The term “elderspeak” has been around for 40 years and while many of us use it frequently in our interactions with older adults, very few of us realize we are using it and even fewer know how harmful and dehumanizing it feels to older people.

Elderspeak is defined as simplified speech used with older adults and sounds like baby talk. Elderspeak also includes non-verbal gestures and actions, such as patting and excessive or inappropriate smiling.

The most common and recognizable features of elderspeak are: 1) using terms such as “honey” or “sweetie” instead of the person’s actual name; 2) using the collective pronoun “we”, instead of “you” (for example, “how are we today?”); 3) using a high-pitched or unnecessarily loud voice; 4) using exaggerated intonation; 5) standing or sitting too close; 6) using exaggerated praise (for example, “great job!”) or 7) using reflective speech patterns that request the older person to take action for someone else (for example, “would you stand up for me, please?” or “lift your arm for Dr. Jones”). These are all patterns of speech and actions that we typically use with infants and children, except that older people – even those with cognitive changes – are not children and we do not like being treated as children.

Studies show that 75% of elderspeak directed at nursing home resident could not be distinguished from babytalk directed at two-year-olds. And worse yet, nearly 97% of interactions between care staff in a hospital and patients with dementia had elements of elderspeak.

Studies also show that elderspeak results in a 50% increase in resistance to care in older adults with dementia and it causes older adults to feel frustrated, embarrassed, and incompetent, and it leads to loss of independence. It also reflects unprofessionalism in care staff.

Even though elderspeak-users do not intend harm; in fact, elderspeak is an attempt to convey care, it does cause harm. It denies older people of their adult identity – an identity that still resides within us, despite any physical or cognitive changes occurring in our bodies and minds.

When engaging with older people, we might ask ourselves from now on: is this how I would talk or engage with a 45-year-old? And older people, when it feels safe to do so let’s speak up when people talk to us in child-like ways.

In April 2022, the National Academies of Science, Engineering, and Medicine (NASEM) issued a bracing report of nursing home quality in the wake of the disproportionate number of COVID-19 related deaths in nursing homes and assisted living communities during the pandemic. The 600-page report offered an array of recommendations for improved quality. Shortly thereafter, The John A. Hartford Foundation funded efforts to convene experts across sectors and disciplines - including nursing home residents - to work together to address the NASEM recommendations and entrusted this effort to LeadingAge, a non-profit long-term care advocacy organization. The resulting Moving Forward Coalition (MFC), is now in its second year and closing in on starting to test a variety of improvements in nursing homes across the country.

The Coalition's work was originally divided up among seven committees reflecting the seven goals outlined in the NASEM report. Over the first year of the Coalition's work, as individual committees created action plans to structure and organize the work ahead of them, it became clear that there was overlap among the committees. As a result, the nine formal Action Plans laid out on the MFC website, reflect deep study and collaboration to generate as much positive change in nursing home care as possible in the short term. Longer term efforts are also needed and the Coalition is laying the ground work for federal and state policy and culture change that is long overdue. 

As one example of change, Goal Committee One has focused on developing a guidebook that will help nursing home leaders and managers deepen the conversations with residents and family members around each resident's preferences and priorities for daily care. Too often care staff make decisions on behalf of residents that, while well-meaning, may not truly reflect what is important or meaningful for that particular resident. The guidebook will support nursing homes with training content, assessment forms, and templates that encourage including residents and their family members in care conversations in ways that are better aligned with individual sensitivities, personality, temperment, capacity, and identity, with the goal of identifying and delivering care that is truly person-centered.

Sunday, January 11, 2021 9:30 p.m. - It has been an eventful few weeks since Christmas, both at HillHouse and politically. On January 4th we began biweekly covid testing for all staff and that will continueuntil DHHS guidance changes. HillHouse expects to hear from Guardian LTC Pharmacy this week about our covid vaccine clinic date, which we so hope will be this week or next. We understand from news reporting that the vaccines are in the state, but the roll-out has been slower than expected. This Sun Journal article today is informative. 
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We currently have half of our 90 staff who have agreed to get the vaccine. Of course, we would like this number to be higher, but it is consistent with what has been seen across health care settings nationwide. Vaccine confidence is low as public health messaging targeted specifically to direct care workers has been lacking. We have encouraged family members to send letters of support to our staff and convey the sense of urgency that truly exists for families. 

Covid is still rising around Maine and as a result residents must still refrain from all group activities. All staff continue to try and spend extra time with residents for socializing, but quiet days coupled with cold winter weather is challenging.  We urge families and community members to reach out with cards and letters.