Understanding Elderspeak: What It Is and Why Caregivers Should Avoid Using It

However, when other nursing home staff, helpers in your home or even adult children adopt the same tone, it may not be well received. 

Why do we do it?

When caregivers slip into elderspeak, it usually comes from the best intentions, but it may reflect deep-seated perceptions about older adults that are less endearing. 

“We naturally do it, but it’s really rooted in the way we see older people,” Gitlin says. "In the larger societal view of aging as something to be dreaded and that people become diminished as they get older. When we feel a tendency to speak like that, which is really speaking down to the person, we have to question how we view this person.” 

How is it received?

By the time an older adult finds themselves reliant on others —typically younger adults — for care, they have lived a long and full life during which they’ve been taking care of themselves and making their own decisions for a very long time. Now they’ve lost some of their independence and are being spoken to in tones they may have once used with their own children and grandchildren. 

“Even if a person is less functionally competent, cognitively or physically,” Gitlin says, “there’s never a time that elderspeak is appropriate, ever.” 

Older adults who are able to advocate for themselves may quickly make it known that they don’t want to be spoken down to. But even adults living with severe cognitive impairment, though they may not be able to express it with words, don’t take to being infantilized by their caregivers. 

“They may not understand complex commands,” Gitlin says, “like ‘Go down the hall and take a right,’ but the emotional tone by which it’s said is definitely understood.” 

If the older adult doesn’t have the verbal abilities to express how they feel about elderspeak, they will express it in other ways, Shaw says. “Once you start having cognitive decline, your ability to cope with those stressors declines and you respond with behaviors.” 

Research shows that those behaviors can include refusing essential care, as shown in a 2022 study authored by Shaw in the Journal of the American Geriatric Society.  

Researchers made audio recordings of 88 patient care encounters between 16 adults living with dementia and 53 nursing staff at a care facility. They analyzed the audio recordings for instances of elderspeak and refusal of care. Elderspeak made up more than 11 percent of 10-plus hours of audio recordings, and there was a direct correlation between the demeaning communication and the likelihood that an elder would refuse what was being offered, such as medication or food. The final analysis found that reducing elderspeak by just 10 percent reduced the odds the patient would refuse care by more than 75 percent. 

While this study involved only 16 adults with dementia, a large body of research confirms these findings. A systematic review of 19 studies on refusal of care among adults with dementia receiving professional care, published earlier this year in the Journal of Applied Gerontology, found that exposure to elderspeak was a top risk factor for refusing care. 

What can you do about it?

According to a 2024 study in the journal Nursing Older People, attitudes vary widely among older adults who can articulate an opinion about elderspeak. Interviews with 15 older adults revealed that some were indifferent to being addressed as “honey,” “sweetie” and “dear” by caregivers; others liked it, and others found it disrespectful. 

The study underscores the message that “caregivers should ask a family member or the older adult themselves what they want to be called,” Gitlin says. 

Family caregivers should advocate for other caregivers to address their loved ones according to their preferences. You can simply say, “My mother prefers to be called by her first name,” or “She prefers to be called Ms. _____.” 

Family members can also encourage other caregivers to offer their loved ones choices, whenever possible and appropriate, rather than directives. For example, “Do you want your lunch now, or should I come back after your TV show is over?” rather than “It’s time for lunch.”

If you or the professional caregivers who help you are getting negative attitudes from your loved one, Shaw says, it’s time to consider, Could this be my communication? Let’s try a different approach.