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Power Relations in Older Adults’ Cognitive Interaction in Clinical Setting: A Multimodal Pragmatic Perspective

  • Zhongquan Ma

    Zhongquan Ma is a PhD student at the School of Foreign Studies, Tongji University. His research interests are gerontolinguistics and multimodal pragmatics.

    and Lihe Huang

    Lihe Huang (the corresponding author) is Professor at the School of Foreign Studies, Tongji University. His research efforts have focused on gerontolinguistics and multimodal pragmatics.

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Published/Copyright: December 7, 2024
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Abstract

This study explored the construction of power relations in the cognitive assessment of older adults within the Chinese clinical context. Data is derived from audio and video recordings that nine older adults produced in the cognitive assessment of the Chinese version of the Montreal Cognitive Assessment-Basic (MoCA-B), which were then annotated and analyzed from a multimodal pragmatic perspective. The study reveals that examiners and older adults employed various speech acts to achieve distinct communicative goals, with power relations between them being reflected through these speech acts. Examiners tend to claim high power, utilizing discourse strategies such as request, interruption, evaluation, rhetorical questions, and directive speech acts. In contrast, older adults assert high power through directive speech acts, rhetorical questions, and interruptions. Both parties also exhibit low power by using confirming questions and explanations. Additionally, gestures, smiles, prosody features, and other non-verbal communicative resources are synergistically employed to exercise power. The interactive mechanism of constructing power relations reveals that age affects older adults’ power relations construction even in a professional setting of the Chinese context. The negotiation between the advanced age of older adults and the expertise of examiners jointly shapes power relations in their interactions.

About the authors

Zhongquan Ma

Zhongquan Ma is a PhD student at the School of Foreign Studies, Tongji University. His research interests are gerontolinguistics and multimodal pragmatics.

Lihe Huang

Lihe Huang (the corresponding author) is Professor at the School of Foreign Studies, Tongji University. His research efforts have focused on gerontolinguistics and multimodal pragmatics.

Acknowledgments

This research is grant-supported by the project of Philosophy and Social Science Foundation of Shanghai “A Study of Pattern and Criteria of Age-Friendly Business Development” (No. 2023BSH011).

References

Ainsworth-Vaughn, N. (1995). Claiming power in the medical encounter: The whirlpool discourse. Qualitative Health Research, 5(3), 270-291.10.1177/104973239500500302Search in Google Scholar

Ainsworth-Vaughn, N. (1998). Claiming power in doctor-patient talk. Oxford University Press.10.1093/oso/9780195096064.001.0001Search in Google Scholar

Aizatul, A., & Isma, N. (2023). Request modifications by Malay speakers of English in the workplace: A contrastive pragmatic analysis. Studies in English Language and Education, 10(2), 981-999.10.24815/siele.v10i2.26464Search in Google Scholar

Amalraj, S., Starkweather, C., Nguyen, C., & Naeim, A. (2009). Health literacy, communication, and treatment decision-making in the older cancer patients health literacy: Improving patient understanding, Oncology, 23, 369-375.Search in Google Scholar

Brown, L., & Prieto, P. (2017). (Im)politeness: Prosody and gesture. In J. Culpeper, M. Haugh and D. Z. Kádár (Eds.), The Palgrave handbook of linguistic (im)politeness (pp. 357-379). Palgrave Macmillan.10.1057/978-1-137-37508-7_14Search in Google Scholar

Brown, P., & Levinson, S. (1987). Politeness: Some universals in language use. Cambridge University Press.10.1017/CBO9780511813085Search in Google Scholar

Brown, R., & Gilman, A. (1960). The pronouns of power and solidarity. In G. Pier Paolo (Eds.), Language and social context, (pp. 252-282). Harmondsworth.10.1515/9783110805376.252Search in Google Scholar

Burbules, N. C. (1986). A theory of power in education. Educational Theory, 36(1), 95-114.10.1111/j.1741-5446.1986.00095.xSearch in Google Scholar

Careless, J. (2018). Don’t forget the body: Exploring the curative potential of nonverbal communication in medical encounters. In V. P. Richmond, J. C. McCroskey, & M. Hickson (Eds.), Handbook of nonverbal communication, (pp. 299-318). American Psychological Association.Search in Google Scholar

Chen, X. R., & Qian, Y. H. (2011). 多模态分析法在语用学研究中的应用 [The application of multimodal analysis in pragmatic research]. Foreign Languages in China, 8(5), 89-93.Search in Google Scholar

Chiang, S.-Y. (2009). Personal power and positional power in a power-full‘I’: A discourse analysis of doctoral dissertation supervision. Discourse & Communication, 3(3), 255-271.10.1177/1750481309337199Search in Google Scholar

Deng, Y. (2017). 法庭话语言据性策略选择中的交际目的及权势关系 [The communicative purpose and power relation in the selection of evidential strategies in court discourse]. Journal of Hubei University (Philosophy and Social Sciences Edition), 44(5),151-157.Search in Google Scholar

Drew, P., & Heritage, J. (1992). Analyzing talk at work: An introduction. In P. Drew & J. Heritage (Eds.), Talk at work: Interaction in institutional settings (pp. 359-417). Cambridge University Press.Search in Google Scholar

Er, I. (2020). The voiceless in The Voice: A multimodal critical discourse analysis. Text & Talk, 40(6), 705-732.10.1515/text-2020-2071Search in Google Scholar

Fisher, S. (1983). Doctor/patient talk: How treatment decisions are negotiated in doctor-patient communication. In S. Fisher & A. Todd (Eds.), The social organization of doctor-patient communication (pp. 135-158). The Center for Applied Linguistics.Search in Google Scholar

Gimenez, L., Kelly-Irving, M., Delpierre, C., Rougé-Bugat, M.-E., Lepage, B., & Lang, T. (2023). Interaction between patient and general practitioner according to the patient body weight: A cross-sectional survey. Family Practice, 40(2), 218-225. https://doi.org/10.1093/fampra/cmac08610.1093/fampra/cmac086Search in Google Scholar

Harris, S. (2003). Politeness and power: Making and responding to requests in institutional settings. Text— Interdisciplinary Journal for the Study of Discourse, 23(1). https://doi.org/10.1515/text.2003.00310.1515/text.2003.003Search in Google Scholar

He, Z. R., & Ran, Y. P. (2001). 关联性: 交际与认知 [Relevance: communication and cognition (An introduction)]. Foreign Language Teaching and Research Press.Search in Google Scholar

Holmes, J., Stubbe, M., & Vine, B. (1999). Constructing professional identities: “Doing power” in policy units. In S. Sarangi & C. Roberts (Eds.), Talk, work and institutional order: Discourse in medical, mediation and management settings (pp. 351-385). Mouton de Gruyter.10.1515/9783110208375.3.351Search in Google Scholar

Hou, Y. Y. (2022). 夫妻争吵话语的多模态互动分析——兼论权势关系对争吵话语模态选择的影响 [Multimodal interactive analysis of husband and wife’s argument discourse: Discussion about the influence of power relations on the choice of argument discourse mode] Chinese Character and Culture, 13, 185-190.Search in Google Scholar

Huang, L. H. (2022). Toward multimodal pragmatics: A study of illocutionary force in Chinese situated discourse. Routledge.10.4324/9781003251774Search in Google Scholar

Huang, L. H., Qu, H. Y., & Zhou, D. Y. (2023). Older adults’ refusal speech acts in cognitive assessment: A multimodal pragmatic perspective. Frontiers in Psychology, 14, 1026638. https://doi.org/10.3389/fpsyg.2023.102663810.3389/fpsyg.2023.1026638Search in Google Scholar

Huang, L. H., & Yang, J. J. (2023). 多模态语用学研究的视野与方法 [The perspective and methods of multimodal pragmatics research]. Contemporary Rhetoric, 6, 84-93.Search in Google Scholar

Ibrahim, Y. (2001). Doctor and patient questions as a measure of doctor-centeredness in UAE hospitals. English for Specific Purposes, 20, 331-344.10.1016/S0889-4906(00)00020-XSearch in Google Scholar

Keating, E. (2009). Power and pragmatics. Language and Linguistics Compass, 3(4) 996-1009.10.1111/j.1749-818X.2009.00148.xSearch in Google Scholar

Korc-Grodzicki, B., Alici, Y., Nelson, C., Alexander, K., Manna, R., Gangai, N., Shen, M. J., Parker, P. A., & Banerjee, S. C. (2020). Addressing the quality of communication with older cancer patients with cognitive deficits: Development of a communication skills training module. Palliative & Supportive Care, 18(4), 419-424.10.1017/S1478951520000218Search in Google Scholar

Kovarsky, D. (1990). Discourse markers in adult-controlled therapy: Implications for child centered intervention. Journal of Childhood Communication Disorders, 13(1), 29-41.10.1177/152574019001300105Search in Google Scholar

Kress, G. (2009). Multimodality: A social-semiotic semiotic approach contemporary communication. Routledge.Search in Google Scholar

Lee-Wong, S. M. (2000). Politeness and face in Chinese culture. Peter Lang.Search in Google Scholar

Li, L. (2008). Requests and refusals in English and Chinese (Order No. U521656). Available from ProQuest Dissertations & Theses Global. (898745602).Search in Google Scholar

Liao, M. Z. (2003). 法庭问答及其互动研究 [Court questions-responses and their interaction research]. Legal Publishing House.Search in Google Scholar

Lu, J.-Y., Lee, Y.-H., Lee, C.-W., Wang, Y.-F., & Lee, Y.-K. (2022). Communicate with elderly patients in the medical visit: Doctors’ service experiences of a regional hospital. Journal of Social Service Research, 48 (2), 226-233.10.1080/01488376.2021.2006856Search in Google Scholar

Lyu, W. Y. (2006). 法官话语的权力支配 [The power domination of judge’s speech]. Foreign Language Research, (2), 9-13.Search in Google Scholar

Ma, X. C. (2022). 后五四时期老年人家庭秩序“危机”及其价值重构的话语变迁 [The “Crisis” of the elderly family order and its value reconstruction in the post-May 4th period]. History Teaching, (10), 28-37.Search in Google Scholar

Mayr, A. (2008). Language and power: An introduction to institutional discourse. Continuum.Search in Google Scholar

McGraw, A. P., & Warren, C. (2010). Benign violations: Making immoral behavior funny. Psychological Science, 21(8), 1141-1149.10.1177/0956797610376073Search in Google Scholar

Mills, S. (2003). Gender and politeness. Cambridge University Press.10.1017/CBO9780511615238Search in Google Scholar

Min, S. K., David, H. S., & Gu, Y. G. (1999). Medical decision making and Chinese patients’ self-construals, Health Communication, 11(3), 249-260. https://doi.org/10.1207/S15327027HC11030710.1207/S15327027HC110307Search in Google Scholar

Mullany, L. (2007). Gendered discourse in the professional workplace. Palgrave Macmillan.10.1057/9780230592902Search in Google Scholar

Nair-Brodeur, K. (1995). A discourse analysis of “office hours”: Questions and power in an academic speech event (Order No. 9619877). Available from ProQuest Dissertations & Theses Global. (304217388).Search in Google Scholar

Ninomiya, T., & Shadayeva, M. (2020). Request strategies in Kazakh and Japanese: A cross-cultural pragmatic analysis. Media Watch, 11(4), 648-667.10.15655/mw/2020/v11i4/204633Search in Google Scholar

O’Reilly, M. (2008). What value is there in children’s talk? Investigating family therapists’ interruptions of parents and children during the therapeutic process. Journal of Pragmatics, 40(3), 507-524.10.1016/j.pragma.2007.12.005Search in Google Scholar

Paramasivam, S. (2007). A discourse-oriented model for analyzing power and politeness in negotiation interaction: A cross-linguistic perspective. Journal of Universal Language, 8, 91-127.10.22425/jul.2007.8.1.91Search in Google Scholar

Perkins, M. R. (2007). Pragmatic impairment. Cambridge University Press.10.1017/CBO9780511486555Search in Google Scholar

Preisig, B. C., Eggenberger, N., Cazzoli, D., Nyffeler, T., Gutbrod, K., Annoni, J.-M., Meichtry, J. R., Nef, T., & Müri, R. M. (2018). Multimodal communication in Aphasia: Perception and production of co-speech gestures during face-to-face conversation. Frontiers in Human Neuroscience, 12, 200.10.3389/fnhum.2018.00200Search in Google Scholar

Pressman, P. S., Simpson, M., Gola, K., Shdo, S. M., Spinelli, E. G., Miller, B. L., Gorno-Tempini, M. L., Rankin, K., & Levenson, R. W. (2017). Observing conversational laughter in frontotemporal dementia. Journal of Neurology, Neurosurgery & Psychiatry, 88(5), 418-424.10.1136/jnnp-2016-314931Search in Google Scholar

Ren, Y. X. (2015). 学术互动中权势关系建构的语用分析 [Pragmatic analysis of the construction of power relations in academic interaction]. Modern Foreign Language, (2), 147-158.Search in Google Scholar

Roberts, L., Cornell, C., Bostrom, M., Goldsmith, S., Ologhobo, T., Roberts, T., & Robbins, L. (2018). Communication skills training for surgical residents: Learning to relate to the needs of older adults. Journal of Surgical Education, 75(5), 1180-1187.10.1016/j.jsurg.2018.02.005Search in Google Scholar

Spencer-Oatey, H. (1996). Reconsidering power and distance. Journal of Pragmatics, 26 (1), 1-24.10.1016/0378-2166(95)00047-XSearch in Google Scholar

Spencer-Oatey, H. (2008). Face, (im)politeness and rapport.In H. Spencer-Oatey (Eds.), Culturally speaking: Culture, communication and politeness theory (pp. 11-47). Continuum.Search in Google Scholar

Verschueren, J. (2000). Understanding pragmatics. Foreign Language Teaching and Research Press.Search in Google Scholar

Waard, C. S., Poot, A. J., den Elzen, W. P. J., Wind, A. W., Caljouw, M. A. A., & Gussekloo, J. (2018). Perceived doctor-patient relationship and satisfaction with general practitioner care in older persons in residential homes Scandinavian Journal of Primary Health Care, 36(2), 189-197.10.1080/02813432.2018.1459229Search in Google Scholar

West, C. (1983).“Ask me no questions...” In S. Fisher & A. Todd (Eds), The social organization of doctor-patient communication (pp. 127-139). The Center for Applied Linguistics.Search in Google Scholar

West, C. (1984). Routine complications: Troubles with talk between doctors and patients. Indiana University Press.Search in Google Scholar

Xu, J. N. (2018). 普通话口语中“啊、呀、哪、哇”的分布 [The distribution of “Ah, ya, na, wa” in spoken Mandarin]. Application of Language and Character, (2), 62-71.Search in Google Scholar

Yang, Z. (2019). Turn allocation within the medical-service-seeking party in Chinese accompanied medical consultations. Journal of Pragmatics, 143, 135-155.10.1016/j.pragma.2019.02.005Search in Google Scholar

Yongbing, L., & Huaqing, H. (2009). Regulative discourse in Singapore primary English classrooms: Teachers’ choices of directives. Language and Education, 23(1), 1-13.10.1080/09500780802152812Search in Google Scholar

Zhang, Y. (2021). Discursive strategies of self-promotion by doctors in online medical consultations in China: An e-commercialized practice. Applied Linguistics Review, 14(5), 1109-1128.10.1515/applirev-2020-0050Search in Google Scholar

Zhou, D. Y., & Huang, L. H. (2023). 语用障碍多模态补偿的功能和机制 [The function and mechanism of multimodal compensation for pragmatic obstacles]. Modern Foreign Language, (1), 15-28.Search in Google Scholar

Published Online: 2024-12-07
Published in Print: 2024-11-26

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