The Problems With Elderspeak

Elderspeak is a term that refers to the way some people speak to older adults, especially those with Alzheimer's disease or another kind of dementia. Elderspeak involved speaking slowly, using a high-pitched voice, using terms of endearment such as "honey" or "sweetheart," and speaking to the adult as if he was an infant or young child. For that reason, elderspeak is also described as using communication that "infantilizes" the adult.

close-up of a senior woman with her eyes closed
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"Oh Honey Bun, you want to go to bed, don't you?"

"Sweetie, you're just so cute!"

"Is our tummy hungry for some foodie?"

So what's so bad about it?

It's Irritating, Degrading, and Patronizing

That person you're speaking with is an adult who's had many experiences in life. He or she may have raised children, run a company, served our country in the military, directed a board meeting, cooked up amazing dinners, and ran a marathon. Treat adults like adults.

It Contributes to Depersonalization

Using inappropriate terms of endearment instead of names can cause you to think in a vague way about the person with whom you're speaking and make it easier to forget that he is an individual with a unique personality and specific preferences. We should be moving toward person-centered care, not away from it. Remember that this individual has a name. Ask him what he would like to be called and do it. For example: "Do you prefer Mr. Smith or Fred?"

It Implies Power

Even when someone has dementia (and sometimes, especially in dementia), our non-verbal communication such as tone, the pitch of voice, and demeanor can speak very loudly to others. Elderspeak can seem to say, "I'm in charge of you because you're old and helpless."

It Conveys the Presumed Incompetence of the Elder

A recent study found that elderspeak was significantly more likely to occur when interacting with someone with dementia. A patronizing tone conveys that the elder is in desperate need of direction because she's just the same as a child. She's not a child, and her memory loss requires compassion, not pity.

It Increases Challenging Behaviors

Multiple studies have found that elderspeak increases the likelihood of challenging behaviors such as resistance to care in individuals with dementia. It has also been theorized to increased agitation, frustration and calling out. Additionally, according to the University of Miami, elderspeak may elicit catastrophic reactions, a term for a sudden over-reaction to an ordinary interaction, such as a loud outburst or an act of physical aggression to a caregiver.

What to Do Instead

Take care to communicate with respect. Be mindful of the tendency (in yourself or others) to speak down to older adults. Understand that elderspeak may have been modeled to the person using it, and she might need a gentle reminder of the individual with whom she's communicating.

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By Esther Heerema, MSW
Esther Heerema, MSW, shares practical tips gained from working with hundreds of people whose lives are touched by Alzheimer's disease and other kinds of dementia.