A Surefire Way to Drive Older Clients Away

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elderlyOK – so I confess. I talk baby talk to my dog. He’s little, and snuggly, and adorable – and it’s just so easy to call him cutesy names and fall into that simplification of short sentences that we do with babies, too.

Just what is it about babies and puppy dogs that begs us to speak baby talk to them?  I think that it’s that aura of vulnerability that surrounds them. Vulnerability that begs us to be reassuring or coddling or just drippy-sweet.  They clearly need caretaking or caregiving, and we, as their protectors, want to make them feel secure and… well, loved.

Thus, babytalk. It makes us feel as if we are providing that security and happiness we know they crave. We think it makes us sound supportive and helpful. It just seems to come so naturally.

An email I received from an APHA member this week made me think about this topic. She shared her own elderly mother’s experience with a home health worker.  Hazel, the elderly mother (not her real name) is sharp as a tack, but knew she could use some assistance. Our member helped her mom, Hazel, find a private advocate. Unfortunately, it didn’t go so well. Turns out Hazel got frustrated because she felt pressure to do things, or sign things, or make choices she didn’t want to make. Specifically she felt as if her advocate wouldn’t listen to her or trust her ability to make decisions.

I’ve heard this complaint many times before, from older people who have felt discounted when they have asked for help. The helper becomes patronizing, as if someone has thrown a switch and the older person can no longer think straight or make good decisions.  As if they are… babies.

And then there is elderspeak, the spoken version of that patronizing, condescending attitude.

We hear elderspeak being used when younger people call someone who is older “Honey” or “Sweetie.” But it doesn’t stop with the words that are used. It’s as much about tone, speed and assumptions as it is about cutesy nicknames. Slowed speech (have to be sure those old people can process it, right?), or louder speech (assuming they can’t hear, or they will understand better if you’re louder) simplified vocabulary, a higher tone or cadence of the voice, or even using pronouns incorrectly, “Mrs. Smith, how are WE feeling today?” – these are all received by older people as disrespectful.

In fact, there are studies that show that when exposed to elderspeak on a regular basis, some older people develop negative behavioral changes – just the opposite of what we patient advocates hope to achieve.

What’s unique about elderspeak is that no one ever means to be disrespectful or condescending by using it. The INTENT is to be helpful and supportive. The problem is that the receiver just doesn’t hear it that way. Instead they hear it as the speaker being patronizing, and they are upset and insulted.

A few years ago, I had a conversation with my father about this after attending a doctor visit with him. We both heard the doctor’s support staff (nurses, CNAs, others) using elderspeak with many of the patients in the office. It went right up Dad’s backbone – enough so that he mentioned it to me. “Don’t ever let them talk to me that way!” he begged.

Now, yes, I know that some of this varies with one’s culture and geographic location. Those terms Honey and Sweetie may be considered in some places, like the Southern US, as terms of endearment. In my area, culture, and upbringing, it’s simply condescending. You’ll have to think it through based on where you live, and make your judgment from there. But even if you use those terms, it doesn’t mean the remaining aspects of elderspeak are an acceptable approach.

This entire topic of respect and tone provides a good lesson for us advocates who may deal with older people.

Listen to yourself speak to older folks and see if your own words and approach need adjustment. Here’s a good list of the features of elderspeak you’ll want to avoid. If necessary, work on your own communication style to be sure your older clients hear respect in your tone of voice. You might ask yourself – if someone spoke to ME that way, how would I perceive it?

Then do your elderly clients a favor, and if you hear their providers using elderspeak, clue them in, too. After Dad and I discussed the subject, we decided the best way to address it was to print out something from the web that addresses the subject, and to just give it to the doctor so he could discuss it with his staff.

Now extend your observation of the tone of your conversations with older people to the content of the conversation. Are you really listening? Are you respectful of their capabilities, experience, opinions and decisions?

Our elders may be old, and they may be vulnerable. They may even be dealing with cognitive issues. But they aren’t babies, and treating them or talking to them as such will surely put a wedge in your relationship and your ability to be the true advocate you want to be.

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Agree? Disagree?

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Comments

  1. Heidi Harrigan  November 21, 2013

    I think this is an important point. Perhaps you could follow up with a piece about how to respectfully communicate with seniors who do have cognitive impairment.

    reply
    • Trisha Torrey  November 21, 2013

      Heidi,

      You’ve asked a good question and I think the answer depends very much on the type and degree of that impairment. That said, no matter how cognitively impaired someone is, talking to them, and treating them like children takes away their dignity.

      reply

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