‘I like 88.’ ‘Do you mean you like rice?’

1. ‘I like 88.’ ‘Do you mean you like rice?’ Intra- and Intergenerational Talk in a Japanese Geriatric Hospital ToshiHamaguchi, 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 http://www.bluezones.com/2011/09/5-rules-for-building-true-friendships/ 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 UshiOkushima still gardening at age 109” • http://www.bluezones.com/live-longer/

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 79.44 yrs old • Women 85.90 yrsold • 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 ShimbunJune 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. (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 60-120 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 ShimbunJune 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 2005 • 240 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)

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: dewaminasama • konnichiwa • All: konnichiwa • CP: sanji de gozaimasu • Mrs. Tamura: A sou • CP: hai e: kyouwa • desunedai 145 • kaime no oshaberi • no kai de gozaimasu. • maishuumokuyoubi • nikochiraniojama • shite • CP: OK, everybody, good • 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

21. Mrs. Goto: A: • arigatou • gozaimasu • 7. CP: Oshaberi no kai • wookonatte • orimasukeredomo • itsumo no youni • hizuke no kakunin • karaitashimashou • 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: Kyouwananyoubi • deshouka. • 2. Mrs. Goto: Mokuyou bi. • 3. CP: Arigatougozaimasu. • 1. CP: What day of the week • is it today? • 2. Mrs. Goto: Thursday. • 3. CP: Thank you very much.

26. CP’s revoicingTopic: Manners Mrs. Sakura: Mild, no AD • CP: Sakura-sama, nankaokaasamakaranankakouiwaretakotottearimasuka? • Mrs. Sakura: tokuninaniiwaretatte oboe monaindesukedo • CP: hai • Mrs. Sakura: yapparimukasiwaotokonokowayuukannionnnanokowaoshitoyakanitteiufunnikigaattanjanaikashira ne? • CP: hai, otokonokowayuukanniyuukanni • [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).

29. CP’s rephrasing: Q-A-R sequence • CP: hai, otokonokowayuukanniyuukanni [writes yuukan on the board] • Mrs. Sakura: yuukannitteiuka • CP: otokorashiku • Mrs. Sakura: Otokorashiku ne? imawadanjokinntouninarimashitakara • CP: haiotokonokowaotokorashikuonnnanokowaoshitoyakanionnanokoorasihkutoiu no wawaritoiwaretekitakotonanjanaika • Mrs. Sakura: Ee. • CP: OK. boys should be brave, boys should be brave, brave [writes BRAVEon 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.

30. Cp’srevoicingin Tea-time talk • Maintaining participationframework 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. 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. • Goto: Yes. • 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. Bethea2001, 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 Mrs. Goto (Moderate, AD) • CP: HaiKyo:uwa nan-nenno nan-gatsu nan-nichideshouka • Mrs.Tamura: [Heisei • Mrs. Goto: [Heisei 23nen no • CP: hai 23nen no • Goto: hachigatsu • CP: hachigatsu • Goto: ikutsuyattakashira, nijuugonchi? • Workers: O: a: subarashii • Tamura: atari 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!

38. 10. Goto: atarimashita? • 11. CP: atarimashita • 12. Tamura: arasugoi • 13. CP: nantetondemonai • seikaidesu • Goto: /?/detaramenano • dattekanjin no ne: • kyuuryouganaimon • ne: • 15. SW: a ha ha • 16. Goto: a ha ha • 17. Tamura: a: • 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 paycheck. • SW: [laughs] • Mrs. Goto: [laughs] • Mrs. Tamura: Ahh

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-samawa pan to • okomedeshitara • dochiragaosukiesuka? • 2. Mrs. Kaede: N: soudesu ne • watashiwahachi- • juu-hachino houga ii • desu • 3. CP: hachi-juu-hachi no hougaii • [laughs] sore waokome no • houga ii tteiukotodesuka? • 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: sorekaraminasamasupootsukansenyakyuu demo ma suiei demo sakkaa demo mini irashitakotowaarimasuka? • Mrs. Kaede: Gozaimasuyo. • CP: gozaimasu? Naniwo mini ikimasita? • Kaede: sono: ano: kurasuni ne ma ouchigaoarininarukatawa ne sorede shite irashitakedo • CP: sorede site rasshattakurasunokurasuno • 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.

43. Kaede: hai • CP: haiotonaninattekararikujotokakakekkotokayakyuutokaashiwoohakobininatakotowaarimasuka? • Kaede: yappariarimasu • CP: osukidesita? • Kaede: dousihitemominasamanasarukarakocchimodamattewairaremasendeshita ne • [laughter] • Kaede: kochokochokochotte. • 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 kochokochokocho[tickling hand gesture]

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. 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 Welfare • Statistics Japan