“Hi, honey.” 

“How are we doing today?” 

“Are we ready for therapy?” 

These quotes contain elderspeak, or infantilizing communication, and have been said to older adults living in nursing facilities. Many of us who communicate with older adults are guilty of using elderspeak at some point or another. 

Communication and Context

It’s true that the way we communicate changes based on context. Language and register vary depending on the people we talk to, the setting in which we communicate, and the things that we talk about. For example, people often use infant-directed speech (also known as ‘baby talk’) when speaking to infants. This includes using melodic, exaggerated, slower, and repetitive speech, which can help with language development. Sometimes, however, a similar register (aka, elderspeak) is used when talking to older adults. 

Elderspeak and Cultural Sensitivity 

Research shows that elderspeak may stem from the stereotype that younger adults are more capable than older adults. Elderspeak and the implications of the accompanying stereotypes may jeopardize an individual’s self-concept and feelings of competence and independence. In addition, elderspeak correlates with resistance to care in people with dementia in nursing home settings (Williams et al., 2009). It seems that the main issue with elderspeak is that it disrupts communication by raising feelings of communicative incompetence and patronization (Kemper & Harden, 1999). 

Yet for some older adults, elderspeak can actually be perceived as comforting and warm. Therefore, it’s important to apply person-centered communication to treatment and interactions with these (and all) individuals. Like person-centered care, person-centered communication validates peoples’ feelings, preferences, and needs, and collaborates with them to meet their personal goals (Ryan, Martin & Beaman, 2005). Ultimately, we must recognize that age is a part of an individual’s identity and should be treated as such. Person-centered communication takes age into account, as well as other aspects of an individual’s identity, such as race, religion, and gender identity (Williams et al., 2018). 

Communication and Aging

As people age, communicating may become increasingly difficult. The ability to express ideas and comprehend what others say changes both in typical and pathological aging (e.g., dementia). It may become more difficult to keep track of conversation and keep up with conversational demands because of subtle changes in working memory. Other changes that affect cognition, hearing, and vision can all play a role in the communication changes that take place with healthy aging. 

Although there are some subtle communication differences as healthy individuals age, there are more pronounced impairments in individuals with dementia and other degenerative neurologic conditions. Communication in dementia varies greatly based on both the individual and the disease progression. As the dementia becomes more severe, word retrieval becomes increasingly challenging. Conversation and discourse also tend to contain fewer meaningful ideas and be less topically related. Even though people with dementia may have more difficultly communicating, they still react to the presence of elderspeak. But does using elderspeak help or hinder effective communication? Well, it depends.

The Do’s and Don’ts of Elderspeak:

Despite overall negative feelings toward elderspeak among adults, there are still some aspects that can be helpful for those who are struggling with communication.

The Do’s

  1. Do repeat and expand what you say – Repeating and elaborating what you’re trying to communicate can support comprehension in adults with and without dementia. 
  2. Do speak directly to the individual – When providing instructions or information, make sure to speak directly to the individual you are talking to, rather than directing your attention to a younger caregiver. This shows the person the respect they deserve. 
  3. Do give the patient time to respond – It can be tempting to interject or to speak for someone who is taking a while to respond. By providing more time, however, you allow the individuals to process and to have their own voice.
  4. Do minimize distractions – When communicating, make sure to do so in a quiet space where the individual can focus and hear. If the person has hearing amplification, make sure they are able to use it. 
  5. Do reduce the number of clauses in your sentences – Limiting subordinate clauses can help reduce processing demands. This does not mean you need to simplify the grammar of the sentence. Rather, be aware of the embedded phrases in the sentence that may be make the sentence harder to process. 

The Dont’s

  1. Don’t use exaggerated pitch – Changing prosody (as is done in baby talk) increases negative self-perceptions and perceptions of the speaker. To maximize communicative success, talk to the individual in the same tone as you would talk with any other adult. 
  2. Don’t speak slower – Although slower speech rate may be a part of some communication strategy programs, there is no evidence that this is specifically helpful for this population.  
  3. Don’t use collective pronouns – Again, using collective pronouns like “we” and “us” can sound condescending, but so many of us are guilty of using them. Instead of asking, “Are we ready to get started?,” ask, “Are you ready to get started?” 
  4. Don’t use diminutives – Diminutives are nicknames, which can be terms of endearment, but can also convey smallness, such as “honey,” “sweetie,” and “darling.” I’ve even once heard a therapist say to a ninety-year-old woman, “way to go, kiddo!” This is clearly inappropriate and insensitive to the individual’s age. When beginning to work with someone, make sure to note their preferred title and use that unless the individual gives permission otherwise. 
  5. Don’t simply shorten your sentences – While it would make sense that shortening sentences would help comprehension, using several short sentences increases demands on working memory. Instead, try to just reduce the number of clauses in a sentence. (Kemper & Harden, 1999)

Sources:

Kemper, S., & Harden, T. (1999). Experimentally disentangling what’s beneficial about elderspeak from what’s not. Psychology and Aging, 14(4), 656-70.

Ryan, E., Martin, L., & Beaman, A. (2005). Communication strategies to promote spiritual well-being among people with dementia. The Journal of Pastoral Care & Counseling : Jpcc, 59(1-2), 43-55.

Williams, K., Herman, R., Gajewski, B., & Wilson, K. (2009). Elderspeak communication: Impact on dementia care. American Journal of Alzheimer’s Disease and Other Dementias, 24 (1), 11-20. 

Williams, K., Perkhounkova, Y., Jao, Y., Bossen, A., Hein, M., Chung, S., Turk, M. (2018). Person-centered communication for nursing home residents with dementia: Four communication analysis methods. Western Journal of Nursing Research, 40(7), 1012-1031.


Kayla Kaplan is part of the the Cultural and Linguistic Diversity program for Speech-Language Pathology students at the University of Maryland. The program aims to broaden students’ understanding of culture and language in order to minimize disparities in service delivery to culturally and linguistically diverse populations.