What’s So Wrong with “Elderspeak,” Anyway? Answer: Everything

Hypocorisma: It’s the bane of older adulthood. What is hypocorisma, you ask? Here is a helpful (and perceptive) definition from Maeve Maddox at the excellent Daily Writing Tips blog:

profile of a person with gray hair

Hypocorisma is a type of euphemism derived from a Greek word meaning “pet name.” The English word hypocorism may be defined as “the diminutive or otherwise altered version of a given name.”

The use of diminutives and pet names is usually an indication of affection or intimacy, but sometimes hypocorisma is used to diminish, infantilize, or insult. For example, the same words used as endearments by family members and close friends are seen as insulting when they come from strangers.

A friendly “Hon” to frequent customers in a local restaurant is one thing, but in the workplace in general, employees, customers, and healthcare workers would be wise to avoid terms of endearment, especially when dealing with a segment of the population that is bombarded with such empty endearments.

People in their seventies and above are so often addressed in nursery language that researchers have a word for this type of hypocorisma: elderspeak.

The University of Kansas: Elderspeak and Resistance to Care

In addition to being annoying, infantilizing, disrespectful, and demeaning, elderspeak can have additional – and far more serious – deleterious effects as well. Doctors Ruth Herman and Kristine L. Williams from the University of Kansas School of Nursing explored the effects of elderspeak in the American Journal of Alzheimer’s Disease & Other Dementias.

Their study, entitled Elderspeak’s Influence on Resistiveness to Care: Focus on Behavioral Events, concluded that:

Resistiveness to care in older adults with dementia commonly disrupts nursing care. Research has found that elderspeak (infantilizing communication) use by nursing home staff increases the probability of resistiveness to care in older adults with dementia.

We found that older adults with dementia most frequently reacted to elderspeak communication by negative vocalizations (screaming or yelling, negative verbalizations, crying).

Because negative vocalizations disrupt nursing care, reduction in elderspeak use by staff may reduce these behaviors, thereby increasing the quality of care to these residents.

Elderspeak in Rehabilitation

As a vision rehabilitation therapist and low vision therapist who specializes in the rehabilitation needs of older adults with vision loss, I am particularly attuned to the negative effects of elderspeak/hypocorisma. All too often, when working with older adults in community-based settings and in long-term care, I have heard the following statements – likely intended as endearments, but infantilizing nonetheless:

  • “Hello, Mary dear. Maureen is here to see you. And how are we doing today, sweetie?”
  • “You’re looking for Martha? She’s in the day room. You know, we just love Martha – she’s such a sweetheart. She never gives us any trouble.”
  • “Ah, Thomas. He’s such a sweetheart. We all love him. But I’m not sure you’ll be able to do anything with him – he’s blind, you know.”

Soul-crushing, isn’t it? I cringe when I experience such statements: seemingly well-intentioned, but ultimately deadening. And yes, I have been called “Hon” many times when delivering vision rehabilitation services in these settings. (In case you’re wondering, I am the polar opposite of sweet, demure, and accommodating.)

The New York Times Examines Elderspeak

Thus, I found it heartening to read a serious examination of the “elderspeak problem” in The New York Times. Throughout the article, entitled In ‘Sweetie’ and ‘Dear,’ a Hurt for the Elderly, author John Leland systematically debunks this infantilizing practice and clearly describes its negative effects on both quality of life and life expectancy:

Professionals call it elderspeak, the sweetly belittling form of address that has always rankled older people: the doctor who talks to their child rather than to them about their health; the store clerk who assumes that an older person does not know how to work a computer, or needs to be addressed slowly or in a loud voice. Then there are those who address any elderly person as “dear.”

Now studies are finding that the insults can have health consequences, especially if people mutely accept the attitudes behind them, said Becca Levy, an associate professor of epidemiology and psychology at Yale University, who studies the health effects of such messages on elderly people.

“Those little insults can lead to more negative images of aging,” Dr. Levy said. “And those who have more negative images of aging have worse functional health over time, including lower rates of survival.”

In a long-term survey of 660 people over age 50 in a small Ohio town, published in 2002, Dr. Levy and her fellow researchers found that those who had positive perceptions of aging lived an average of 7.5 years longer, a bigger increase than that associated with exercising or not smoking. The findings held up even when the researchers controlled for differences in the participants’ health conditions.

Hello, Sweetie

Despite such research, the worst offenders are often health care workers, said Kristine Williams, a nurse gerontologist and associate professor at the University of Kansas School of Nursing.

To study the effects of elderspeak on people with mild to moderate dementia, Dr. Williams and a team of researchers videotaped interactions in a nursing home between 20 residents and staff members. They found that when nurses used phrases like “good girl” or “How are we feeling?” patients were more aggressive and less cooperative or receptive to care. If addressed as infants, some showed their irritation by grimacing, screaming or refusing to do what staff members asked of them.

Dr. Williams said health care workers often thought that using words like “dear” or “sweetie” conveyed that they cared and made them easier to understand. “But they don’t realize the implications,” she said, “that it’s also giving messages to older adults that they’re incompetent.” She added that patients who reacted aggressively against elderspeak might receive less care.

Elderspeak and Adult Learning Theory

Closely aligned with the issues surrounding elderspeak is “andragogy,” also called adult learning theory: the art and science of teaching adults. Dr. Malcolm S. Knowles (1913-1997), widely considered to be the “Father of Andragogy” in the United States, wrote extensively about how adults learn and the differences between adult and child learning.

One of his sharpest observations regarding the teaching of adults and older adults is also one that took me many years to truly comprehend: “Most teachers of adults have only known how to teach adults as if they were children. Most of what is known about teaching has been derived from experience with teaching children under conditions of compulsory attendance.”

Essentially, there are four important differences between andragogy (teaching adults) and pedagogy (teaching children):

  • Self-Concept: A child’s self-concept is derived primarily from external sources. In other words, if you ask children to describe themselves, they will likely mention the school they attend, who their siblings are, and where they live. An adult’s self-concept, on the other hand, is derived mainly from “internalized” life experiences. If you ask adults to describe themselves, they will likely mention the work they have done and what their life experiences have been.
  • The Role of Experience: To a child, experience is something that happens to her or him. A child is still learning to internalize and use these experiences to learn more about the world. Adults, on the other hand, have accumulated and internalized vast quantities of experience, which provide a rich background for all types of learning. When working with adults, therefore, acknowledge and respect their substantial life experiences through mutual discussion and problem solving. Don’t treat adult learners as “blank slates” to be filled with new knowledge that you bring to them.
  • Readiness to Learn: In pedagogy, the teacher usually (but not always, of course) determines when the child is “ready to learn.” The teacher decides what will be learned and when this learning will take place. In andragogy, the adult decides when he or she is “ready to learn.” In vision rehabilitation, this generally happens when a specific need arises; in other words, the adult needs to know or do something “right now” in order to perform a task more effectively in his or her daily life.
  • Time Perspective: In pedagogy, education is preparation for the future, or information to be stored and finally used “some day.” In andragogy, learning is task-centered and involves everyday problems that require more immediate solutions. Therefore, teachers of adults help learners move toward independent self-direction and determine what it is that they need to learn in the present – which may not necessarily be what family members or other professionals want the adult to learn.

So What’s the Takeaway?

First, examine your own speech and attitudes for any tendency to use elderspeak. As John Leland says, “Words matter. So does context. Terms of endearment are probably best reserved for the people we hold dear.”

Next, if you teach adults and older adults in any capacity, examine your attitudes toward your adult learners. Ask yourself these questions:

  • Has the way you learned as a child affected or had an influence upon your adult professional behavior in education or rehabilitation?
  • Do any of Dr. Malcolm Knowles’s descriptions of adult learners describe you?
  • Reflect on a professional issue that you have addressed recently with an adult or older adult. Could you rethink your actions in light of these andragogical principles?

What have I learned after all these years? Essentially, that my role is to “get out of the way.” People know what they need to learn. I’m just the facilitator. In truth, I’ve gone from thinking I knew everything about vision rehabilitation to finally realizing I don’t know very much at all. Learning, for me, is a forever process.