“It’s time to take your pills now, sweetie.”
“Hey, chief, are you ready to go to your physical therapy appointment?”
“Let’s go potty now, honey.”
Just seeing these often-uttered phrases on your screen may set your teeth on edge. That’s because countless caregivers have either heard (or been on the receiving end of) so-called “elderspeak”—the slow, simplistic, exaggerated tone of voice that younger individuals often use when addressing older adults. Peppered with terms of endearment, such as sweetie, hun and chief, even when well-intentioned, elderspeak can come off as condescending and breed resentment and miscommunication between older adults and their care providers. In fact, the words we use with seniors and how we say them can even result in quite a few negative health consequences.
Studies indicate that a significant percentage of interactions between residents and staff members in long-term care facilities involve some variation of elderspeak. Unfortunately, most caregivers who resort to this speech pattern do so with the goal of enhancing interactions with their elders, not degrading them. Everyone communicates differently, but it’s important to understand the risks of using elderspeak. For some seniors, “endearing” pet names and juvenile turns of phrase can erode their self-esteem and hopes for the future.
Words Have Consequences
Most people are familiar with the popular children’s rhyme, “Sticks and stones may break my bones, but words will never hurt me.” It is wonderful in theory, but research on how elderspeak can affect an aging adult’s mental and physical well-being refutes the premise of this old adage.
A group of scientists led by Becca Levy, PhD, Professor of Public Health (Social and Behavioral Sciences) and Psychology at the Yale School of Public Health, discovered that older individuals who were subjected to negative stereotypes of aging were far more likely to have memory and balance problems. Additionally, other studies have shown that older people who have a more optimistic attitude about aging could potentially outlive their not-so-positive counterparts by more than seven years.
Levy’s study didn’t investigate elderspeak in particular, but individuals who encounter condescending communication styles from their doctors, nurses and other people in their communities may be more prone to developing a pessimistic outlook about getting older.
Kristine Williams, RN, PhD, associate professor of nursing at the University of Kansas, did conduct a study that delved into the specific effects of elderspeak on older adults’ health. Williams found that people with Alzheimer’s disease became more aggressive and resistant to care when their care providers used elderspeak.
Not only does this affect the care that these dementia patients receive (or do not receive), but it can also impact the welfare of their caregivers, both professional and informal.
“The disruptive interaction adds to caregiver stress and burnout and contributes to staff turnover and increased costs of care in residential settings,” says Williams.
Why Do Caregivers Use Elderspeak?
Men and women who employ elderspeak don’t usually do so because they are blatantly ageist or trying to be patronizing. The more likely cause for their changes in speech when addressing older individuals is a phenomenon referred to as communication accommodation theory (CAT), which argues that people change how they act and speak based on who they are conversing with.
These alterations are often subconscious and made with the intent of fostering stronger interactions by catering to the perceived handicaps of the other conversant(s). A common example of communication accommodation that most people are familiar with occurs when an individual raises the volume of their voice, slows down their speech and uses simpler words while conversing with someone they know (or assume) is hard of hearing. However, when it comes to evaluating and accommodating an older adult’s conversational needs, younger people are prone to overcompensation, often resulting in elderspeak. Essentially, too much of a good thing isn’t necessarily better.
According to a study conducted by scientists at Minnesota State University and Oklahoma State University, there are certain scenarios that appear more likely to result in professional care providers’ use of elderspeak. Researchers surveyed certified nursing assistants (CNAs) from several long-term care facilities in the Midwest and found that three factors influenced the use of elderspeak among nursing home and assisted living staff members: familiarity with the resident, whether the resident had dementia, and whether the resident was alone or there were other people present during the interaction. CNAs were more likely to use elderspeak when they knew the resident well, with residents who had some form of dementia, and/or in cases where no family members or other residents were present.
Tips for Avoiding Elderspeak
One of the best ways for family caregivers and professional caregivers to refrain from using elderspeak is to focus on an older adult’s strengths, rather than their weaknesses.
“Negative factors/cues appear to increase the likelihood and perceived appropriateness of elderspeak use,” study authors note. “Perhaps actively attending to residents’ strengths as opposed to solely deficits or perceived deficits would be beneficial.”
Also, keep in mind that no matter how much an aging loved one may decline physically or mentally, they are still an adult. Make a conscious effort to use words and a tone of voice that infuse dignity into the care you provide, especially with tasks that can be embarrassing, such as bathing, toileting and dressing. For example, opt for “going to the restroom” instead of “going potty” and “briefs” in lieu of “diapers.” Providing reminders and instructions can be done gently and in a pleasant way without infantilizing your care recipient.
There is no doubt that catering to our loved ones’ physical and mental needs while keeping their strengths and abilities in mind is a challenge. A good rule of thumb is to interact with all elders in the way you would want to be treated if the tables were turned.