The Perils of Elderspeak
Introduction to Elderspeak
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 — Smith no longer remembers exactly what — said, “Let me help you, sweetheart.”
“He just gave her The Look — under his bushy eyebrows — and said, ‘What, are we getting married?’” 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.
“He wouldn’t normally get too frosty with people,” Smith said. “But he did have the sense that he was a grown-up and he wasn’t always treated like one.”
What is Elderspeak?
People understand almost intuitively what “elderspeak” means. “It’s communication to older adults that sounds like baby talk,” said Clarissa Shaw, a dementia care researcher at the University of Iowa College of Nursing and a co-author of a recent article that helps researchers document its use.
“It arises from an ageist assumption of frailty, incompetence, and dependence.”
Its elements include inappropriate endearments. “Elderspeak can be controlling, kind of bossy, so to soften that message there’s ‘honey,’ ‘dearie,’ ‘sweetie,’” said Kristine Williams, a nurse gerontologist at the University of Kansas School of Nursing and another co-author of the article.
“We have negative stereotypes of older adults, so we change the way we talk.”
Characteristics of Elderspeak
Or caregivers may resort to plural pronouns: Are we ready to take our bath? There, the implication “is that the person’s not able to act as an individual,” Williams said. “Hopefully, I’m not taking the bath with you.”
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 “potty” or “jammies.”
With what are known as tag questions — It’s time for you to eat lunch now, right? — “You’re asking them a question but you’re not letting them respond,” Williams explained. “You’re telling them how to respond.”
The Prevalence of Elderspeak
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.
“Most of elderspeak is well intended. People are trying to show they care,” Williams said. “They don’t realize the negative messages that come through.”
Consequences of Elderspeak
For example, among nursing home residents with dementia, studies have found a relationship between exposure to elderspeak and behaviors collectively known as resistance to care.
“People can turn away or cry or say no,” Williams explained. “They may clench their mouths shut when you’re trying to feed them.” Sometimes, they push caregivers away or strike them.
Combating Elderspeak
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 the same sort of decline in resistance behavior.
Online Training and Cultural Differences
What’s more, CHAT training in nursing homes was associated with lower use of antipsychotic drugs. Though the results did not reach statistical significance, due in part to the small sample size, the research team deemed them “clinically significant.”
“Many of these medications have a black box warning from the FDA,” Williams said of the drugs. “It’s risky to use them in frail, older adults” 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., “unless or until they say, ‘Please call me Betty.’”
Conclusion
Elderspeak is a pervasive issue in healthcare settings, with negative consequences for older adults. However, by understanding its characteristics, prevalence, and consequences, we can work to combat it. Training programs like CHAT and increased awareness can help reduce elderspeak and promote more respectful communication with older adults.
FAQs
- What is elderspeak?
Elderspeak refers to communication to older adults that sounds like baby talk, arising from ageist assumptions of frailty, incompetence, and dependence. - What are the characteristics of elderspeak?
Characteristics of elderspeak include inappropriate endearments, plural pronouns, louder volume, shorter sentences, simple words intoned slowly, and exaggerated vocal quality. - What are the consequences of elderspeak?
Consequences of elderspeak include resistance to care, such as turning away, crying, or saying no, and increased use of antipsychotic drugs. - How can we combat elderspeak?
We can combat elderspeak through training programs like CHAT, increased awareness, and promoting respectful communication with older adults. - Is elderspeak limited to healthcare settings?
No, elderspeak is not limited to healthcare settings and can occur in various contexts, including daily interactions with older adults.
