September 3, 2010

AUSTRALIA: The elderly aren't babies, so why talk to them that way?

MELBOURNE, Victoria / The Age / Society & Culture / September 3, 2010

By David Campbell

A patronising manner from aged-care staff adds to their patients' woes.

I am a ''sweetie'' and a ''darl''.
I was on the receiving end of these cutesy endearments recently. Not from a family member, but as a patient in a hospital. ''OK, sweetie, up on the bed,'' and, ''Hang on, darl, don't get down yet.''

It made me distinctly uncomfortable. Now that I've reached a time in life when grey is the predominant hair colour, it seems I'm to be spoken to like a child. Age and signs of frailty bring increasing anonymity. Our names disappear, to be replaced by convenient trivialities. Sadly, it reminds me all too clearly of the way my mother was regularly addressed in her nursing home.

''How are we this morning, love? Have we moved our bowels yet?'' I have a ready answer: ''I don't know about you, honeybunch, but I put mine over there in the cupboard.''

I resent this patronising, condescending name-calling habit, which seems all too common in the caring professions, particularly where older people are concerned. It even has a name: ''elderspeak''.

It involves the use of a singsong tone, slower speech and a limited vocabulary. In a 2008 study at Yale University, psychologist Becca Levy reported that: ''Elderspeak sends a message that the patient is incompetent, and begins a downward negative spiral for older persons, who react with decreased self-esteem, depression, withdrawal and the assumption of dependent behaviours.'' Researchers found that those who have a positive attitude towards ageing live an average of 7½ years longer than those who don't.

The negative impact of elderspeak was supported by a study at the University of Kansas. Professor Kristine Williams analysed interactions between staff and residents at a nursing home and found that ''older adults with dementia most frequently reacted to elderspeak communication by negative vocalisations''. That is, by being more aggressive and yelling or crying. Williams argued that a reduction in elderspeak use by staff ''may reduce these behaviours, thereby increasing the quality of care to these residents".

At a conference on dementia in Sydney in June, Dr Stephen Judd, the chief executive of aged-care provider HammondCare, said elderly residents of nursing homes were ''voiceless citizens''.

"'Does anyone seriously believe that an older citizen in residential aged care has not had their rights eroded, however subtly, by being obliged to conform to a regimented schedule that - let's be frank - revolves around what suits staff or operational efficiencies . . . rather than continuing to enjoy the daily rhythms that most of these people have been enjoying quite happily for many years?''

So the elderly in care can be under attack from two directions. That most important of attributes, a sense of individuality, can be undermined by both excessive regimentation and methods of communication.

Williams commented: ''The main task for a person with Alzheimer's is to maintain a sense of self and dignity. If you know you're losing your cognitive abilities and trying to maintain your dignity, and someone talks to you like a baby, it's upsetting to you."

I admire those who work in any of the caring professions, for their roles are inevitably challenging and require a great deal of dedication and patience.

But there needs to be a conscious effort to avoid talking down to those, particularly the elderly, who are receiving the care.

I can understand why it happens. Interactions in hospitals and nursing homes can be erratic and short-term. Stays can be relatively brief, and shift-changes in a busy schedule are constant. It must be easy for staff to move into automatic elderspeak as a fallback position, perhaps believing that it's a sign of warmth and concern.

It may also be a distancing mechanism, helping to insulate the carer from any suffering experienced by the individual.

But research suggests that it is counterproductive and I'm not surprised that anger is a common response. We are vulnerable at such times and I, for one, am extremely resistant to solicitous head-patting and a "there, there, darl, you poor old thing, we'll look after you" attitude. I don't want to be constantly told I'm incompetent.

David Campbell is a freelance writer.

Copyright © 2010 Fairfax Media

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