Wednesday, April 25, 2012

Elderspeak: Babytalk Directed at Older Adults

Photo by Neighborhood Centers
About a year after I started volunteering at a skilled nursing home, I observed a set of new teenaged volunteers who came to help with a craft at the monthly meeting of the Red Hat Society.  

I heard several of the volunteers speak slowly and loudly, using a sing-song voice.  In response, I saw many of the residents roll their eyes.   

Unfortunately, I had flashbacks to when I first started as a volunteer.   I had altered my speech inappropriately as well, hoping to be supportive but coming off as patronizing instead.

I have since learned to identify the features of elderspeak.  More importantly, I’ve learned to change my attitude.   

[Note: The links to this post were refreshed in January of 2018 to reflect current research.]

At its core, elderspeak communicates a condescending attitude.   And from that attitude the person’s language might demonstrate the following features of elderspeak:
  •  Speaking slowly
  •  Speaking loudly
  • Using a sing-song voice
  • Inflecting statements to sound like a question
  • Using the pronouns “we,” “us,” and “our” in place of “you.”: “How are we doing today?"
  • Using pet names such as “sweetheart,” “dearie,” or “honey"
  • Shortening sentences
  • Simplifying syntax (sentence structure)
  • Simplifying vocabulary
  • Repeating statements or questions
  • Answering questions for the older adult: “You would like your lunch now, wouldn’t you?”
  • In other ways talking for the older adult: “You are having a good time on the patio today, I see. And you have your pink sweater on, which you love. Right?”
  • Asking people questions that assume role loss, idleness and powerlessness such as “Who did you used to be?” “What did you used to do?” 

This post also appears at the fabulous blog Changing Aging.  

Dr. Susan Kemper published several classic articles in the 1990s that describe the features of elderspeak. Since then many other studies have been conducted in an effort to further describe features, measure the effects, and suggest alternatives. 

For a more academic description of elderspeak based on videotaped interactions in a skilled nursing facility, see this 2004 article by Williams, Hummert, and Kemper. 

Even though this list describes various ways in which people sometimes alter their speech when talking to older adults, a couple of misperceptions generate the communication problem:
  • Elderspeak assumes that the older adult is dependent, frail, weak, incompetent, childlike, etc.
  • Elderspeak assumes that the speaker has greater control, power, value, wisdom, knowledge, etc than the older adult listening.
  • Elderspeak assumes that all older adults equally suffer from memory problems, hearing problems, stamina problems, etc.
Public health experts such as Dr. Becca Levy have found that when older adults are exposed to the patronizing language of elderspeak, their performance on tasks decreases and their rates of depression increase.  

Other studies show that even people with moderate to severe dementia can tell when people are talking down to them, and it decreases their level of co-operation.  

I have witnessed this myself.   

One of the residents, who was a retired nurse struggling with dementia, was trying to care for another resident.  The activity director and two certified nurse assistants tried to redirect her away from her neighbor’s apartment.   The employees were using dulcet tones with her, and she quickly replied: “Don’t you get all sweet on me. I won’t be treated this way!”   

People of all levels of cognition preserve the ability to read tone.   

Managing nurses might consider providing training on how to transform elderspeak into more effective acts of communication.  For example, a 2017 study  by Corwin suggests replacing elderspeak with blessings, jokes, and narratives as productive forms of communication.

As the percentage of older adults increases in the US, the need for communicating effectively will be more apparent in many fields, not just health care. 2000 US Census data shows that Americans aged 65+ outnumber the combined populations of London, Moscow, and New York.

About a year before I started my gerontology program, I had the privilege to meet a friend’s nonagenarian mother who had traveled to Wichita from western Kansas.  I unwisely raised my voice and spoke slowly to her: “HOW. ARE. YOU. TODAY?”  She shot back a very energetic, rapid-fire reply--putting me in my place. 

Since that day, I assume that older adults have full hearing and full cognition when I first address them.   If their reply indicates otherwise, then I make moderate adjustments, but I still address them as independent, empowered individuals.

Have you caught yourself using elderspeak?  Has anyone ever talked down to you before?  How is this problem parallel for second language speakers or those managing a disability?  Can you think of any other features of elderspeak? 


PC Terms for AgingShoulder Pain and Ageism
Modify Conversation with Older Adults as Needed
Talking with Older Adults in a Crisis


  1. What a wonderful blog post about elderspeak. I really appreciate reading all of your experiences with this type of communication. This is seen a lot in intergenerational communications so I have been witness to elderspeak when I volunteered at a nursing home during my sophomore year at college. Thankfully I was introduced to this concept that year so I was ahead of the curve but quite a few of my classmates were speaking to the residents in a slow, exaggerated manner with short sentences. They spoke this way with everyone, even with the residents that did not have hearing problems! Assuming that the older adult has a hearing problem or is cognitively impaired can do personal damage such as lowering self-esteem and life satisfaction. Communicating to an older adult by elderspeak is also associated with higher rates of depression! So even though people are thinking they are just being nice, they don’t actually know they are being hurtful and insulting to the older adult they are talking to.

    1. Thanks for sharing your experience here and at the SNF where you volunteered. All my best to you, Sierra.

  2. I have vainly tried to educate the director of my father's assisted living facility about Elderspeak. She can't or won't understand and said if I wasn't satisfied with the care my father was receiving, I was welcome to move him elsewhere!

    Dad was referred to as a "bad boy" by a CNA after he had refused, for the nth time, to participate in the daily bingo game. She said teasingly "Oh, now don't be a bad boy!" What part of no didn't she understand? Dad hates bingo and he hasn't been a "boy" since Franklin Roosevelt was President.

    Perhaps the worst was when, in the lobby in front of two dozen people, a CNA loudly asked a resident if she needed to "tee-tee." How humiliating and demeaning! If I had been that elderly woman, I think I would have tee-tee'd all over the place just for spite.

    1. Oh, those are good examples of bad communication acts. Agreed. They are disrespectful. Gah!

  3. Great post, you've really hit the nail on the head with this. I provide in-home assisted living services in Concord, New Hampshire and the surround areas. As a care giving professional babytalk quickly becomes part of the job. It's an effective, warm way to speak to seniors and overall helps the level of communication both ways. Thanks for sharing!

    - Sue

    1. Well, there is warmth and affection and there is treating someone in a childlike manner. It's important to really read the other person's preferences. Some people don't like an overly familiar tone. They want to control the level of intimacy. Thank you for being a caregiver. It's a vital profession, and ones who are caring are extra appreciated by the consumer and the family.

  4. I finally found your blog, Karen! Brava!

  5. I recently had a heart attack and was offered a Cardiac Rehab course. The first session was ok, then a new nurse took over. I was treated like a child by this, probably well meaning, but very annoying and over enthusiastic, super happy nurse. Although I had told her that I was into a lot of sports before the heart attack and therefore used to going to the Gym, I was told off and called a naughty girl when I picked up some dumbbell which she said were to heavy for me (1kg!) Then she went into hyper mode, doing all sorts of really silly dances and faces, wanting us to join in as if we were all slightly demented or mentally deficient kids. And it went on like this for 8 weeks, during which time I did get called "good girl" a few times.
    To add insult to injury. On the last day, I was presented with a certificate of attendance. Well, This certificate was about the same level as the ones my children used to get for being brave whenever they went to hospital: A4 with ridiculous cartoon like characters all around. This was presented to me as if it was an Olympic gold medal that I would surely treasure for ever. Laminated, of course. I'm surprised they did not frame it. I obviously did not manage to look excited enough and was told I should show it to my friends and family. Really. I am 70 years old not senile! perhaps they should have stuck a gold star on my forehead too.

    1. Andrea: I'm sorry that people were patronizing towards you. So frustrating!