Monday, April 11, 2016

Elderspeak Views of Certified Nursing Assistants (CNA Research)

What is elderspeak? Basiclly, it’s baby talk that most adults would not think of using in conversations with other adults. As a hospice volunteer in nursing homes, I noticed elderspeak being used often. For example, “Hi, Mr. Smith. I hope you’re enjoying your day? Did you have a good dinner?” might become a singsong version of this: “Hey, Handsome. Are you behaving today? Did you eat all your dinner veggies like a good boy? You did? That’s my baby!” Imagine what the average adult would think about being addressed in this manner. But some nursing home staff members, caregivers, and others think nothing of speaking to residents in this way.

This research on elderspeak focused on the perspectives of certified nursing assistants (CNAs) who frequently spend time with older residents. The goal was to learn more about the intent and conditions under which elderspeak is used. Participants who were interviewed included 26 CNAs who worked in long-term care facilities. It should be noted that half of the CNAs reported that elderspeak is more appropriate with individuals with dementia and that others believed elderspeak was always inappropriate.

These were the findings regarding the intended purposes of CNAs using elderspeak:

1)   Make residents feel more comfortable.
2)   Make caregivers seem friendlier.
3)   Help residents better comprehend verbal communication.
4)   Increase the likelihood that residents cooperate during caregiving tasks.

Based on these findings, more staff education is needed that incorporates previous research results. For example, elderspeak research reported in Behavior Therapy states that resistiveness to care has been linked to communication by staff using elderspeak. This study examined videotapes of nursing home residents with dementia interacting with staff.

Use of elderspeak implies that the resident is not competent enough to be spoken to on an adult level. Even when residents get used to being spoken to in elderspeak and seem not to mind, research studies indicate that their self-esteem may be lowered. In addition, using elderspeak perpetuates negative stereotypes about the elderly.

On a personal note, I was raised in the Jim Crow South and was taught that children should never call adults by their first names. For many African Americans, including adults addressing other adults, this was not only a practice of respect, but mandatory in society under certain racial conditions. After I received my driver’s license at sixteen, I felt proud when I was told I could start picking up my grandmother from her job as a cook at a segregated white school.

Imagine my distress when I arrived at the school and saw young children calling my grey-haired grandmother “Lou.” She allowed it because she needed the job, but words cannot describe the humiliation in her eyes when she saw me and realized I had witnessed how she was treated there. That night, my mother told me I couldn’t pick up my grandmother from work again. For many older African Americans, being called by their first names without their permission by younger adults is connected to painful memories of historical injustices.

Frances Shani Parker, Author
Becoming Dead Right: A Hospice Volunteer in Urban Nursing Homes is available in paperback and e-book editions in America and other countries at online and offline booksellers.
Hospice and Nursing Homes Blog


  1. I am a CNA. I have been in this field for 5 years. I do use elderspeak. Mostly in terms of vernacular...using sayings they understand from their time peeiod...such as, when a patient is laying crooked in bed I will say "let's get you up in the bed darlin, you're crooked as a dog's leg". Usually they laugh and comply with being repositioned.
    I had an inservice about a year ago discussing how to meet your patients where they are. Meaning, if you have a patient with some form of dementia and they may think it's 1942; you talk with them about that time, meet them where they are and slowly redirect them if possible; like letting them know it is actually 2016.
    I had a patient and meeting her where she was meant I had to act like I was her mom because she thought she was a baby. So I would talk to her that way. "I'm gonna roll u toward me darlin". And she did not understand what a brief was so I would actually have to say "diper". I was meeting her where she was and speaking the language she understood.
    I don't feel that elderspeak is a bad thing when used with patients that are demented.
    I don't use it for patients that do not have dementia or would not appreciate it.
    I won the award for being "most comforting" and it is because of how I address the residents and I sing to them.
    I conclude that elderspeak is helpful when it is appropriate. Each patient is different and therfore I speak to each of my 22 patients in a manner unique to them.
    You can't teach that;it is compassion. And when I tell my patients I live them. It is because I do. When I tell the they are my baby it is because they are.
    That's just the kind of CNA I am. Right or wrong I will not change. I am on the front line in nursing and I do what works and what makes my patients happy. That is what is important to me.

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  2. We would receive a deficiency from the Department of Health if we ever called a resident by a name (like Honey or Sweetie) if the resident had not given us permission to do so.

  3. Those of you who justify elderspeak (baby talk, "honey" and "sweetie") as part of capturing the past for people with dementia to make them feel more at home enjoying pleasant memories, keep this in mind: A younger person first-naming an older adult back in the past was often viewed as disrespectful behavior. Although the person with dementia may not be able to articulate this to you, you are really capturing a negative part of their past.