Don’t call me ‘honey’: Avoiding elderspeak

“You don’t really want to wear THAT, do you, sweetie?”

“Wait for me to help you, or you’ll hurt yourself.”

"Are we ready for our bath today?"

Elderspeak is the use of language that coddles older adults by focusing on their age and frailties instead of their abilities.  Psychologists have long protested the use of such terms in senior care, but the long-term care industry is still realizing how the words we use—and how we say them—can affect a resident’s reactions and ultimately quality of life.

The use of “baby talk,” ageist terminology and pandering tones can prompt resident reactions ranging from silent offense to oppression. For residents with dementia, the reactions can be much more dramatic, including screaming, crying, frustrated outbursts and angry resistance to care, noted a landmark study by researchers at the University of Kansas School of Nursing and published in the American Journal of Alzheimer’s Disease and Other Dementias in 2009.

When healthcare professionals use elderspeak, they usually aren’t intentionally trying to be insulting. “But they don’t realize the implications,” Kristine Williams, a nurse gerontologist and lead author on the Kansas study, told the New York Times. “It’s also giving messages to older adults that they’re incompetent. If you know you’re losing your cognitive abilities and trying to maintain your personhood, and someone talks to you like a baby, it’s upsetting to you.”

But aren’t we just trying to be nurturing? Using elderspeak on the job is caregiving gone wrong, explain Pamela Sims, MSN, RN, and Frances Civilette Downs, PhD, RN, in a presentation given through the Center on Aging at Miami University. Diminutive terms and “infantilizing communication” are disrespectful and demeaning. Worse, some words and gestures can be misinterpreted as badgering or subordination. Then, it’s not too many steps before someone could be accusing your staffer of psychological abuse, the presentation adds.

Words also change in hue over time, which can muddle the context and lead to misunderstandings. Words like “gay,” “precious” and “dear” have changed quite a bit in meaning since the 1940s and 50s, when many residents were young. Likewise, terms like “frail,”  “forgetful” and even “elderly” have declining degrees of acceptance these days, because they suggest inability, dependence or negativity. The same goes for industry terms such as “facility” and “continuing care retirement community,” the latter of which LeadingAge campaigned to change to “life care community” in 2015.

Most elderspeak tends to occur while caregivers are assisting with activities of daily living (ADLs), Williams says. Caregivers should focus on decision-making as a resident/staff partnership—the hallmark of person-centered care—instead of reinforcing negative stereotypes about aging by detaching the resident from the choices in his or her daily life.

Be upfront about asking residents what they prefer to be called and always err on the side of formality, Sims and Downs suggest. Calling a resident “sir” or “Mr. Jones” may seem overly formal depending on the setting, but it elicits more respect than “sweetie”—and just might assist the caregiving process along the way.

Pamela Tabar

Pamela Tabar was editor-in-chief of I Advance Senior Care from 2013-2018. She has worked as a writer and editor for healthcare business media since 1998, including as News Editor of Healthcare Informatics. She has a master’s degree in journalism from Kent State University and a master’s degree in English from the University of York, England.