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 鈥� Smith no longer remembers exactly what 鈥� said, 鈥淟et me help you, sweetheart.鈥�
鈥淗e just gave her The Look 鈥� under his bushy eyebrows 鈥� and said, 鈥榃hat, are we getting married?鈥欌�� 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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鈥淗e wouldn鈥檛 normally get too frosty with people,鈥� Smith said. 鈥淏ut he did have the sense that he was a grown-up and he wasn鈥檛 always treated like one.鈥�
People understand almost intuitively what 鈥渆lderspeak鈥� means. 鈥淚t鈥檚 communication to older adults that sounds like baby talk,鈥� 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.
鈥淚t arises from an ageist assumption of frailty, incompetence, and dependence.鈥�
Its elements include inappropriate endearments. 鈥淓lderspeak can be controlling, kind of bossy, so to soften that message there鈥檚 鈥榟oney,鈥� 鈥榙earie,鈥� 鈥榮weetie,鈥欌�� said Kristine Williams, a nurse gerontologist at the University of Kansas School of Nursing and another co-author of the article.
鈥淲e have negative stereotypes of older adults, so we change the way we talk.鈥�
Or caregivers may resort to plural pronouns: Are we ready to take our bath? There, the implication 鈥渋s that the person鈥檚 not able to act as an individual,鈥� Williams said. 鈥淗opefully, I鈥檓 not taking the bath with you.鈥�
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 鈥減otty鈥� or 鈥渏ammies.鈥�
With what are known as tag questions 鈥� It鈥檚 time for you to eat lunch now, right? 鈥� 鈥淵ou鈥檙e asking them a question but you鈥檙e not letting them respond,鈥� Williams explained. 鈥淵ou鈥檙e telling them how to respond.鈥�
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 .
鈥淢ost of elderspeak is well intended. People are trying to show they care,鈥� Williams said. 鈥淭hey don鈥檛 realize the negative messages that come through.鈥�
For example, among nursing home residents with dementia, between exposure to elderspeak and behaviors collectively known as resistance to care.
鈥淧eople can turn away or cry or say no,鈥� Williams explained. 鈥淭hey may clench their mouths shut when you鈥檙e trying to feed them.鈥� 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.
What鈥檚 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 鈥渃linically significant.鈥�
鈥淢any of these medications have a black box warning from the FDA,鈥� Williams said of the drugs. 鈥淚t鈥檚 risky to use them in frail, older adults鈥� 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., 鈥渦nless or until they say, 鈥楶lease call me Betty.鈥欌��
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 鈥渟weetie鈥� and 鈥渉oney babe,鈥� the staff 鈥渨ould hover and coo, and they put her hair up in two pigtails on top of her head, like you would with a toddler,鈥� said Fahy, a psychologist in Kaneohe, Hawaii.
Although she recognized the aides鈥� agreeable intentions, 鈥渢here鈥檚 a falseness about it,鈥� she said. 鈥淚t doesn鈥檛 make someone feel good. It鈥檚 actually alienating.鈥�
Fahy considered discussing her objections with the aides, but 鈥淚 didn鈥檛 want them to retaliate.鈥� Eventually, for several reasons, she moved her mother to another facility.
Yet objecting to elderspeak need not become adversarial, Shaw said. Residents and patients 鈥� and people who encounter elderspeak elsewhere, because it鈥檚 hardly limited to health care settings 鈥� 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 鈥渄oesn鈥檛 come from underestimating your intellectual ability. It鈥檚 a term of affection.鈥�
He emigrated from Colombia, where his 80-year-old mother takes no offense when a doctor or health care worker asks her to 鈥渢贸mese la pastillita鈥� (take this little pill) or 鈥渕ueva la manito鈥� (move the little hand).
That鈥檚 customary, and 鈥渟he feels she鈥檚 talking to someone who cares,鈥� Agudelo said.
鈥淐ome to a place of negotiation,鈥� he advised. 鈥淚t doesn鈥檛 have to be challenging. The patient has the right to say, 鈥業 don鈥檛 like your talking to me that way.鈥欌��
In return, the worker 鈥渟hould acknowledge that the recipient may not come from the same cultural background,鈥� he said. That person can respond, 鈥淭his is the way I usually talk, but I can change it.鈥�
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 hadn鈥檛 filled a prescription as expected.
These 鈥済ently condescending鈥� callers, apparently reading from a script, all said, 鈥淚t鈥檚 hard to remember to take our meds, isn鈥檛 it?鈥� 鈥� 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, 鈥淚 asked them to stop calling,鈥� she said. 鈥淎nd they did.鈥�
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