (71), Care Workers (96) Pharmacologists (3), Radiologist (2), Lab technicians (1) Occupational therapist (6), Physical therapist (4), Speech therapist (1) , Clinical Psychologist (1) Medical Social Workers (4)

TEA-TIME TALKThursday afternoon (3:00-3:30pm, during or immediately after afternoon snack)At a loungeLed by a female clinical psychologist (age 32)

• Participant observation • Recorded sessions: August 2011 (4)

January 2012 (1) March 2012 (1)

PARTICIPANTSTotal participants: 13 Average age: 89.7 All have Dementia/DAT Dementia levels

• Mild (MMSE 23<): 1• Moderate (MMSE 15-23): 5• Severe (MMSE 15>): 7

• People with AD: 6

TV

KITCHEN

CW

RW

CW: Care workerRW: Recreation worker

ACTIVITY FORMAT OF TEA-TIME TALKClinical psychologist (CP) moderates the session.1. CP’s opening by greetings2. Date 3. Warm-up talk 4. Explanation of the topic (with handouts)　5. CP’s questions 6. Participants’ responses

There has been concerns about young people's manners lately. How did you acquire manners? Do you have anything to say to the young people?

TOPIC: “MANNERS”

OPENING1. CP: dewa minasama konnichiwa2. All: konnichiwa 3. CP: sanji de gozaimasu4. Mrs. Tamura: A sou5. CP: hai e: kyou wa desune dai 145 kaime no oshaberi no kai de gozaimasu. maishuu mokuyoubi ni kochira ni ojama shite

1. CP: OK, everybody, good afternoon.2. All: Good afternoon.3. CP: It’s 3 o’clock.4. Mrs.Tamura: Oh, is it?5. CP: Yes, ah today is 145th

Tea-Time Talk. Every Thursday, I come here and

6. Mrs. Goto: A: arigatou gozaimasu7. CP: Oshaberi no kai wo okonatte orimasu keredomo itsumo no youni hizuke no kakunin kara itashimashou ka8. Mrs. Goto: a:so:ka

6. Mrs. Goto: Oh, thank you very much.7. CP: (we) do this Tea-Time Talk. As usual, why don’t we start with checking today’s date?8. Mrs. Goto: Oh, I see.

INTERACTIONAL FORMAT OF TEA-TIME TALK1. CP gives a topic of the day.2. CP asks a question (Q) to a participant and s/he

answers (A).3. CP immediately rephrases what the participant has

just said (R).4. CP has some agenda, but other topics come up and

get developed (by the participants) on the course of the discussion.

INTERACTIONAL & INSTITUTIONAL POWER OF CP• Control of the activity from opening to closing• Control of each turn-at-talk by Q-A sequences• Justification of facts (e.g., date) • Repetition of participants’ utterances• Display of authority by a lab coat

THREE-PART STRUCTURE IN INSTITUTIONAL DISCOURSE

• 1st utterance: Inquiry• 2nd utterance: Response• 3rd utterance: Elaboration/Feedback/Acknowledgement

IRE sequence 1. Teacher: What are the two bending [mirrors] called? … something

that begins with C. 2. Sheila: Concave and convex.3. Teacher: Good. OK.

(Wells 2007, cited in O’Connor et al. 2007: 280)

1st position (Inquiry) &3rd position (Evaluation)-Teacher’s knowledge and authority

THREE-PART STRUCTURE BY CP

1. CP: Kyou wa nanyoubi deshou ka.2. Mrs. Goto: Mokuyou bi.3. CP: Arigatou gozaimasu.

1. CP: What day of the week is it today?2. Mrs. Goto: Thursday.3. CP: Thank you very much.

CP’S REVOICINGTOPIC: MANNERS

1. CP: Sakura-sama, nanka okaasama kara nanka kou iwareta koto tte arimasuka?

2. Mrs. Sakura: tokuni nani iwareta tte oboe mo naindesu kedo

3. CP: hai4. Mrs. Sakura: yappari mukasi

wa otokonoko wa yuukan ni onnnanoko wa oshitoyaka ni tte iu funniki ga attan janai kashira ne?

5. CP: hai, otokonoko wa yuukan ni yuukan ni

[writes yuukan on the board]

1. CP: Mrs. Sakura, do you have anything you were told by your mother?

2. Mrs. Sakura: I don’t remember being told anything in particular but

3. CP: Yes.4. Mrs. Sakura: There was this

ambience that boys should be brave, girls should be graceful, I think.

5. CP: OK. boys should be brave, boys should be brave, brave

[writes BRAVE on the board]

Mrs. Sakura: Mild, no AD

Inquiry

Response

Repetition of response utterance

“REVOICING” (O’CONNOR AND MICHAELS 1993, 2007)

Revoicing sequence in classroom(1) Ms. Davies: Paulo, is 24 even or odd?(2) Paulo: Well, if we could use 3, then it could go into

that, but 3 is odd. So then if it was … but … 3 is even. I mean odd. So then if it’s odd, it’s not even.

(3) Ms. Davies: OK, so let me see if I understand. So you’re saying that 24 is an odd number?

(4) Paulo: Yeah, because 3 goes into it. Because 24 divided by 3 is 8.

(O’Connor et al. 2007: 279)

TEACHER’S REVOICING

“Whereas the IRE is a three-part move, ended by the teacher’s evaluation, the revoicing move is a four-part move, with the student having the ultimate interpretive clout, the right to agree or disagree with the teacher’s formulation” (281).

CP’S REPHRASING: Q-A-R SEQUENCE5. CP: hai, otokonoko wa

yuukan ni yuukan ni [writes yuukan on the board]

6. Mrs. Sakura: yuukan ni tte iuka

7. CP: otoko rashiku8. Mrs. Sakura: Otoko rashiku

ne? ima wa danjokinntou ni narimashita kara

9. CP: hai otokonoko wa otoko rashiku onnnanoko wa oshitoyaka ni onnanokoo rasihku toiu no wa warito iwarete kita koto nanja naika

10. Mrs. Sakura: Ee.

5. CP: OK. boys should be brave, boys should be brave, brave [writes BRAVE on the board]

6. Mrs. Sakura: Not brave but manly/masculine.

7. CP: Manly/masculine.8. Mrs. Sakura: Manly, you

know? Now there is gender equality so

9. CP: Yes so you’re saying, boys should be boyish, girls should be graceful and girlish, and this has been said quite often.

10. Mrs. Sakura: Yes.

CP’S REVOICING IN TEA-TIME TALK

• Maintaining participation framework in which CP has the overall control of the discourse.

• Facilitating elderly participants’ comprehension of the prior utterance by rephrasing word-for-word in a louder and clearer voice.

• Giving time for the participants with AD/Dementia to process information.

• Acknowledging and foregrounding the voice of the old, i.e., their knowledge and experiences.

CP’s interactional authorityvs. Participants’ collective knowledge

ROLE SHIFTING : NEGOTIATION OF AUTHORITY

Rice polishing

1. CP: So nowadays, we have rice miller- rice milling machines. But in the past uh, what was it, like this, in a jar, in a jar,

2. Mrs. Goto (Goto): Oh, that’s right. 3. Mrs. Tamura (Tamura): Right, and there was rice bran inside.4. Goto: Yes, yes. 5. CP: And you put rice in it.6. Goto: Uh-huh.7. CP: And then you do tsuntsun (poking) with a stick like this 8. Goto: [Right, and the bran9. Tamura: [Yes, (we) did it.10. Goto: (It’s) a child’s job.

Mrs. Tamura: Severe, No ADMrs. Goto: Moderate, AD

11. CP: Is that so? Child’s job. It’s child’s helping (the mother)12. Goto: [Chuckles]13. CP: If you do that, would that remove bran?14. Goto: It removes bran.15. Tamura: That’s right. 16. CP: Did you do it, Mrs. Tamura?17. Tamura: Yes, I did. So it’s not washing the rice, with rice /?/ poking18. that thing.19. CP: What is it? 20. Tamura: That thing.21. CP: Bran?22. Tamura: Bran, it was the same as that.23. CP: Oh, Mrs. Kaede fell asleep. 24. RN: Why do you do tsuntsun?25. Tamura: Because bran is removed. Isn’t that right? 26. Goto: Bran is removed. Then we make rice27. bran paste out of it because we need bran.

1. CP: Did you make sake?2. Goto: Oh yes, we made it quite often. 3. CP: Oh, really? Did you make it? Did you make sake? 4. Tamura: Yes.5. Goto: Like amazake (sweet sake). Sake, no, adding bran to rice, 6. CP: Adding bran7. Tamura: Right.8. Goto: For Ohinasama (Girls’ Festival)　9. CP: Oh, you give it to the Ohinasama (dolls).10. Goto: Yes. 11. CP: You made it by yourself.12. Goto: My parents did.13. CP: Oh, your parents did.14. Goto: Yes. 15. CP: Oh, I see.  

16. CP: How about miso (bean paste) or soy sauce?17. Goto: Those things, we’d buy.18. Tamura: Yes, we bought them.19. CP: Have you made them?20. Tamura: Well.21. Goto: I don’t think so.22. Tamura: Me, neither. May be in the past, (people made

them), but when we became old enough to understand, I don’t think people made such things.

23. CP: OK, I see. So in your mothers’ or grandmothers’ generations, may be people were making miso or soy sauce at home, but

24. Goto: [Right, right.25. Tamura: [Right, right.26. CP: But in your generation, you bought them.27. Tamura: That’s right.28. Goto: Right [nods] 

DEMENTIA/AD TALK: HUMOR• Decline of humor comprehension in comparative

studies with younger generations (e.g. Mak and Carpenter 2007).

• Humor and laughter for life enhancement for the eldery (e.g. Bethea 2001, Gladding and Martin 2010, Takeda et al. 2010)

• Humorous comments and laughter as self- and other-face-saving devices (Grainger 2004, Matsumoto 2009)

??Humor production of people with dementia/AD

HUMOR AND MEMORY1. CP: Hai Kyo:u wa nan-

nen no nan-gatsu nan-nichi deshou ka

2. Mrs.Tamura: [Heisei 3. Mrs. Goto: [Heisei

23nen no4. CP: hai 23nen no5. Goto: hachi gatsu 6. CP: hachi gatsu7. Goto: ikutsu yatta

kashira, nijuugonchi?8. Workers: O: a: subarashii9. Tamura: atari

1. CP: Yes. What day of what year is it today?

2. Mrs. Tamura: Heisei3. Mrs. Goto: Heisei 234. CP: Yes, Heisei 235. Goto: August6. CP: August7. Goto: what day was it, 25th?8. Workers: O:h, wow, great9. Tamura: Bingo!

Mrs. Goto (Moderate, AD)

10. Goto: atari mashita?11. CP: atari mashita12. Tamura: ara sugoi13. CP: nante tondemo nai seikai desu14. Goto: /?/detarame nano datte kanjin no ne: kyuuryou ga naimon ne: 15. SW: a ha ha16. Goto: a ha ha17. Tamura: a:

10. Mrs. Goto: Did I get it right? 11. CP: (You) got it right.12. Mrs. Tamura: Wow, great!13. CP: Well, no, it was the correct answer.14. Goto: /?/ (I) made it up because, (we) don’t have the most important thing, you know, the pay check. 15. SW: [laughs]16. Mrs. Goto: [laughs]17. Mrs. Tamura: Ahh

“RICE”Today is Rice Day. This year, buying futures or cornering of old rice have been in the news. Rice is a staple for Japanese. What memories about rice do you have?

“RICE” DAY: AUGUST (8) 18TH (10+8)

“Rice” “Eight” “Ten” 米　 八　十 　

ALZHEIMER’S DISEASE: MEMORY DOES NOT LAST BUT HUMOR DOES NOT RUST

1. CP: Kaede-sama wa pan to okome deshitara dochira ga osuki esuka? 2. Mrs. Kaede: N: sou desu ne watashi wa hachi- juu-hachi no hou ga ii desu3. CP: hachi-juu-hachi no hou ga ii [laughs] sore wa okome no hou ga ii tteiu koto desu ka?4. Kaede: [smiles] 5. [laughter]

1. CP: Mrs. Kaede, which one do you like better, rice or bread?2. Mrs. Kaede: Mm, well, I like eighty-eight. 3. CP: You like eighty-eight [laughs]. Do you mean you like rice better?4. Kaede: [smiles]5. [laughter]

Mrs. Kaede (severe, AD)

AD TALK1. CP: sorekara minasama

supootsu kansen yakyuu demo ma suiei demo sakkaa demo mini irashitakoto wa arimasuka?

2. Mrs. Kaede: Gozaimasuyo. 3. CP: gozaimasu? Nani wo

mini ikimasita?4. Kaede: sono: ano: kurasu

ni ne ma ouchi ga oarini narukata wa ne sorede shite irashita kedo

5. CP: sorede site rasshatta kurasuno kurasuno

1. CP: so has everybody gone watch sports games? Baseball or soccer or, have you gone watching sports?

2. Mrs. Kaede: Yes, I have.3. CP: You have? What did

you go watch?4. Kaede: well, uh, in the

class, well, those who had the house, you know, they did it by that

5. CP: did it by that, for/of class. For/of class.

6. Kaede: hai7. CP: hai otonani natte kara

rikujo toka kakekko toka yakyuu toka ashi wo ohakobini nata koto wa arimasuka?

8. Kaede: yappari arimasu9. CP: osuki desita?10. Kaede: dousihitemo

minasama nasaru kara kocchimo damatte wa iraremasen deshita ne

11. [laughter]12. Kaede: kocho kocho

kocho tte.

6. Kaede: Yes.7. CP: Yes, after you were

grown up, did you go watch track and field or sprint or baseball?

8. Kaede: Yes I did.9. CP: Did you like it?10. Kaede: By all means,

because everybody would do it, I couldn’t keep quiet.

11. [laughter]12. Kaede: Go kocho kocho

kocho [tickling hand gesture]

DISCOURSE ANALYSIS OF PEOPLE WITH DEMENTIA/AD• Some conversational features that require highly cognitive

and highly communicative skills (e.g. turn-taking management, humor production in anticipation of its uptake by the recipients) may remain relatively unaffected by the disease.

• Close observation of naturally occurring discourse enables us to look at the data from multiple perspectives in order to find out (1) discourse behavior (abilities/inabilities) of the elderly, (2) interactional behavior (abilities/inabilities) of the younger conversational partners, (3) meaning of aging in a given culture.

REFERENCESBethea, Lisa Sparks. 2001. “The function of humor within the lives of older adults.” Communication

Quarterly, Winter 2001, 49 (1): 49-56.Gladding, Samuel, T., and Beth Martin. 2010. “Creativity and self-esteem in later life.” Ed. Mary M.

Guindon. Self-esteem across the life span: Issues and interventions. New York: Routledge. 311-323.Grainger, Karen. 2004. “Verbal play on the hospital ward: Solidarity and power?” Multilingua 23 (2004): 39-59.Mak, Wingyun., and Brian D. Carpenter. 2007. “Humor comprehension in older adults.” Journal of the International

Neuropsychological Society 2007 (13): 606-614.Matsumoto, Yoshiko.2009. “Dealing with life changes: Humour in painful self-disclosures by elderly Japanese

women.” Ageing and Society 29 (2009): 929-952. O’Connor, Catherine., and Sara Michaels. 1993. Aligning academic task and participation status through revoicing:

Analysis of a classroom discourse strategy.” Anthropology and Education Quarterly (24): 318-335.---. 2007. “When is dialogue ‘dialogic’?” Human Development 2007 (50): 275-285.Takeda, Masatoshi., et al. 2010. “Laughter and humor as complementary and alternative medicines for dementia

patients.” BMC Complementary and Alternative Medicine 2010 (10:28).Terasaki, Noriko., and Kota Takeda. 2013. “Elderly with dementia reaches 4620000.” Asahi Shimbun [morning

edition] June 1st, 2013.Ministry of Health, Labor and WelfareStatistics Japan