"Elderspeak" puts elderly health at risk

Today's health care provider works to promote health and successful aging of the growing population of older adults. Unknowingly, younger care providers may communicate messages of dependence, incompetence and control to older adults through the use of elderspeak, a common intergenerational speech style.

A U.S. study suggests the terms "dear" and "sweetie" are insulting forms of so-called elderspeak that can damage the health of elderly patients.

Becca Levy, an associate professor of epidemiology and psychology at Yale University, said elderspeak can lead to more negative images of aging that can lower rates of survival, The New York Times reported Tuesday.

Kristine Williams, a nurse gerontologist and associate professor at the University of Kansas School of Nursing, said researchers found that nursing home patients became more aggressive and less cooperative when nurses used phrases like "good girl" or "How are we feeling?"

The findings, which will be published in The American Journal of Alzheimer's Disease and Other Dementias, suggest elderspeak sent a message that the patient was incompetent and "begins a negative

downward spiral for older persons, who react with decreased self-esteem, depression, withdrawal and the assumption of dependent behaviors."

"They also tend to alter the pronouns, so they might say, 'Are we ready for our bath?' That really gives the message that the person isn't able to act independently, instead of, 'Are you ready for me to help you with your bath?'," Williams explained.

"What, theoretically, we think is going on is that younger people have stereotypes of older adults as being less able to communicate, less competent in a lot of different areas," she said. According to Williams, the tendency of a caregiver to use "elderspeak" rises with the perceived level of infirmity in the patient.

Experts have long noted that mentally competent elderly patients in hospitals and nursing homes are irritated by "elderspeak." But would the same be true for Alzheimer's patients with dementia?

To find out, Williams' team videotaped the interactions of nurses and nursing assistants tending to the daily needs of 20 nursing home residents. The residents ranged between 69 and 97 years of age, and had moderate levels of dementia.

The researchers used a measure called the Resistiveness to Care Scale to gauge the intensity of behaviors that tended to disrupt care. This "resistiveness" included actions like grabbing onto persons or objects, turning away, pulling the limbs tightly to the body, saying no or crying out, hitting or kicking.

Whenever such behaviors occurred, the researchers rewound the tape seven seconds to see what type of communication (if any) might have precipitated it.

"What we found was that they were more likely to be resistive to care if the nurses were using the 'elderspeak' communication compared to the normal adult-to-adult kind of talk," Williams said.

"There's the suggestion that these people are unable to communicate that their needs aren't being met. And because they can't communicate verbally, they may respond in these other nonverbal ways," Williams said. The "need" in question could be as simple as the desire to be thought of as an adult person worthy of respect, she added.

So, what should family members do if they witness "elderspeak" in an assisted-care setting? Lecturing staff might not be the smartest route to take, Williams said. However, a gentle reminder of just who the patient or resident is might help.

"Try and tell them a little bit about your loved one, that they were a high-functioning adult," she said. "To get them thinking more of the person in terms of that competent adult framework. That might be a better approach."