Social Contact and Communicative Competence in the Oldest Old1
Deborah Keller-Cohen, Amanda Toler, Diane Miller,
Katherine Fiori, and Deborah Bybee
University of Michigan
Paper to be presented at the Annual Meeting of the American
Psychological Association, Honolulu, July 28, 2004
1
We appreciate the comments of Evan Cohen and Kristine Ajrouch on earlier versions of
this paper.
1
Introduction
Despite the fact that the oldest old are the fastest growing segment of the
population, the relationships among language, cognition and social engagement have not
been examined in this age group. Indeed even the existing literature on oral language and
aging has largely focused on adults under the age of 85. Change in the language of the
elderly is typically attributed to neuro-cognitive decline (Au et al, 1995; Kemper et
al,2001). Memory, attention, inhibition and processing speed have all been thought to
play a role in how language changes with age. However these changes have varied across
areas of linguistic knowledge. For example, vocabulary knowledge has been found to
improve whereas word retrieval is compromised with aging (Au, 1995); (S. S. Kemper,
A., 2001); (Borod, 1980). A decline in sentence complexity has been reported in
statements of elderly adults but the same statements were judged to be more interesting
than those by younger speakers(S. Kemper, Kynette, D., Rash, S., O'Brien, K., Sprott, R.,
1989). Cognitive effects on communicative skills have not been uniform, i.e. there is no
single dynamic that captures the relation of cognition to communication. What role social
contact plays in the maintenance of communicative skills remains largely unexplored. It
seems likely that social contact would impact the maintenance of language skills since
evidence exists that social engagement is protective against cognitive decline (Seeman et
al, 2001; Zunzunegui et al. (2003).
The present investigation, a pilot study, focuses on social contact as well as some
aspects of social networks and their relation to language and cognition in the oldest old.
We use social contact here to refer to the engagement individuals have in their social
world. This includes the frequency with which individuals interact with others, the range
2
of conversational partners and the variety of activities in which they engage. Social
networks entail several features: objective (structural factors such as network size and
composition) , functional (what the supportive others in the network actually do for the
individual) , and subjective ( the individual’s qualitative evaluation of the relationships
in the network) (Antonucci, 1990). Beckman et al. (2000:849) capture the connection
between social contact and social networks observing that “through opportunities for
engagement, social networks define and reinforce meaningful social roles.”
How might social relationships relate to the maintenance of communicative
skills? One hypothesis is that communicative competence is maintained by use.
Individuals with a limited social engagement will over time begin to lose their ability to
recruit the linguistic resources needed to maintain this competence (Ryan, 1995). An
alternate hypothesis is that limited or unsatisfactory social contact has selective effects.
Perhaps dimensions of language use that require a speaker to take another’s perspective
into account are affected more by reduced social contact. These communicative skills
might include providing instructions as well as descriptions sufficient to distinguish one
referent from another. Our project examines the relationships among social engagement,
cognition and communicative skills where social engagement is operationalized as the
frequency, purpose and quality of interactions. Our hypothesis was that the frequency,
purpose and satisfaction with social engagement would be related to higher performance
on communicative tasks. We also expected that performance on our cognitive measure
would be positively associated with higher levels of social contact and better language
scores.
Design
3
Participants
The participants for our study were 20 non-Hispanic whites drawn from two
retirement communities2 which were administratively part of a Protestant denomination
retirement entity. Setting one, described as without programming, offered apartments in a
building designated as senior residences. Although there was an occasional facility
organized event such as the monthly birthday party, no roster of daily activities was
planned. The second setting, referred to here as with programming, was an old
established setting offering a continuum of services, from free standing independent
apartments to dementia care. This setting offered a daily schedule of residential
community events. All of our participants were living alone and independently in their
own apartments; they were not in assisted living. We chose respondents in senior
residences rather than community dwelling residents to ensure that individuals had the
opportunity for regular social interaction due to their physical proximity to each other. It
also allowed us to examine the effect of type of setting on communicative behavior.
Because there were only five men in our sample, we were not able to include analyses
based on gender although we plan to do so in the future.
Procedures
To obtain information about social contact, we modified the Rochester Interaction
Record (Reis, 1991), a daily diary event-based recording instrument (See Figure 1).
Nezlek, et al (2002) have used this instrument successfully with older adults. We limited
2
N= 7 from unprogrammed setting; N=13 from programmed setting.
4
its use to social situations involving talk3 that took place for five minutes or more since
we were interested in the relationship between sustained social interaction and
communicative skills. Participants were provided with notebooks organized into the days
of the week, allowing us to collect objective, functional and subjective aspects of their
social networks.
All individuals were screened for dementia using the Cognistat (formerly known
as the Neurobehavioral Cognitive Status Examination). It provides more information than
the Mini-Mental State Exam, briefly measuring seven different cognitive functions:
confrontation naming, simple auditory attention, recent verbal memory, verbal judgment,
verbal abstract reasoning, mental calculations, and constructional skill. Following Drane
et. al (2003) we used the composite score with the 9th percentile as a cut off for
participation.4 Because of the breadth of information the Cognistat elicits, we also used it
as our cognitive measure.
Three language tasks were selected to reflect different aspects of communicative
competence. The Boston Naming Test (BNT) taps into the ability to name referents and
the ability to retrieve those names. (We used the full 60-item version). The tasks referred
to here as WIAT Discourse are the Rollercoaster and Vending Machine items from the
WIAT 2. In the Vending Machine task, the participant is asked to explain how to
purchase candy from a vending machine to someone who does not know how to do this.
They do this while looking at a set of pictures so that recall is not at issue . In the
3
The RIR in its original form does not require talk, but others have adapted it for talk. It
also required interactions of 10 minutes or more which we felt was not appropriate for a
much older population.
4
The composite score abandons the screen and metric approach of the Cognistat and
instead uses the total score achieved on the test items (82).
5
Rollercoaster item, the individual is asked to create a story using a panel of five pictures
showing three boys at an amusement park who have differing reactions to a rollercoaster
ride. Here too the pictures are held in sight for the participant to consult. With a
Cronbach’s alpha of .763, we combined those two tasks into one variable. Finally, the
Cognistat Picture Description involves the ability to perceive the substance of a complex
picture and convey that.
Methods
Our first step was to examine the bivariate relations among the communication
measures, their relation to cognition and education, and the relations among the social
measures using Pearson correlations. Because education was highly correlated with the
BNT, we ran partial correlations using education as the control variable (see Table 5). To
further explore the relationships among the linguistic and social variables, we selected
those social variables that were significantly correlated with the language measures for
inclusion in regressions. Because of the small sample size, we were limited in the number
of variables we could include at once. Therefore, for each dependent variable we ran
multiple models using a control variable and one social variable. We then evaluated the
contribution of each of the social variables individually. In the case of the BNT,
education served as the control variable in each of the models. However, the Composite
Cognistat, rather than education was significantly correlated with the WIAT and
remained significant after controlling for education. Therefore, we used the Cognistat as
the control variable for the regressions with the WIAT as the dependent variable. The
Picture Description was not correlated with either education or the Cognistat and did not
6
contribute significantly to subsequent regression models. Therefore, we dropped these
controls and were able to include the social variables of interest simultaneously.
Results
Table 1 summarizes the performance of our participants on the social and language tasks.
As a group participants with more than a high school education received higher scores on
the language tasks, participated in a larger number of social interactions and participated
with a greater diversity of individuals.
Bivariate correlations
Communication measures. We anticipated that performance among the language tasks
would not be related because they tap different types of language skills: word retrieval,
providing instructions, telling a story and describing a picture. As shown in Table 2, this
is the case. Both the BNT and the WIAT discourse tasks were related to the Cognistat.
Consistent with prior research, BNT scores were strongly associated with education
although the WIAT Discourse scores were not. The picture description total word score
was not related to any of the tasks and was dropped from subsequent analyses. The
substance score was not associated with either education or the Cognistat.
Social measures. In contrast to the communication measures, the social measures
displayed many associations. This can be seen in Table 3. In part this was because some
of the measures recorded overlapping behaviors. For example, each conversation log
recorded at least one activity, although they could record more than one per log, so the
number of logs and the number of activities were expected to be correlated. In other
cases, the variables measure different behaviors such as the number of activities and type
7
of relationship. Their strong correlation may be due to a third factor such as the
participant’s cognitive status.
Importantly we found that the proportion of all interactions devoted to family
members was negatively associated with three other social variables: the proportion of
interactions with friends, the number of different types of relationships, and the number
of different activities. That is, individuals whose interactions were more oriented toward
family were involved with fewer friends, had a more limited variety of role relationships,
and participated in fewer activities. All the social variables except the number of different
activities were positively associated with performance on the Cognistat (see Table 4).
Because setting might be a proxy for any number of contrasts, we examined it
more closely. We found no association between setting and the number of different
activities in which people participated despite the differences in programming. However
we did observe a correlation between setting and number of different relationships. Those
in the programmed setting were engaged in a wider variety of relationships than those in
the unprogrammed setting. Moreover setting was associated with conversational partner.
In particular, we found that setting was negatively correlated with the proportion of
interactions with family members (see Table 4). In the unprogrammed setting, residents
tended to interact more often with family members whereas in the setting with
programming, residents interacted less often with family and with a wider variety of
individuals overall.
In fact, there was very little overlap in the frequency of interaction with family
members between the two settings. Over half of the residents in the programmed setting
interacted with one to four family members during the week, whereas nearly half of the
8
residents from the unprogammed setting interacted with nine to thirteen family members
during the week (see Figure 2).
Relationships among language, cognitive and social variables. Next we examined the
relations among social, cognitive and communicative variables simultaneously. As we
can see in Table 4, initial correlations of all the measures showed a number of social
variables to be of interest: number of conversation logs completed, the residential
setting, the number of activities, the number of different types of relationships
represented across a week’s logs, the proportion of interactions involving family and the
proportion of interactions involving friends. We did not observe an association between
satisfaction and cognitive or communicative functions so that variable was dropped from
subsequent analyses.
Regression Results
BNT. Performance on the BNT was predicted by models including education plus
each of the following: setting, the number of different relationships, and the proportion of
interactions involving family (see Table 6). Models 2, 3 and 5 were the most
informative. Models 2 and 3 reveal that participants who had a wider range of
relationships and a lower proportion of interactions with family members performed
better on the BNT. Moreover, recall that the programmed setting had participants with a
lower proportion of interactions with family. The association between the BNT and
setting meant that the higher the score on the BNT the more likely they were to come
from the second setting, i.e. the programmed setting
WIAT Discourse. Table 7 summarizes the models for the WIAT discourse tasks. Model 5
was the most informative. Performance on the Cognistat plus residence in a particular
9
setting accounted for 42% of the variance, significant at the trend level (p=.086). Those
with higher Cognistat scores living in the programmed setting performed better on the
WIAT Discourse tasks
Cognistat Picture Description. For the Picture Description (see Table 8) the model
relating performance to number of different activities was significant; the model with
logs was not. Both of these variables capture engagement in number and variety of
activities. This differentiates the picture description from the other communication tasks.
Discussion
Much is known about the association between declines in cognitive function and
the ability to communicate but little has been explored about what role social engagement
might play in their relationship. This pilot study suggests that a consideration of social
contact in the relationship between language and cognition in the oldest old is a fruitful
avenue for further inquiry.
The relationships among cognition, social contact and communication. One of the
repeated observations here was that higher levels of performance on some language
measures were associated with higher levels of cognitive functioning and a wider range
of social contacts which confirms our hypothesis. An even more intriguing and
unexpected finding was the inverse relationship between range of contacts and the
proportion of contacts allocated to family. We also found that as the proportion of family
contact increased, both the naming and discourse performances decreased. The
proportion of family contact was also strongly related to Setting, i.e. programmed vs.
unprogrammed. This Setting variable emerged as a clearer predictor than family contact.
A fuller understanding of the family contact, setting and linguistic skill relationship
10
would require more settings and repeated measures over time. However, the current data
suggest at least two possible explanations: a) functional decline; and b) normative
patterns of family interaction.
One possibility is that as individuals decline cognitively, they become less able to
handle social contact and become more dependent on family members who by virtue of
kin obligations, will continue to interact with them. The fact that we found a negative
correlation between the number of logs (that is total number of interactions over five
minutes), a measure of social activity, and the proportion of interactions with family does
suggest the family may be filling a gap with those experiencing some cognitive decline.
If that were the explanation, then cognitive decline might stimulate the pattern of social
contact with family but it would still remain uncertain what the relationship was between
social engagement and communicative competence. It could be that routinized exchanges
between family members and the oldest old provide less stimulation for the maintenance
of communicative skills. A detailed analysis of interactions with family is needed.
A second explanation is that normative patterns of family interaction contribute to
this pattern. Recall that we found the two settings differed in the proportion of
interactions residents had with family members. It is possible that family members feel
greater responsibility for their oldest-old relatives when the setting does not provide them
with more opportunities for social engagement. The level of family participation might
be subject to moderation if the oldest-old member reported changing involvement with
non-family members. Longitudinal evidence would be required to assess that.
Even so, it is also plausible that family members direct their loved ones to
settings that are consistent with their attitudes toward interactional patterns. In this
11
account, socioeconomic status (SES) or cultural patterns of interaction might well guide
their collective selection of a setting. The setting we have described as unprogrammed
was considerably less expensive than the programmed setting which might point to SES
as a factor in the selection of a residential setting for one’s parents. Another possibility is
that SES and cognitive status interact here. Prior work has shown the protective benefits
of education against dementia. With proportionately more residents with only a high
school education in the unprogrammed setting and lower performance on the Cognistat,
these factors may jointly work against the support of a high level of communicative
competence.
However, in the absence of cognitive decline, how might social engagement
support communicative skills? (Crohan, 1989) argues that because friendship relations
are voluntary, they may contribute more to the well being of the elderly than family
relations. Individuals who are experiencing little cognitive decline involve themselves in
a wider range of relationships, each of which challenges individuals to speak and listen to
others on a range of topics and in a range of contexts all of which may contribute to
keeping one’s linguistic skills activated.
Communication measures. The current study also demonstrated that confrontation
naming and discourse are two meaningful and separate communicative skills, and as
such, should be included in any larger study. We found performance on the BNT to be
highly correlated with education (consistent with a large body of prior research), whereas
performance on the WIAT was not. It’s possible that vocabulary skills are enhanced by
post-secondary education whereas the particular oral discourse skills we examined are
not.
12
The absence of association among the language measures suggests that they
represent different aspects of communicative competence, that is the ability to label
aspects of the world and the ability to create different types of connected discourse. A
larger sample will be needed to assess whether features of social engagement impact
these domains of communicative behavior differently.
Satisfaction, social contact and communication. The relationship between satisfaction
with interactions and well being has been previously reported. Why would satisfaction
not have been found related to our study variables? Carstensen(1997) and
Fingerman(2003) report an increase in satisfaction with social relations with age; others
report a decline in negative social exchanges or a low frequency of negative exchanges
with age (Rook, 2003). This is consistent with the the absence of variation in satisfaction
reported in the conversation logs. Participants were quite satisfied with their interactions.
The oldest old in our sample seem to have restricted interactions to those they enjoy.
Our study suggests that the time spent in contact with family members as
conversational partners rather than a wider range of social contacts, was
associated with lower communicative and cognitive performance. Our future work will
involve a closer look at the patterns of family interactions and their relationship to
functional decline and the maintenance of communication skills. This will require a
multi-site, longitudinal effort. We will also be expanding the range of communicative
skills so that we can more fully the assess the relationship of each skill to types of social
contact.
13
Table 1
Descriptives of study variables
Variable
Range
Full sample
(n=20)
Mean
SD
HS only
(n=9)
Mean
SD
More than HS
(n=11)
Mean
SD
Boston Naming Test (BNT)
43-59
50.50
4.926
46.22
2.59
54
3.29
WIAT Discourse5
7-24
17.3
4.60
16.00
5.10
18.36
4.08
Picture Description6
0-1
.5973
Composite Cognistat
64-80
72.95
5.206
69.44
5.25
75.82
3.06
# of social logs
9-58
25.7
11.40
19.78
7.68
30.55
11.93
# of diff. Types relationships
1-6
4.35
1.23
3.67
1.58
4.91
.302
Proportion Of interactions
with family
.04-1
.276
.225
.357
.284
.210
.144
Proportion Of interactions
with friends
0-.75
.353
.229
.211
.197
.469
.189
# of different activities
0-20
5.80
1.88
5.56
2.01
6.00
1.84
.333
.636
# of relationships—total number of relationships indicated across the social logs
# of different types of relationships—number of different types of relationships indicated across the social
logs
Proportion of interactions with family—number of interactions with family / total number of relationships
Proportion of interactions with friends—number of interactions with friends / total number of relationships
5
WIAT Discourse includes the Vending Machine and Rollercoaster tasks (Cronbach’s alpha=.7633)
Picture Description is coded 1 if the respondent mentioned the relationship between the boys and 0 if they did
not.
6
14
Figure 1
15
Table 2
Bivariate correlations for language tasks, cognition and education
BNT
WIAT
Picture Composite
7
Discourse description Cognistat
WIAT Discourse
.264
Picture description
.250
-.290
Composite Cognistat
.582**
.557*
.069
Education
.806***
.262
.302
**
*
+
.625**
Correlation is significant at the 0.01 level (2-tailed).
Correlation is significant at the 0.05 level (2-tailed).
Correlation is significant at the 0.10 level (2-tailed).
7
WIAT Discourse includes the Vending Machine and Rollercoaster tasks (Cronbach’s
alpha=.7633).
16
Table 3
Bivariate correlations among social variables
# of logs
Setting
# of different Proportion of Proportion of
types of
interactions
interactions
relationships
w/family
w/friends
Setting
.471*
# of different types of
relationships
.581**
.566**
Proportion of interactions
w/family
-.486*
-.745***
-.795***
Proportion of interactions
w/friends
.477*
.499*
.544*
-.519*
# of different activities
.513*
.377
.648**
-.582**
.220
** Correlation is significant at the 0.01 level (2-tailed).
* Correlation is significant at the 0.05 level (2-tailed).
+ Correlation is significant at the 0.10 level (2-tailed).
17
Table 4
Bivariate correlations for all variables
BNT
WIAT
Picture Composite Education # of logs Setting # of different Proportion of Proportion of
Discourse8 description Cognistat
types of
interactions interactions
relationships w/family
w/friends
WIAT Discourse
.264
Picture description
.250
-.290
Composite Cognistat
.582**
.557*
.069
Education
.806***
.262
.302
.625**
# of logs
.489*
.321
.450*
.567**
.482*
Setting
.600**
.540*
.314
.427+
.390+
.471*
# of different types of
relationships
.658**
.438+
.209
.522*
.517*
.581**
.566**
Proportion of interactions -.535*
w/family
-.458*
-.214
-.548*
-.333
-.486*
-.745***
-.795***
Proportion of interactions
w/friends
.490*
.472*
.107
.639**
.576**
.477*
.499*
.544*
-.519*
# of different activities
.358
.129
.600**
.192
.121
.513*
.377
.648**
-.582**
.220
** Correlation is significant at the 0.01 level (2-tailed).
* Correlation is significant at the 0.05 level (2-tailed).
+ Correlation sis significant at the 0.10 level (2-tailed).
8
WIAT Discourse includes the Vending Machine and Rollercoaster tasks (Cronbach’s alpha=.7633).
18
Figure 2
# of interactions with family members by setting
14
12
10
8
6
4
2
0
N=
2
9
Unprogrammed
Programmed
Setting
19
Table 5
Partial correlations controlling for education9
WIAT Composite # of logs Setting # of different Proportion of Proportion of
# of
Discourse Cognistat
types of
interactions interactions different
10
relationships w/family
w/friends activities
-.005
BNT
WIAT Discourse
Composite Cognistat
.169
.194
.525*
.476*
-.477*
.054
.444+
.521*
.230
.493*
.366
-.407+
.407+
.102
.389
.255
.298
-.462*
.437+
.151
.351
.442+
-.394+
.279
.523*
.462*
-.710**
.365
.361
-.771***
.351
.690**
-.425+
-.579**
# of logs
Setting
# of different types of
relationships
Proportion of interactions
w/family
Proportion of interactions
w/friends
**
*
+
9
.186
Correlation is significant at the 0.01 level (2-tailed).
Correlation is significant at the 0.05 level (2-tailed).
Correlation sis significant at the 0.10 level (2-tailed).
Picture description not included because it is a dichotomous variable.
WIAT Discourse includes the Vending Machine and Rollercoaster tasks (Cronbach’s alpha=.7633).
10
20
Table 6
OLS regression results (standardized coefficients) with BNT as dependent variable, controlling for education
Education
(1= more than high school)
Model 1
Model 2
Model 3
Model 4
Model 5
.806***
.636***
.706***
.783***
.674***
.329*
# of different relationships
-.299*
Proportion of interactions
with family
.039
Proportion of interactions
with friends
.338*
Setting
R2
R2 change
.650
.729
.079
.729
.079
.651
.001
.746
.096
F
F-change
33.363***
22.861***
4.981*
22.889***
5.000*
15.827***
.050
24.990***
6.473*
+
p<.10, * p<.05, **p<.01, ***p<.001
21
Table 7
OLS regression results (standardized coefficients) with WIAT Discourse11 as dependent variable, controlling for cognition
Composite Cognistat
Model 1
Model 2
Model 3
Model 4
Model 5
.557*
.451+
.437+
.431
.399+
.202
# of different relationships
-.218
Proportion of interactions
with family
.197
Proportion of interactions
with friends
.370+
Setting
R2
R2 change
.310
.339
.029
.343
.033
.333
.023
.422
.112
F
F-change
8.079*
4.368*
.764
4.438*
.860
4.238*
.584
6.198**
3.289+
+
p<.10, * p<.05, **p<.01, ***p<.001
11
WIAT Discourse includes the Vending Machine and Rollercoaster tasks (Cronbach’s alpha=.7633).
22
Table 8
Logistic regression results with the Picture Description as dependent variable12
Model 1
# of different activities
B
Exp(B)
B
Exp(B)
.987*
2.682
.834+
2.302
.054
1.055
# of logs
LR chi-square
+
Model 2
8.687**
.720
p<.10, * p<.05, **p<.01, ***p<.001
12
Picture description is coded 1 if the respondent mentioned the relationship between the
two boys and 0 if they mentioned both boys, but not the relationship.
23
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