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 â Smith no longer remembers exactly what â said, âLet me help you, sweetheart.â
âHe just gave her The Look â under his bushy eyebrows â and said, âWhat, are we getting married?ââ 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.
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âHe wouldnât normally get too frosty with people,â Smith said. âBut he did have the sense that he was a grown-up and he wasnât always treated like one.â
People understand almost intuitively what âelderspeakâ means. âItâs communication to older adults that sounds like baby talk,â said Clarissa Shaw, a dementia care researcher at the University of Iowa College of Nursing and a co-author of that helps researchers document its use.
âIt arises from an ageist assumption of frailty, incompetence, and dependence.â
Its elements include inappropriate endearments. âElderspeak can be controlling, kind of bossy, so to soften that message thereâs âhoney,â âdearie,â âsweetie,ââ said Kristine Williams, a nurse gerontologist at the University of Kansas School of Nursing and another co-author of the article.
âWe have negative stereotypes of older adults, so we change the way we talk.â
Or caregivers may resort to plural pronouns: Are we ready to take our bath? There, the implication âis that the personâs not able to act as an individual,â Williams said. âHopefully, Iâm not taking the bath with you.â
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 âpottyâ or âjammies.â
With what are known as tag questions â Itâs time for you to eat lunch now, right? â âYouâre asking them a question but youâre not letting them respond,â Williams explained. âYouâre telling them how to respond.â
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 .
âMost of elderspeak is well intended. People are trying to show they care,â Williams said. âThey donât realize the negative messages that come through.â
For example, among nursing home residents with dementia, between exposure to elderspeak and behaviors collectively known as resistance to care.
âPeople can turn away or cry or say no,â Williams explained. âThey may clench their mouths shut when youâre trying to feed them.â Sometimes, they push caregivers away or strike them.
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.
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.
Furthermore, resistant behaviors accounted for almost 36% of the time spent in encounters; after training, that proportion fell to about 20%.
A study conducted in a Midwestern hospital, again among patients with dementia, found behavior.
Whatâs more, CHAT training in nursing homes was associated with . Though the results did not reach statistical significance, due in part to the small sample size, the research team deemed them âclinically significant.â
âMany of these medications have a black box warning from the FDA,â Williams said of the drugs. âItâs risky to use them in frail, older adultsâ because of their side effects.
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.
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., âunless or until they say, âPlease call me Betty.ââ
In long-term care, however, families and residents may worry that correcting the way staff members speak could create antagonism.
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.
Calling her âsweetieâ and âhoney babe,â the staff âwould hover and coo, and they put her hair up in two pigtails on top of her head, like you would with a toddler,â said Fahy, a psychologist in Kaneohe, Hawaii.
Although she recognized the aidesâ agreeable intentions, âthereâs a falseness about it,â she said. âIt doesnât make someone feel good. Itâs actually alienating.â
Fahy considered discussing her objections with the aides, but âI didnât want them to retaliate.â Eventually, for several reasons, she moved her mother to another facility.
Yet objecting to elderspeak need not become adversarial, Shaw said. Residents and patients â and people who encounter elderspeak elsewhere, because itâs hardly limited to health care settings â can politely explain how they prefer to be spoken to and what they want to be called.
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 âdoesnât come from underestimating your intellectual ability. Itâs a term of affection.â
He emigrated from Colombia, where his 80-year-old mother takes no offense when a doctor or health care worker asks her to âtĂłmese la pastillitaâ (take this little pill) or âmueva la manitoâ (move the little hand).
Thatâs customary, and âshe feels sheâs talking to someone who cares,â Agudelo said.
âCome to a place of negotiation,â he advised. âIt doesnât have to be challenging. The patient has the right to say, âI donât like your talking to me that way.ââ
In return, the worker âshould acknowledge that the recipient may not come from the same cultural background,â he said. That person can respond, âThis is the way I usually talk, but I can change it.â
Lisa Greim, 65, a retired writer in Arvada, Colorado, pushed back against elderspeak recently when she enrolled in Medicare drug coverage.
Suddenly, she recounted in an email, a mail-order pharmacy began calling almost daily because she hadnât filled a prescription as expected.
These âgently condescendingâ callers, apparently reading from a script, all said, âItâs hard to remember to take our meds, isnât it?â â as if they were swallowing pills together with Greim.
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.
Then, âI asked them to stop calling,â she said. âAnd they did.â
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