1. ‘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

2. Social motivation of studying language and aging
Cultural influences on discourse of and with the elderly
Scholarly implications for further research

3. 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)

4. Okinawa: Blue Zone
“Okinawa’s Ushi Okushima still gardening at age 109”

5. 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).

6. 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.”

7. Japan as Super-Aging Society
Life expectancy (2012): Men yrs old
Women yrs old
In 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)

8. Population by age: Declining birthrate & aging growth
1,326,000
Roughly one in 4 is over 65.
Change of social structure
(1000)
Statistics Japan

9. Elderly population growth (1990-2012)
Ministry of Health, Labor and Welfare

10. Centenarians in Japan (1991-2010)
Women
Men
Ministry of Health, Labor and Welfare

11. Japan as “Aged” Society
WHO’s definition of ‘aging’ vs ‘aged’ society 65+ < →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 years” (Takeda et al. 2010: 10).

12. # of People with Dementia
Dementia: 4,620,000 (15% of age over 65)
MCI: 4,000,000
40% 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)

13. “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)

14. Observation
Geriatric hospital in the outskirts of Tokyo Founded by a psychiatrist in beds Full-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)
“I wanted to make a (nursing) facility where I feel assured to leave my mother.”
On-site clinic, rehab facilities with nursing home

15. Tea-Time Talk
Thursday afternoon (3:00-3:30pm, during or immediately after afternoon snack)
At a lounge
Led by a female clinical psychologist (age 32)
Participant observation
Recorded sessions: August 2011 (4)
January 2012 (1)
March 2012 (1)

16. Participants Total 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

17. CW TV RW
CW: Care worker
RW: Recreation worker
KITCHEN

18. Activity Format of Tea-time Talk
Clinical psychologist (CP) moderates the session.
CP’s opening by greetings
Date
Warm-up talk
Explanation of the topic (with handouts)　
CP’s questions
Participants’ responses

19. Topic: “manners”
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?

20. opening CP: OK, everybody, good CP: dewa minasama afternoon.
All: Good afternoon.
CP: It’s 3 o’clock.
Mrs.Tamura: Oh, is it?
CP: Yes, ah today is 145th
Tea-Time Talk. Every
Thursday, I come here
and
CP: dewa minasama
konnichiwa
All: konnichiwa
CP: sanji de gozaimasu
Mrs. Tamura: A sou
CP: hai e: kyou wa
desune dai 145
kaime no oshaberi
no kai de gozaimasu.
maishuu mokuyoubi
ni kochira ni ojama
shite

21. Mrs. Goto: A:
arigatou
gozaimasu
7. CP: Oshaberi no kai
wo okonatte
orimasu keredomo
itsumo no youni
hizuke no kakunin
kara itashimashou ka
8. Mrs. Goto: a:so:ka
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.

22. Interactional format of tea-Time Talk
CP gives a topic of the day.
CP asks a question (Q) to a participant and s/he answers (A).
CP immediately rephrases what the participant has just said (R).
CP has some agenda, but other topics come up and get developed (by the participants) on the course of the discussion.

23. 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

24. Three-part structure in institutional discourse
1st utterance: Inquiry
2nd utterance: Response
3rd utterance: Elaboration/Feedback/Acknowledgement
IRE sequence
Teacher: What are the two bending [mirrors] called? … something that begins with C.
Sheila: Concave and convex.
Teacher: Good. OK.
(Wells 2007, cited in O’Connor et al. 2007: 280)
1st position (Inquiry) &3rd position (Evaluation)-Teacher’s knowledge and authority

25. 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.

26. CP’s revoicing Topic: Manners
Mrs. Sakura: Mild, no AD
CP: Sakura-sama, nanka okaasama kara nanka kou iwareta koto tte arimasuka?
Mrs. Sakura: tokuni nani iwareta tte oboe mo naindesu kedo
CP: hai
Mrs. Sakura: yappari mukasi wa otokonoko wa yuukan ni onnnanoko wa oshitoyaka ni tte iu funniki ga attan janai kashira ne?
CP: hai, otokonoko wa yuukan ni yuukan ni
[writes yuukan on the board]
CP: Mrs. Sakura, do you have anything you were told by your mother?
Mrs. Sakura: I don’t remember being told anything in particular but
CP: Yes.
Mrs. Sakura: There was this ambience that boys should be brave, girls should be graceful, I think.
CP: OK. boys should be brave, boys should be brave, brave
[writes BRAVE on the board]
Inquiry
Response
Repetition of response utterance

27. “Revoicing” (O’connor and Michaels 1993, 2007)
Revoicing sequence in classroom
Ms. Davies: Paulo, is 24 even or odd?
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.
Ms. Davies: OK, so let me see if I understand. So you’re saying that 24 is an odd number?
Paulo: Yeah, because 3 goes into it. Because 24 divided by 3 is 8.
(O’Connor et al. 2007: 279)

28. 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).
Teacher, doctor

29. CP’s rephrasing: Q-A-R sequence
CP: OK. boys should be brave, boys should be brave, brave [writes BRAVE on the board]
Mrs. Sakura: Not brave but manly/masculine.
CP: Manly/masculine.
Mrs. Sakura: Manly, you know? Now there is gender equality so
CP: Yes so you’re saying, boys should be boyish, girls should be graceful and girlish, and this has been said quite often.
Mrs. Sakura: Yes.
CP: hai, otokonoko wa yuukan ni yuukan ni [writes yuukan on the board]
Mrs. Sakura: yuukan ni tte iuka
CP: otoko rashiku
Mrs. Sakura: Otoko rashiku ne? ima wa danjokinntou ni narimashita kara
CP: hai otokonoko wa otoko rashiku onnnanoko wa oshitoyaka ni onnanokoo rasihku toiu no wa warito iwarete kita koto nanja naika
Mrs. Sakura: Ee.

30. 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.

31. Role shifting : negotiation of authority
CP’s interactional authority
vs.
Participants’ collective knowledge
Rice polishing

32. CP: So nowadays, we have rice miller- rice milling
Mrs. Tamura: Severe, No AD
Mrs. Goto: Moderate, AD
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,
Mrs. Goto (Goto): Oh, that’s right.
Mrs. Tamura (Tamura): Right, and there was rice bran
inside.
Goto: Yes, yes.
CP: And you put rice in it.
Goto: Uh-huh.
CP: And then you do tsuntsun (poking) with a stick like this
Goto: [Right, and the bran
Tamura: [Yes, (we) did it.
Goto: (It’s) a child’s job.

33. CP: Is that so? Child’s job. It’s child’s helping (the mother)
Goto: [Chuckles]
CP: If you do that, would that remove bran?
Goto: It removes bran.
Tamura: That’s right.
CP: Did you do it, Mrs. Tamura?
Tamura: Yes, I did. So it’s not washing the rice, with rice /?/ poking
that thing.
CP: What is it?
Tamura: That thing.
CP: Bran?
Tamura: Bran, it was the same as that.
CP: Oh, Mrs. Kaede fell asleep.
RN: Why do you do tsuntsun?
Tamura: Because bran is removed. Isn’t that right?
Goto: Bran is removed. Then we make rice
bran paste out of it because we need bran.

34. CP: Did you make sake?
Goto: Oh yes, we made it quite often.
CP: Oh, really? Did you make it? Did you make sake?
Tamura: Yes.
Goto: Like amazake (sweet sake). Sake, no, adding bran to rice,
CP: Adding bran
Tamura: Right.
Goto: For Ohinasama (Girls’ Festival)　
CP: Oh, you give it to the Ohinasama (dolls).
Goto: Yes.
CP: You made it by yourself.
Goto: My parents did.
CP: Oh, your parents did.
CP: Oh, I see.

35. CP: How about miso (bean paste) or soy sauce?
Goto: Those things, we’d buy.
Tamura: Yes, we bought them.
CP: Have you made them?
Tamura: Well.
Goto: I don’t think so.
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.
CP: OK, I see. So in your mothers’ or grandmothers’ generations, may be people were making miso or soy sauce at home, but
Goto: [Right, right.
Tamura: [Right, right.
CP: But in your generation, you bought them.
Tamura: That’s right.
Goto: Right [nods]

36. 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

37. Humor and memory CP: Yes. What day of what year is it today?
Mrs. Goto (Moderate, AD)
CP: Yes. What day of what year is it today?
Mrs. Tamura: Heisei
Mrs. Goto: Heisei 23
CP: Yes, Heisei 23
Goto: August
CP: August
Goto: what day was it, 25th?
Workers: O:h, wow, great
Tamura: Bingo!
CP: Hai Kyo:u wa nan- nen no nan-gatsu nan- nichi deshou ka
Mrs.Tamura: [Heisei
Mrs. Goto: [Heisei 23nen no
CP: hai 23nen no
Goto: hachi gatsu
CP: hachi gatsu
Goto: ikutsu yatta kashira, nijuugonchi?
Workers: O: a: subarashii
Tamura: atari

38. Mrs. Goto: Did I get it right? CP: (You) got it right.
Mrs. Tamura: Wow, great!
CP: Well, no, it was the
correct answer.
Goto: /?/ (I) made it up
because, (we) don’t have
the most important thing,
you know, the pay check.
SW: [laughs]
Mrs. Goto: [laughs]
Mrs. Tamura: Ahh
10. Goto: atari mashita?
11. CP: atari mashita
12. Tamura: ara sugoi
13. CP: nante tondemo nai
seikai desu
Goto: /?/detarame nano
datte kanjin no ne:
kyuuryou ga naimon
ne:
15. SW: a ha ha
16. Goto: a ha ha
17. Tamura: a:

39. “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?

40. “Rice” day: August (8) 18th (10+8)
“Rice” “Eight” “Ten”
米　 八　十

41. Alzheimer’s disease: Memory does not last but Humor does not rust
Mrs. Kaede (severe, AD)
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 desu 3. 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?
Kaede: [smiles]
[laughter]

42. AD talk
CP: so has everybody gone watch sports games? Baseball or soccer or, have you gone watching sports?
Mrs. Kaede: Yes, I have.
CP: You have? What did you go watch?
Kaede: well, uh, in the class, well, those who had the house, you know, they did it by that
CP: did it by that, for/of class. For/of class.
CP: sorekara minasama supootsu kansen yakyuu demo ma suiei demo sakkaa demo mini irashitakoto wa arimasuka?
Mrs. Kaede: Gozaimasuyo.
CP: gozaimasu? Nani wo mini ikimasita?
Kaede: sono: ano: kurasu ni ne ma ouchi ga oarini narukata wa ne sorede shite irashita kedo
CP: sorede site rasshatta kurasuno kurasuno

43. Kaede: Yes.
CP: Yes, after you were grown up, did you go watch track and field or sprint or baseball?
Kaede: Yes I did.
CP: Did you like it?
Kaede: By all means, because everybody would do it, I couldn’t keep quiet.
[laughter]
Kaede: Go kocho kocho kocho [tickling hand gesture]
Kaede: hai
CP: hai otonani natte kara rikujo toka kakekko toka yakyuu toka ashi wo ohakobini nata koto wa arimasuka?
Kaede: yappari arimasu
CP: osuki desita?
Kaede: dousihitemo minasama nasaru kara kocchimo damatte wa iraremasen deshita ne
[laughter]
Kaede: kocho kocho kocho tte.

44. 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.

45. References
Bethea, Lisa Sparks “The function of humor within the lives of older adults.” Communication Quarterly, Winter 2001, 49 (1): Gladding, Samuel, T., and Beth Martin “Creativity and self-esteem in later life.” Ed. Mary M. Guindon. Self-esteem across the life span: Issues and interventions. New York: Routledge Grainger, Karen “Verbal play on the hospital ward: Solidarity and power?” Multilingua 23 (2004): Mak, Wingyun., and Brian D. Carpenter “Humor comprehension in older adults.” Journal of the International Neuropsychological Society 2007 (13): Matsumoto, Yoshiko “Dealing with life changes: Humour in painful self-disclosures by elderly Japanese women.” Ageing and Society 29 (2009): O’Connor, Catherine., and Sara Michaels Aligning academic task and participation status through revoicing: Analysis of a classroom discourse strategy.” Anthropology and Education Quarterly (24): “When is dialogue ‘dialogic’?” Human Development 2007 (50): Takeda, Masatoshi., et al “Laughter and humor as complementary and alternative medicines for dementia patients.” BMC Complementary and Alternative Medicine 2010 (10:28). Terasaki, Noriko., and Kota Takeda “Elderly with dementia reaches ” Asahi Shimbun [morning edition] June 1st, Ministry of Health, Labor and Welfare Statistics Japan