- Title
- "Believe me I'm awake": language, dementia and abuse among older women, and opportunities for abuse detection
- Creator
- Lithgow, Stephanie Jane
- Relation
- University of Newcastle Research Higher Degree Thesis
- Resource Type
- thesis
- Date
- 2023
- Description
- Research Doctorate - Doctor of Philosophy (PhD)
- Description
- Addressing abuse in older age is acknowledged as complex and challenging, particularly in relation to people living with dementia, who suffer negative societal responses in addition to challenges imposed by the disease itself. The detection of abuse is fundamental to its successful prevention and intervention, however there is little research upon which to build adequate policies and systems. Primarily, this thesis examines how older women may report abuse, with a view to understanding how best to detect it, with a particular emphasis on those living with dementia. The women of the 1921-26 birth cohort of the Australian Longitudinal Study on Women’s Health (ALSWH) provided the data analysed within this thesis. Three studies are direct analyses, principally of their free-text data, while the fourth is based upon the findings these data produced. Study 1 (Chapter 5), a quantitative analysis of free-text data, examines written responses to a survey question: ‘Have we missed anything?’. In this analysis, grammatical complexity was assessed using the propositional density (PD) linguistic measure (used previously in studies of the language of people living with dementia). The women wrote with a high level of grammatical complexity, suggestive of cogent communication. Women in both non-dementia and dementia groups made incremental improvements in grammatical complexity with age in Linear Mixed Model (LMM) analyses (β=.00171 with ageing, and β=.00698 with developing dementia (both p<.05)). This study demonstrated the strength of the women’s written text as a reliable data source while supporting theories around prolonging resilience to language decline in the dementia disease trajectory, through active engagement. Study 2 (Chapter 6) is a mixed methods examination of women’s indicators of abuse, triangulating abuse survey items with free-text reports. Women often used the method that allowed them to choose their own words (the free-text item). Directly worded questions about abuse with binary (yes/no) answer options were used less frequently. In written comments, most women used direct terminology (e.g., ‘yelling’, ‘threats’, ‘bullied’), except about abuse occurring in the present tense, when there was more use of indirect, discreet terminology (e.g., ‘difficulties’, ‘problems’). In Study 3 (Chapter 7), examination of abuse reporting was centred on women who developed dementia. This group of women also used language of their choice most often but with greater use of indirect terminology across contexts. More idiomatic language was demonstrated among these women, who may have the same needs for discretion as women who never experience dementia, but additional needs for formulaic language to repair communication when word retrieval problems occur. In Chapter 8, the fourth and final study qualitatively examined and critically reviewed abuse assessment tools using the abuse reporting findings. The tools matched poorly with women’s endorsed methods, described in Studies 2 and 3, lacking both indirect terminology to pose questions, and open-ended response formats to collect response language. There was generally poor validation for use in dementia contexts. This thesis contributes knowledge about abuse reporting behaviours among older women, with results that may translate to improved detection methods, particularly in relation to reducing risk of idiomatic reports being dismissed as symptoms of dementia. The lack of an assessment tool that meets older women’s needs exposes underlying social issues around a failure to listen to older women, particularly those living with dementia, and to open avenues to reduce attitudes of ageism, misogyny, and ableism.
- Subject
- grammatical complexity; idea; elder; mistreatement; detection; terminology; dementia; assessment; screening; propositional; density; cognitive reserve; communication; language; heterogeneity; abuse; older
- Identifier
- http://hdl.handle.net/1959.13/1503658
- Identifier
- uon:55370
- Rights
- Copyright 2023 Stephanie Jane Lithgow
- Language
- eng
- Full Text
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| Thumbnail | File | Description | Size | Format | |||
|---|---|---|---|---|---|---|---|
| View Details Download | ATTACHMENT01 | Thesis | 8 MB | Adobe Acrobat PDF | View Details Download | ||
| View Details Download | ATTACHMENT02 | Abstract | 629 KB | Adobe Acrobat PDF | View Details Download |