"No, no, sweetheart, don't do that."  "Come now, dear, don't be silly now."

This type of communication - dubbed "elderspeak"- almost doubles "resistiveness to care" (RTC) in individuals with Alzheimer's disease, according to nurse researchers at the University of Kansas School of Nursing (KU) in Kansas City, KS.

Characterized by baby talk, infantilizing communication, and overly-caring and overly-controlling behaviors, elderspeak often triggers disruptive behaviors such as crying, screaming, grabbing, hitting, pulling away or kicking.

Led by Kristine Williams, PhD, RN, the KU researchers explored how nursing home staff communications with patients with dementia triggers RTC. The results of the study, Linking Communication with Resistiveness to Nursing Care in Persons with Dementia, was reported in July at the 2008 Alzheimer's Association International Conference on Alzheimer's Disease (ICAD 2008) in Chicago.

For the study, 20 residents in special dementia care units were filmed during bathing, dressing, oral care and other care activities. The probability of RTC varied significantly with the type of communication nursing staff used. With elderspeak, RTC occurred 55 percent of the time; with normal adult communication, 26 percent; and when staff remained silent, 36 percent.

Where Does It Come From?

Kay Sharp, RN, director of resident services, James L. West Alzheimer Center, Fort Worth, TX, wasn't surprised at the Kansas nurses' findings.

"I've seen examples of how inappropriate communicate agitates people with dementia," she explained.  "And I've heard comments from residents that confirm that. They might say, 'I'm not your child!' Or, 'I've been a principal for 40 years, and you don't tell me what to do!'"

While most people acknowledge this type of communication is inappropriate when talking with seniors, it's very common to hear elderspeak in long-term care settings, said Pam Berkson, RN, ANP, SeniorHealth Center, University of California-Irvine.

"It's always sad when people talk baby talk to older folks," she said. "Certainly, people deteriorate as they move across the dementia continuum: Someone with early or moderate dementia may struggle to figure out what's going on during a conversation, and those in advanced stages have even less understanding."

And while caregivers get tired as the day moves on, Berkson added, "that's not an excuse to interact inappropriately or treat someone disrespectfully."

Mary Val Palumbo, DNP, GNP-BC, geriatric nurse practitioner, Memory Center, Fletcher-Allen Health Care, Burlington, VT, believes elderspeak is actually well-intentioned.

"One of the problems is caregivers who get close to individuals with dementia may think using 'sweetie' or 'honey' shows affection," she explained. "However, from the older person's perspective, it's disrespectful."

Courtney Cook, BSW, client services coordinator at Alzheimer's Family Services, Pensacola, FL, agrees. She has witnessed numerous examples of elderspeak within institutions.

"It comes from healthcare workers wanting to be caring and sensitive to the need of the person with dementia, but they're just going about it the wrong way," she said. "They're trying to be really sweet to the person without being condescending, but it is condescending."

Changing the Focus

Nancy Watson, PhD, RN, FGSA, director of the Elaine C. Hubbard Center for Nursing Research on Aging at the School of Nursing, University of Rochester, Rochester, NY, advocates an immediate shift from elderspeak to respectful communication.

"My mother had Alzheimer's for 15 years, and she became my most important patient, the one who taught me the most," Watson shared. "I would never, and my family would never, have dreamed of speaking down to her! Even when she was agitated, I was able to use validation therapy, accepting the reality of where she was and steering her somewhere else.

"Respectful communication with someone with dementia means not excluding them from conversations but making them a part of the discussion, respecting their ideas and not denying their reality."