By Paula Span, Kff Health News
An excellent example of Elderspeak: Cindy Smith visited her father in his assisted apartment in Roseville, California. An assistant who was trying to encourage him to do something – Smith does not remember what – said: “Let me help you, darling.”
“He just launched her gaze – under his bushy eyebrows – and said,” What, did we get married? “” Records Smith, who laughed well, she said. His father was then 92 years old, a retired county planner and a veteran of the Second World War; Macular degeneration had reduced the quality of his vision, and he used a walker to move, but he remained cognitively lively.
“He would not normally become too freezing with people,” said Smith. “But he had the feeling that he was an adult and that he was not always treated like one.”
People almost intuitively understand what “Elderspeak” means. “It is a communication with the elderly who looks like baby discussions,” said Clarissa Shaw, dementia researcher at the University of Iowa College of Nursing and co-author of a recent article that helps researchers document their use.
“It follows from an aged hypothesis of fragility, incompetence and dependence.”
Its elements include inappropriate assignments. “Elderspeak can control, a little authoritarian, so to soften this message, there is` honey “,” my dear “,” my darling “,” said Kristine Williams, a gerontologist nurse at the School of Nursing at the University of Kansas and another co-author of the article.
“We have negative stereotypes from the elderly, so we change our way of speaking.”
Or caregivers can use plural pronouns: Are we ready to take our bath? There, the involvement “is that the person is unable to act as an individual,” said Williams. “I hope I don’t take the bath with you.”
Sometimes Elderspeakers use a stronger volume, shorter sentences or simple words launched slowly. Or they can adopt an exaggerated vocal quality more suited to preschool children, as well as words like “pot” or “jammia”.
With what is known as tag questions – It’s time for you to have lunch now, right? “You ask them a question but you don’t let them answer,” said Williams. “You are developer them how to react.
Studies in nursing homes show how common speech is such a speech. When Williams, Shaw and their team analyzed video recordings of 80 interactions between staff and residents with dementia, they found that 84% involved a form of Elderspeak.
“Most Elderspeak are well intended. People try to show that they care,” said Williams. “They do not perform the negative messages that pass.”
For example, among the residents of nursing homes with dementia, studies have found a relationship between the exhibition in Elderspeak and the behaviors known collectively under the name of resistance to care.
“People can turn away or cry or say no,” said Williams. “They can close their mouths when you try to feed them.” Sometimes they repel the caregivers or strike them.
She and her team have developed a training program entitled Cat, to change discussion: three one hour sessions that include communication videos between staff members and patients, intended to reduce Elderspeak.
It worked. Before training, in 13 nursing homes in Kansas and Missouri, almost 35% of the time spent in interactions consisted of Elderspeak; This share fell to around 20% after.
In addition, resistant behaviors represented almost 36% of the time spent in meetings; After the training, this proportion fell to around 20%.
A study in a midwest hospital, again among patients with dementia, found the same type of decrease in resistance behavior.
In addition, cat training in nursing homes was associated with less use of antipsychotics. Although the results have not achieved statistical significance, partly due to the small sample size, the research team deemed them “clinically significant”.
“Many of these drugs have a black box warning from the FDA,” said Williams about medicines. “It is risky to use them in fragile elderly” because of their side effects.
Now Williams, Shaw and their colleagues have rationalized cat training and adapted it for online use. They examine its effects in approximately 200 nursing houses nationwide.
Even without official training programs, individuals and institutions can combat Elderspeak. Kathleen Carmody, owner of Senior Matters Home Health Care and Consulting in Columbus, Ohio, warns her aid to address customers as Mr. or Mme or Mme, “Except or until they say:” Please call me Betty “.
In long -term care, however, families and residents may fear that the correction of how staff are talking about could create antagonism.
A few years ago, Carol Fahy was fleeing the way aid in an assisted life establishment in the suburbs of Cleveland treated his mother, who was blind and had become more and more dependent in the 80s.
The appellant “darling” and “honey”, the staff “hovered and rolled, and they put his hair in two mats on their heads, as you would with a little one,” said Fahy, a psychologist in Kaneohe, Hawaii.
Although she recognized the pleasant intentions of aid, “there is a falsehood,” she said. “It doesn’t make anyone feel good. He’s actually alienating.”
Fahy planned to discuss her objections with aid, but “I didn’t want them to retaliate”. Finally, for several reasons, she moved her mother to another establishment.
However, opposing Elderspeak does not need to become an opponent, said Shaw. Residents and patients – and people who meet Elderspeak elsewhere, because it is hardly limited to health care establishments – can politely explain how they prefer to speak and how they want to be called.
Cultural differences also come into play. Felipe Aguudelo, which teaches health communications at the University of Boston, stressed that, in certain contexts, a tiny or a term of affection “does not come from the underestimation of your intellectual capacity. It is a term of affection. “
He emigrated from Colombia, where his 80 -year -old mother does not take offense when a doctor or a health worker asks him “Tómese la Pastillita” (take this small pill) or “Mueva la manito” (move the small hand).
It’s usual and “she feels that she talks to someone who cares about it,” said AguDelo.
“Come to a place of negotiation,” he advised. “It doesn’t need to be difficult. The patient has the right to say: “I don’t like you to talk to me that way. »»
In return, the worker “must recognize that the beneficiary may not come from the same cultural environment,” he said. This person can answer: “This is how I usually speak, but I can change it.”
Lisa Greim, 65, retired writer in Arvada, Colorado, recently pushed Elderspeak when she signed up for coverage of Medicare drugs.
Suddenly, she told an e-mail, a correspondence pharmacy began to call almost daily because she had not filled out of prescription as planned.
These “slowly condescending” appellants, seeming apparently from a script, have all said: “It is difficult to remember to take our drugs, right?” – As if they swallowed pills with Greim.
Welcomed by their presumption and their question of follow -up on the frequency to which she forgot her medication, Greim informed them that after having filled out earlier, she had sufficient supply, thank you. She would reorganize when she needed it.
Then, “I asked them to stop calling,” she said. “And they did it.”
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