1. Introduction

This chapter discusses power relations in older adults' cognitive assessment interactions in clinical settings, highlighting the lack of focus on interactions in cognitive assessment in the context of population aging. It emphasizes the significance of age in doctor-elderly patient communication and the successful delivery of healthcare services, especially in the Chinese context. The chapter also points out the importance of considering both verbal and non-verbal communicative resources in the study of pragmatic interaction, as well as the need for a detailed analysis of power relations from a multimodal perspective. Additionally, it outlines the study's intention to examine power relation types, construction strategies, and the effects of age and expertise on power relations in cognitive assessment.

2. Power Relations in Clinical Settings

This chapter discusses power relations in clinical settings, exploring diverse definitions of power and the concept of negotiated power. It examines power dynamics in doctor-patient interactions, noting the asymmetry in medical relationships. The role of language in power relations is also discussed, illustrating discourse strategies for constructing power. There is a need for more systematic research on the construction of power in cognitive assessment both domestically and internationally, particularly in examiner-elderly patient interactions. The chapter also highlights the significance of non-verbal signals and multimodal communicative resources in power relation studies, particularly in the context of cognitive assessment with older adults.

3. Analytical Framework

This chapter discusses the characteristics of choice-making in linguistic communication and how power relationships in communication are constructed through multimodal pragmatic resources. It also explains the role of power in controlling discourse and the adaptation of language and nonlinguistic modes in communication. Additionally, it explores power asymmetry in institutional interactions and introduces a multimodal pragmatic analytical framework for analyzing the interaction between older adults and examiners in cognitive assessment.

4. Research Design

This chapter describes the research questions and data collection and processing methods used in the study. The research questions aim to examine the construction characteristics of power relations in the examiner-patient interaction during cognitive assessment, while the data was collected from nine Chinese older adults and their examiners using the Chinese version of the Montreal Cognitive Assessment-Basic (MoCA-B). The data segmentation and annotation followed a working scheme for multimodal pragmatic analysis and involved the analysis of prosodic features, gaze, smile, and other non-verbal acts.

5. Results

The examiner primarily constructs high power in cognitive assessment interaction. Examiners hold authority to make requests, interruptions, evaluations, directives, and inquiries, and utilize various discourse strategies and language forms. Non-verbal acts and multimodal resources are also utilized to enforce their power. Interrupting the older adult establishes the institutional high power of the examiner. Evaluations for each response from the older adult maintain control over the interaction process, establishing high power. Directive acts, rhetorical questions, and explanations are also employed to assert high or low power.

6. Conclusion

This chapter discussed the power dynamics between examiners and older adults during cognitive assessments, highlighting the use of discourse strategies to assert or express power. The pragmatic motivations of both parties contribute to different power relations, with examiners exerting high power due to their role and expertise, while older adults construct low power to maintain their cheerful faces. Both parties also utilize non-verbal communicative resources to exercise power synergistically. Additionally, aging can affect power relations construction in examiner-elderly patient interaction, and both parties gravitate towards rapport-focused discourse strategies to mitigate power imbalances. Politeness in discourse negotiation does not imply powerlessness, but underscores shared goals of deference and rapport.