Have you ever been to a nursing home? If so, one of the things you may have found difficult is talk­ing with the residents, especially when interact­ing with residents who are cognitively impaired. Unfortunately, this uneasiness often results in peo­ple relying on stereotypes of older adults in general and nursing home residents in particular in speak­ing to them, which results in inappropriate com­munication styles.

The communication style most people adopt is one in which younger adults overaccommodate their speech based on their stereotyped expecta­tions of dependence and incompetence. This style is described as a general “communication pre­dicament” of older adults (Ryan et al., 1986). Such speech conveys a sense of declining abilities, loss of control, and helplessness, which, if continued, may cause older adults to lose self-esteem and withdraw from social interactions. As time goes on, older adults who are talked to in this way may even begin behaving in ways that reinforce the stereotypes.

Inappropriate speech to older adults that is based on stereotypes of incompetence and dependence is called patronizing speech. Patronizing speech is slower speech marked by exaggerated intonation, higher pitch, increased volume, repetitions, tag and closed-end questions, and simplification of vocabulary and grammar. Speaking in this way can be conceptualized as “secondary baby talk,” which is baby talk inappropriately used with adults (Ryan et al., 1993). Secondary baby talk, also called infantilization or elderspeak, also involves the unwarranted use of a person’s first name, terms of endearment, simplified expressions, short impera­tives, an assumption that the recipient has no mem­ory, and cajoling as a way to demand compliance (Whitbourne et al., 1995).

Whitbourne and colleagues (1995) showed that infantilizing speech is viewed extremely negatively

172 CHAPTER 5 by some older adults. They found that community­dwelling older adults rated infantilizing speech espe­cially negatively and were particularly resentful of its intonation aspects as indicative of a lack of respect. Nursing home residents were less harsh in their judg­ments, giving support to the idea that being exposed to infantilizing speech lowers one’s awareness of its demeaning qualities. Whitbourne and colleagues also found no evidence that infantilizing speech is high in nurturance, as some previous authors had suggested.

Similarly, Harwood and colleagues (1997) dem­onstrated that adults to whom patronizing speech is directed are more likely to be blamed for acci­dents, especially when the target is an older adult. Residents with dementia tend to be more resistive to care when they are the targets of elderspeak (Williams et al., 2008).

How should people talk to older adults, espe­cially those living in nursing homes? Ryan and her colleagues (1995) propose the communication enhancement model as a framework for appropriate exchange. This model is based on a health promo­tion model, which seeks opportunities for health care providers to optimize outcomes for older adults through more appropriate and effective communi­cation. As you can see from Figure 5.5, this model emphasizes that communication with older adults must be based on recognizing individualized cues, modifying communication to suit individual needs and situations, appropriately assessing health and social problems, and empowering both older adults and health care providers.

What happens when residents respond in dif­ferent ways to a staff member’s patronizing speech? Ryan and colleagues (2000) examined what hap­pened when nursing home residents responded passively, assertively, or humorously to a nurse’s patronizing speech, which was then either main­tained or changed to reflect more respect for the resident. Details of the study are provided in the How Do We Know? feature.

The interchanges were rated by nursing home residents, staff, and community-residing older adults. Patronizing speech was rated negatively by everyone (but less so by the nursing home

residents). The nurse who continued to speak patronizingly when the resident responded assert­ively was rated most negatively, but residents were the most reluctant to endorse the assertive way of responding. Humorous responses were rated in between, perhaps being a safer alternative for residents to use to express opposition to a request yet still maintain an appearance of coop­eration. Taken together, these results show the degree to which patronizing speech is disliked by community-dwelling older adults but accepted as expected by nursing home residents.

Ryan and colleagues’ model and research can be readily applied to interactions with older adults from different ethnic groups and with older adults who have cognitive impairments. For example, an analysis of intergenerational communication comparing Western and Eastern cultures showed
complex cultural variability, including the occur­rence of less positive perceptions of conversations in some cases from respondents in Korea, Japan, China, Hong Kong, and the Philippines than in some Western countries (Williams et al., 1997).

In general, an approach to communication based on the model promotes mental, social, and physi­cal well-being among older adults and counters the fostering of dependence that follows from the traditional medical model discussed earlier. When patronizing speech occurs in nursing homes, active steps should be taken to ensure that the appropriate steps are taken to eliminate it (Dobbs et al., 2008). Most important, this research reminds us that we must speak to all older adults in a way that conveys the respect they deserve.

So what should you do as a visitor? The first time most people visit a nursing home, they are