Rethinking assessment of elderly's language skill in China
A man speaks to his 102-year-old mother, leaning in to help her hear him in Jiujiang, Jiangxi Province. Photo:CFP
The world's population is aging. China, among many countries, is a fast-aging country. Provinces like Jiangsu, Zhejiang, Liaoning, Shandong, Sichuan, and cities including Shanghai have all reached the threshold of an "aged society." To properly provide for senior citizens and deal with social issues related to an aging society, China has introduced many new policies and standards. Among them is an industrial standard titled the Ability Assessment for Older Adults (hereafter referred to as "the Assessment"). Compiled by the Ministry of Civil Affairs, it is a unified, standardized, and practical measure to determine an old person's competencies. By classifying the elderly's competencies, it also provides reliable basis for the government to develop and implement elderly-care policies. A quick look through the competency assessment would allow one to spot many test items related to language competency, which demonstrates how important it is to evaluate seniors language competency via a comprehensive geriatric assessment.
Mirror for health
Decline in one's physical and mental health comes along with old age. When that happens, a senior may gradually move slower, make more mistakes, or even become unable to do certain things. Therefore, we must look ahead when assessing the competencies of elderly populations, so as to not only evaluate their ability to act, but also help them and their family members to identify problems in a timely manner with the help of scientific studies. This would also allow us to take intervening measures to slow the pace of declining competencies, thereby improving the quality of life for seniors and their families, which also helps address the economic and social issues brought by population aging.
While observing how the aged eat, dress themselves, and travel on a daily basis, we also need to focus on their language competency. The ability to speak is intrinsically connected to action. Language makes one capable of accomplishing tasks or reaching a certain goal through the act of speaking. Therefore, speaking should also be included in a person's abilities to act. To understand the changes in an old person's language ability triggered by the natural process of aging or diseases, we normally look for the following behaviors: difficulty in understanding others; lack of fluency in speaking or being unable to express oneself smoothly, such as forgetting the words, forgetting names, lengthy expressions, repeating themselves more, or being unwilling to talk for a long time, etc. These behaviors accelerate seniors' physical, mental, and cognitive declines, and mirror the health status of their bodies, brains, and hearts. Seniors' language ability is also an important dimension of assessing their competencies, therefore deserves more attention.
Language ability
The ability to speak affects senior citizens' ability to act. Its decline indicates recession in one's cognitive and psychological competencies. Typical symptoms include declining ability to socialize or participate in society, deteriorating living conditions, lower self-approval, weakening or even losing social attributes, or their "social ego." In the Assessment, senior's language ability is evaluated based on their cognitive functions, communication competence, working competence, social competence, and more items under three first-level indicators: mental state, sensory perception and communication, as well as social participation.
Much research has been done, both inside and outside China, to assess an aging person's mental state. Many of these studies indicate that the decline in old people’s cognitive competence can be clearly identified in their language ability. For instance, slower cognitive processing speeds will lead to slower reading speeds; degradation of working memory may cause more frequent regressions when reading; using simpler syntax when speaking or writing, or producing sentences with an unbalanced structure, etc. We cannot afford to ignore these behaviors when assessing seniors' competencies.
Emotional changes can also be observed in verbal and non-verbal language. As people grow older, they become more sensitive to words that convey positive emotions. In other words, seniors prefer to hear and use positive words. However, an old person who often conveys negative emotions, or even adopts aggressive language or has aggressive behavior, can be considered to have a negative mental state. Language is an indicator, making it necessary to add evaluation criteria that assesses seniors' emotions and mental states to get a full picture of the situation.
To some extent, elderly people's communication competency is affected by the weakening of their sensory perceptions. Studies show that age-related hearing loss is a potential risk factor for decline in cognitive competence, cognitive disorders, and dementia. Vision-related studies also indicate that visual deficits can be observed in patients with Alzheimer's disease, including color, stereoacuity, contrast sensitivity, and backward masking. When speaking, older people tend to reduce or stop using sensory inputs which are deficient. For example, a senior may intentionally use audio cues instead of visual cues when socializing. As such, language issues triggered by vision loss would subtly affect his/her level of consciousness, language ability, and social competence. However, issues related to gaps in language ability are easily overlooked, since the aged tend to use alternate senses as a compensation strategy in order to communicate with others. Therefore, when evaluating their language competence, we must include loss of sensory perceptions in the scope of assessment. What's more, when designing tests to assess elderly people's language abilities, we need to consider the likeliness of assessment subjects' use of compensation strategies.
Language related to seniors' social participation concerns many parts of their daily lives. An important indicator to assess old people's cognitive competence is to measure their ability to understand metaphors. This common figurative language appears in many conversations, and using or understanding metaphors involves advanced cognitive competence.
What's more, we need to include pragmatic competence into the judgment criteria for language assessment. It is not uncommon for the aged to be deceived by others. This happens because their inferential ability is degenerating, which makes it harder for them to decipher the true intentions of a stranger. Discourses related to aging people's daily lives and their social participation deserve more attention from linguists, particularly regarding intergenerational communication, doctor-patient interactions, communicating with nurses or caretakers, and palliative care.
Integrated approach
To improve the evaluation system, first and foremost, we need to emphasize the assessment of old people's language competence by developing relevant indicators. While strengthening fundamental research on the elderly's language abilities, we also need to make use of AI and big data, set up a data sharing platform, build a norm for senior language competencies, and gradually establish an evaluation system that is scientific, integrated, and open.
Second, we should standardize processes for testing and evaluation. Currently, no institution has been appointed in China as an authority for evaluating senior citizens' competencies. As a result, the assessment usually takes place in nursing homes, care centers, hospitals, or non-governmental organizations. The assessment process should be standardized, including the length of time needed for assessment, the cost, and the protection of subjects' personal information. Meanwhile, more research needs to be done to determine the order of tests, whether or not they should be arranged from easier to hardest, and whether evaluators could rearrange the order of the tests based on each subject's condition. Therefore, a specialized language research institute should be founded to study aging populations' use of language. This institute can record actual situations in language evaluation tests by collecting linguistic data. By adopting scientific research methods, the institute will be able to apply fundamental linguistic research to both assessing seniors' language competence and improving other fields of elderly care.
To improve the evaluation industry for assessing senior citizens' competencies, we need to expand relevant disciplines, introduce more interdisciplinary talent, establish a professional standard for related new occupations, and assign the Ministry of Human Resources and Social Security to manage appraisers. Meanwhile, we need to standardize the examination system for practitioners, and establish an authoritative department to evaluate practitioners’ professional skills and qualities. Next, we need to establish industry standards for the new industry, and deploy a regulatory agency. Finally, relevant functional departments need to promote moral codes and clinical ethics, to create a healthy environment for the industry and society to develop.
The evaluation of Chinese elderly people's competencies must move toward pursuit of the Healthy China initiative. First, this means we must disseminate assessment knowledge across the entire population, and fully engage families, neighborhoods, and communities in this effort. Relatives, neighbors, and caretakers for seniors usually have a more thorough knowledge of his/her conditions than evaluators. Second, social organizations must play a more active role in testing and evaluating senior citizens' language competence, and increase interventions for those who most need help. Third, we need to build an elderly care system with Chinese characteristics by combining assessment with other parts of the support system, such as social security, medical care, spiritual life, living environments, support facilities, elderly care services and industries. By doing so, we can maximize evaluation efficacy, and successfully realize the Healthy China strategy by transitioning a focus on curing diseases to people’s health.
Zhou Deyu is from the Research Centre for Aging, Language and Care at Tongji University.
Edited by CHEN MIRONG