A prime example of elderspeak: Cindy Smith was visiting her father in his assisted living apartment in Roseville, California. An aide who was trying to induce him to do something \u2014 \u00a0Smith no longer remembers exactly what \u2014 said, \u201cLet me help you, sweetheart.\u201d<\/p>\n
\u201cHe just gave her The Look \u2014 under his bushy eyebrows \u2014 and said, \u2018What, are we getting married?\u2019\u201d recalled Smith, who had a good laugh, she said. Her father was then 92, a retired county planner and a World War II veteran; macular degeneration had reduced the quality of his vision, and he used a walker to get around, but he remained cognitively sharp.<\/p>\n
\u201cHe wouldn\u2019t normally get too frosty with people,\u201d Smith said. \u201cBut he did have the sense that he was a grown-up and he wasn\u2019t always treated like one.\u201d<\/p>\n
People understand almost intuitively what \u201celderspeak\u201d means. \u201cIt\u2019s communication to older adults that sounds like baby talk,\u201d said Clarissa Shaw, a dementia care researcher at the University of Iowa College of Nursing and a co-author of a recent article<\/a> that helps researchers document its use.<\/p>\n \u201cIt arises from an ageist assumption of frailty, incompetence, and dependence.\u201d<\/p>\n Its elements include inappropriate endearments. \u201cElderspeak can be controlling, kind of bossy, so to soften that message there\u2019s \u2018honey,\u2019 \u2018dearie,\u2019 \u2018sweetie,\u2019\u201d said Kristine Williams, a nurse gerontologist at the University of Kansas School of Nursing and another co-author of the article.<\/p>\n \u201cWe have negative stereotypes of older adults, so we change the way we talk.\u201d<\/p>\n Or caregivers may resort to plural pronouns: Are we ready to take our bath?<\/em> There, the implication \u201cis that the person\u2019s not able to act as an individual,\u201d Williams said. \u201cHopefully, I\u2019m not taking the bath with you.\u201d<\/p>\n Sometimes, elderspeakers employ a louder volume, shorter sentences, or simple words intoned slowly. Or they may adopt an exaggerated, singsong vocal quality more suited to preschoolers, along with words like \u201cpotty\u201d or \u201cjammies.\u201d<\/p>\n With what are known as tag questions \u2014 It\u2019s time for you to eat lunch now, right? <\/em>\u2014 \u201cYou\u2019re asking them a question but you\u2019re not letting them respond,\u201d Williams explained. \u201cYou\u2019re telling<\/em> them how to respond.\u201d<\/p>\n Studies in nursing homes show how commonplace such speech is. When Williams, Shaw, and their team analyzed video recordings of 80 interactions between staff and residents with dementia, they found that 84% involved some form of elderspeak<\/a>.<\/p>\n \u201cMost of elderspeak is well intended. People are trying to show they care,\u201d Williams said. \u201cThey don\u2019t realize the negative messages that come through.\u201d<\/p>\n For example, among nursing home residents with dementia, studies have found a relationship<\/a> between exposure to elderspeak and behaviors collectively known as resistance to care.<\/p>\n \u201cPeople can turn away or cry or say no,\u201d Williams explained. \u201cThey may clench their mouths shut when you\u2019re trying to feed them.\u201d Sometimes, they push caregivers away or strike them.<\/p>\n She and her team developed a training program called CHAT, for Changing Talk: three hourlong sessions that include videos of communication between staff members and patients, intended to reduce elderspeak.<\/p>\n It worked. Before the training, in 13 nursing homes in Kansas and Missouri, almost 35% of the time spent in interactions consisted of elderspeak; that share dropped to about 20% afterward.<\/p>\n Furthermore, resistant behaviors accounted for almost 36% of the time spent in encounters; after training, that proportion fell to about 20%.<\/p>\n A study conducted in a Midwestern hospital, again among patients with dementia, found the same sort of decline in resistance<\/a> behavior.<\/p>\n What\u2019s more, CHAT training in nursing homes was associated with lower use of antipsychotic drugs<\/a>. Though the results did not reach statistical significance, due in part to the small sample size, the research team deemed them \u201cclinically significant.\u201d<\/p>\n \u201cMany of these medications have a black box warning from the FDA,\u201d Williams said of the drugs. \u201cIt\u2019s risky to use them in frail, older adults\u201d because of their side effects.<\/p>\n Now, Williams, Shaw, and their colleagues have streamlined the CHAT training and adapted it for online use. They are examining its effects in about 200 nursing homes nationwide.<\/p>\n Even without formal training programs, individuals and institutions can combat elderspeak. Kathleen Carmody, owner of Senior Matters Home Health Care and Consulting in Columbus, Ohio, cautions her aides to address clients as Mr. or Mrs. or Ms., \u201cunless or until they say, \u2018Please call me Betty.\u2019\u201d<\/p>\n In long-term care, however, families and residents may worry that correcting the way staff members speak could create antagonism.<\/p>\n A few years ago, Carol Fahy was fuming about the way aides at an assisted living facility in suburban Cleveland treated her mother, who was blind and had become increasingly dependent in her 80s.<\/p>\n Calling her \u201csweetie\u201d and \u201choney babe,\u201d the staff \u201cwould hover and coo, and they put her hair up in two pigtails on top of her head, like you would with a toddler,\u201d said Fahy, a psychologist in Kaneohe, Hawaii.<\/p>\n Although she recognized the aides\u2019 agreeable intentions, \u201cthere\u2019s a falseness about it,\u201d she said. \u201cIt doesn\u2019t make someone feel good. It\u2019s actually alienating.\u201d<\/p>\n Fahy considered discussing her objections with the aides, but \u201cI didn\u2019t want them to retaliate.\u201d Eventually, for several reasons, she moved her mother to another facility.<\/p>\n Yet objecting to elderspeak need not become adversarial, Shaw said. Residents and patients \u2014 and people who encounter elderspeak elsewhere, because it\u2019s hardly limited to health care settings \u2014 can politely explain how they prefer to be spoken to and what they want to be called.<\/p>\n Cultural differences also come into play. Felipe Agudelo, who teaches health communications at Boston University, pointed out that in certain contexts a diminutive or term of endearment \u201cdoesn\u2019t come from underestimating your intellectual ability. It\u2019s a term of affection.\u201d<\/p>\n He emigrated from Colombia, where his 80-year-old mother takes no offense when a doctor or health care worker asks her to \u201ct\u00f3mese la pastillita\u201d (take this little pill) or \u201cmueva la manito\u201d (move the little hand).<\/p>\n That\u2019s customary, and \u201cshe feels she\u2019s talking to someone who cares,\u201d Agudelo said.<\/p>\n \u201cCome to a place of negotiation,\u201d he advised. \u201cIt doesn\u2019t have to be challenging. The patient has the right to say, \u2018I don\u2019t like your talking to me that way.\u2019\u201d<\/p>\n In return, the worker \u201cshould acknowledge that the recipient may not come from the same cultural background,\u201d he said. That person can respond, \u201cThis is the way I usually talk, but I can change it.\u201d<\/p>\n Lisa Greim, 65, a retired writer in Arvada, Colorado, pushed back against elderspeak recently when she enrolled in Medicare drug coverage.<\/p>\n Suddenly, she recounted in an email, a mail-order pharmacy began calling almost daily because she hadn\u2019t filled a prescription as expected.<\/p>\n These \u201cgently condescending\u201d callers, apparently reading from a script, all said, \u201cIt\u2019s hard to remember to take our meds, isn\u2019t it?\u201d \u2014 as if they were swallowing pills together with Greim.<\/p>\n Annoyed by their presumption, and their follow-up question about how frequently she forgot her medications, Greim informed them that having stocked up earlier, she had a sufficient supply, thanks. She would reorder when she needed more.<\/p>\n Then, \u201cI asked them to stop calling,\u201d she said. \u201cAnd they did.\u201d<\/p>\n The New Old Age is produced through a partnership with The New York Times<\/a>.<\/em><\/p>\n KFF Health News<\/a> is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF\u2014an independent source of health policy research, polling, and journalism. Learn more about KFF<\/a>.<\/p>\nUSE OUR CONTENT<\/h3>\n