Elderspeak: Impact on Geriatric Care
Kristine N. Williams, RN, CS, FNP, PhD, University of Kansas School of Nursing, Kansas City, KS, USA.
Today's health care provider works to promote health and successful aging of the growing population of older adults. Unknowingly, younger care providers may communicate messages of dependence, incompetence and control to older adults through the use of elderspeak, a common intergenerational speech style. This article describes elderspeak, its underlying negative messages and strategies for clinicians to use in evaluating and enhancing their own interpersonal communication with older patients. Issues critical to communication with older adults are examined and the importance of communication as a therapeutic tool for health care providers is explored.
Key words: communication, provider-client relationship, elderspeak.
Introduction
Communication is a critical but frequently overlooked element in providing quality health care to older patients. Communication is central to the provider-patient relationship and is particularly important for older patients since their ability to understand and adhere to treatment regimens and their satisfaction with the health care provider are greatly influenced by interpersonal communication. Health care providers may fail to recognize the importance of communication to therapeutic relationships with older clients, and how stereotypes and other factors may impact their relationships with patients in geriatric care. For instance, physicians have been found to provide more information and support and share more decision making with younger patients than with older adults.1 Providers working with older adults may avoid sensitive topics and fail to focus on psychosocial issues that are critical for this patient group.2 Communication with older adults also may be complicated by inclusion of family members, as well as by altered communication due to intergenerational stereotypes--a phenomenon called elderspeak that is the primary focus of this article.
Elderspeak
Elderspeak is commonly heard in communications between younger and older adults and frequently occurs in settings where health care is provided to older adults. This style of speech may be indistinguishable from baby talk, and features a slower rate of speech, exaggerated intonation, elevated pitch and volume, greater repetition and simpler vocabulary and grammar than normal adult speech.3,4
Although elderspeak may be an attempt on the part of younger communicators to promote clear and effective communication and to show caring, the Communication Predicament of Aging Model provides a framework to explore how this speech style fails to accomplish these goals.5 Stereotypes that older adults are less competent trigger younger persons to modify their speech in intergenerational communication, such as implementing strategies to simplify speech, add clarification and alter the emotional tone of messages. Providers may assume that frail older adults prefer the nurturance of elderspeak. However, older adults in a variety of settings report that up to 40% of interactions with caregivers are demeaning.6,7
Because older recipients of elder-speak perceive it as patronizing and implying incompetence, they may respond with lowered self-esteem, depression, withdrawal from social interactions and even assumption of dependent behaviour consistent with their own stereotypes of frail older adults.8,9 Not only does elderspeak fail to improve communication effectiveness for older adults,8,9 but the messages inherent in elderspeak may unknowingly reinforce dependency and engender isolation and depression, contributing to the spiral of decline in physical, cognitive and functional status common among frail older adults.10 These outcomes are incongruent with a goal of promoting independence and successful aging.
Communications between the health care provider and older patient frequently feature elderspeak, revealing an imbalance of care and control.11 Overly directive or bossy talk, which reflects a high degree of control but fails to recognize the autonomy of the listener, may occur when a care provider is under pressure to complete multiple work tasks.9 Overly nurturing