Friday, August 29, 2008

HEALTH: Alzheimer's Patients Resist 'Elderspeak'

(previously published here at

Most parents have experienced a child's resistant behavior at being lectured, then realized their tone often outweighs what they try to say. Now a study published in the American Journal of Alzheimer's Disorders and Other Dementias shows Alzheimer's patients often resist care, become upset and act out when caregivers talk to them like children.

University of Kansas School of Nursing researchers found the tendency of caregivers - whether by family or professional nursing staff - to use infantilizing speech dealing with elderly or infirm patients likely increases a patient's agitation and resistance to care.

The disruptiveness to nursing care contributes to an overall 30-percent increase in costs of such care. These findings were presented Monday at the International Conference on Alzheimer's Disease in Chicago.

Nursing experts describe "Elderspeak" as a type of speech involving an overly caring, yet controlling, tone of voice, shortened sentences, repetition and the use of inappropriately intimate terms of endearment such as "sweetie" or "dear."

"The style of communication that we use with people with Alzheimer's influences how they feel about themselves and how well they respond to those providing care," said Sam Fazio, Ph.D., director of medical and scientific relations at the Alzheimer's Institute.

"People who have dementia are trying to maintain their sense of being a person. And ... if someone is talking to them like they are an infant, that might be distressing," said lead researcher Kristine Williams, R.N., Ph.D., an associate professor at the University of Kansas.

In the study, researchers videotaped the nurses' and nursing assistants' daily interactions with 20 nursing home residents. Ranging between 69 and 97 years of age, the residents had moderate levels of dementia, requiring different levels of care.

A measure called the Resistiveness to Care Scale (RTCS) was used to gauge the type and degree of disruptive behaviors. Actions termed "resistive" included grabbing onto persons or objects; turning away; pulling the limbs tightly to the body; saying 'no' or crying out; and hitting or kicking.

When these behaviors occurred, the researchers rewound the tape seven seconds to see whether any particular type of communication led up to it.

"[We found] they were more likely to be resistive to care if the nurses were using the 'Elderspeak' communication compared to the normal adult-to-adult kind of talk," said Dr. Williams.

"They also tend to alter the pronouns, [perhaps saying] 'Are we ready for our bath?' ... instead of 'Are you ready for me to help you with your bath?'"

Combined, these alterations in communication and speech patterns have the effect of enforcing the sense the patient receiving treatment stands helpless or highly dependent on the caregiver. Furthermore, the caregiver tends to use "Elderspeak" more often according to how much infirmity they perceive in the patient.

"What, theoretically, we think is going on is that younger people have stereotypes of older adults as being less able to communicate, less competent in a lot of different areas," Dr. Williams said

For family members who witness "Elderspeak" in a nursing home or assisted-care environment, Dr. Williams does not recommend hostile criticisms. Instead, "try and tell them a little bit about your loved one, that they were a high-functioning adults. To get them thinking more of the person in terms of that competent adult framework."

"[Caregivers] really have to know who that person's been their whole life, and not just define them in terms of their disease or their symptoms," said Dr. Fazio, of the Alzheimer's Institute.

"People are always saying, 'Oh, I can't do that because it's going to take more time and I have too many people to take care of.' But this showed us that the other way of doing things was causing even more time and care."

The number of people with Alzheimer's likely will increase to over 106 million people worldwide by 2050.

Heather J. Chin can be reached at

©The Evening Bulletin 2008

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