A prime example of Elderspeak: Cindy Smith was visiting with his father in his supported living apartment in Roseville, California.
“He just gave her a look under his bushy brows and said, 'What are we married?”,” she said.
Her father was 92 years old, a retired county planner and a World War II veteran. Macular degeneration reduced the quality of his vision and he avoided it using pedestrians, but he remained cognitively sharp.
“He's not usually too calm with people,” Smith said. “But he had the feeling that he was an adult, and he wasn't always treated like that.”
People almost intuitively understand what “Elderspeak” means. Clarissa Shaw, a dementia care researcher at the University of Iowa University of Nursing and a co-author of a recent article that helps researchers document their use, said:
“It arises from the age-ist assumptions of frailty, incompetence and dependency.”
That element includes inappropriate affection. “Elderspeak is like a boss, so there are “honey,” “Dearie,” and “Sweetie” to soften that message,” says Kristine Williams, a nurse gerontologist at the University of Kansas's Faculty of Nursing and another co-author.
“We have negative stereotypes of older people, so we change the way we speak.”
Or, caregivers may resort to multiple pronouns: Are we ready to take a bath? There, “they can't act as an individual,” Dr. Williams said. “Hopefully, I'm not taking a bath with you.”
Sometimes, ElderSpeakers use loud, short sentences, or simple words that are slowly interned. Alternatively, they may adopt exaggerated singing quality that is more suitable for preschoolers, along with words like “toilet” or “jammy.”
There's a question about what you're talking about – it's time to have lunch, right? – “You're asking them questions, but you're not letting them respond,” explained Dr. Williams. “You're telling them how to deal with them.”
Nursing home research shows how common such speeches are. When Dr. Williams, Dr. Shaw, and their team analyzed video recordings of 80 interactions between staff and dementia residents, they found that 84% were involved in some form of elder speaking.
“Most of the ElderSpeak is well intended. People are trying to take care of themselves,” Dr. Williams said. “They don't understand the negative messages that go through.”
For example, among residents of nursing homes with dementia, the study found a relationship between exposure to elders and behaviors that are collectively known as resistance to care.
“People can turn their backs, cry, say no,” explained Dr. Williams. “They may shut their mouths when you're trying to feed them.” Sometimes they push their caregivers away or attack them.
She and her team developed a training program called Chat (Thing for Change Talk), a three-hour session that includes communication videos between staff and patients, aimed at reducing ElderSpeak.
That worked. Before training, 13 nursing homes in Kansas and Missouri consisted of almost 35% of the time spent interacting with them consisted of elder speakers. That number has since been around 20%.
At the same time, resistance behavior accounted for almost 36% of the time spent in encounters. After training, that percentage fell to about 20%.
Among patients with dementia, a study conducted at Midwest Hospital found the same type of decline in resistant behavior.
Furthermore, chat training in nursing homes was associated with reduced antipsychotic medication use. The results did not reach statistical significance, but the researchers considered them “clinical significance” because of some small sample sizes.
“Many of these drugs have a black box warning from the FDA,” Dr. Williams said of the drug. “It's dangerous to use them in frail elderly people” due to side effects.
Now, Dr. Williams, Dr. Shaw and his colleagues have streamlined chat training and adapted it for online use. They are examining its effectiveness in around 200 nursing homes across the country.
Without a formal training program, individuals and institutions can compete with Elderspeak. Kathleen Carmody, owner of Senior Matters Home Care and Consulting in Columbus, Ohio, warns that he is addressing his clients as Mr or Mrs or Mrs or Mrs or Mrs unless he says “call me” or as Mrs or Mrs or Mrs or Mrs.
However, in long-term care, families and residents may be concerned that modifying the way staff speaks can create hostility.
A few years ago, Carol Fahe dealt with a mother who was blind to aides at a support facility outside Cleveland, increasingly dependent in the '80s.
Calling her “sweetie” and “honey baby,” staff members “hover and COO, and like toddlers, they put hair in two pigtails above their heads,” said Fahi, 72, a psychologist from Kaneohe, Hawaii.
She recognized the aide's comfortable intentions, but “there is a false statement about that,” she said. “No one feels good. They're actually alienated.”
Fahee considered discussing her objection with her aide, but “I didn't want to retaliate against them.” Eventually, for several reasons, she moved her mother to another facility.
But opposing Elderspeke doesn't have to be hostile, Dr. Shaw said. Residents and patients, and those who meet Elderspeak elsewhere, can be politely explained how they want to be spoken and what they are called, as it is rarely limited to a medical setting.
Cultural differences also play an active role. Felipe Agudero, a teacher of health communication at Boston University, noted that in certain contexts, the small terms of affection or terminology “doesn't come from underestimating your intellectual abilities. It's a term of affection.”
He moved from Colombia. There, his 80-year-old mother does not attack when a doctor or healthcare worker asks her to “Tómesela pastilita” (take this little pill) or “Muebaramanit” (moving small hands).
It's conventional and “she feels like she's talking to someone she cares about,” Dr. Agudero said.
“Come to the place of negotiation,” he advised. “There's no need to challenge. Patients have the right to say, 'I don't like you talking to me that way.' ”
In return, workers should “acknowledge that the recipient may not come from the same cultural background,” he said. The person said, “This is the way I talk all the time, but I can change that.”
Lisa Graeme, 65, a retired writer from Alvada, Colorado, recently opposed ElderSpeak when she signed up for Medicare drug coverage.
Suddenly, she said via email, mail order pharmacies started calling almost daily, as they didn't meet their prescriptions as expected.
These “mellishly mean” callers apparently read from the script. – Mr. Graeme, as if they were swallowing pills.
Angry at their estimates, and to their follow-up questions about how often she forgot her medication, Ms. Graeme informed them that they had stock early, she had adequate supply, thank you. She sorts when she needs more.
“I asked them to stop calling,” she said. “And they did.”
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