When we speak to him, we exaggerate our enthusiasm, we tell him what a big boy he is, and we sing-song through what would typically be boring or commonplace statements. In essence, we speak to him as if he were a baby.

Because he is a baby. Toddler-aged, sure, but our baby nonetheless.

Speaking this way is helpful for a baby’s development. Since we are not born understanding the rules for speech and grammar, it serves a parent well to become proficient in Baby-ese.

I’m practically bilingual by now.

The last place I expected to hear this kind of baby speech was within a nursing home — and not spoken to a child, either, but to an aging patient. As a psychologist who works in nursing home settings, I hear it a lot, as it turns out.

Usually, it is a young or mid-life staffer speaking to someone who has lived two (or maybe three or even four) times longer than them. Someone who has worked a challenging career, raised a family, and coped successfully with a multitude of historical crises and rapid changes.

“Oh, aren’t you just the cutest little old man?”

“Uh-oh, looks like she made a messy.”

“Are we going to be a big boy today?”

There is a term for using baby-talk to speak to older individuals, and it is called “Elderspeak.” The intention is usually to be helpful, as exaggerating and slowing down certain words may help someone who is hearing-impaired or who has slowed processing speed to better understand the speaker. Unfortunately, studies suggest that slowing or exaggerating speech can interfere with comprehension, as it changes the way the mouth moves for lip-readers and changes the intonation in unnatural ways.

The overall effects of Elderspeak are negative. Most older individuals perceive Elderspeak as insulting, and the most common message older individuals hear when spoken to in such a way is: “You are incompetent, and I must dumb down my words as I would for a baby.”

Over time, this unspoken message can lower self-esteem and even convince the older individual that they are, in fact, incompetent when the reality is anything but the case. We see the same phenomenon when individuals are told repeatedly that they are not good at math or that they would fail in a given career field. The effect is so strong that it lowers math performance and causes people to foreclose on career options.

Hear a message often enough, and you will start to believe it.

But, why would Elderspeak come in the form of a cutesy voice, a sing-song quality straight out of Snow White? I believe it shows the discomfort the speaker feels when interacting with someone older. It can be hard for some to confront old age and accept the fact that they, too, will grow old and inherit all of the challenges that come with it.

By infantilizing an older person, one can create a greater sense of psychological distance. It is a defense mechanism, a kind of metamorphosis to change older age into babyhood —babyhood being a state much easier for the speaker to confront and even control. Individuals are often not aware of this transformation, though it is nevertheless a self-serving act.

…….

Perhaps the most telling incident of Elderspeak I’ve come across involved a locked dementia unit. As a consulting psychologist, I was called in by the nursing facility management to help resolve this unit’s behavior problems. Patients were resisting nursing staff, refusing meals, and at times were even aggressive.

These are not atypical behaviors for patients with major neurocognitive disorders like Alzheimer’s disease, repeated strokes, and frontotemporal dementia, and the first-line treatment by psychologists typically assesses for contributory factors in the environment. Perhaps the noise level of the unit or the approach style of the staff are contributing to these behaviors. Small changes in these areas can make a big difference, both for the staff’s well-being and for the patients’.

When I entered the woebegone unit, I was immediately struck by something out of place yet very familiar. See, my toddler son loves to watch a series of YouTube videos produced by an educator named Ms. Rachel. If you don’t spend the majority of your day with humans under the age of 4 years old, then you may not be familiar with Ms. Rachel or her highly successful series of language learning videos. She sings, puts on elaborate productions with her Broadway actor husband, and breaks down words into easy-to-understand syllables. Think of Mr. Rogers and Lamb Chop with a higher production value. 

Her songs burrow deep into the brain stem, stuck in the heads of hundreds of thousands of parents every day.

And so, as I walked onto the unit, I was surprised to hear that haunting voice, singing from the television in the common area:

“Wake up, little bunnies! Hop little bunnies, hop-hop-hop! Hop, hop, hop, and stop!”

As it turned out (among other things), the Activities Department had been putting on Ms. Rachel’s videos and then leaving the unit. Instead of engaging the residents with group games and socialization, they would put on a TV program for children and leave.

As a result, the patients had begun to act in the way they were expected to: like neglected children.

…….

Other issues needed to be addressed at the facility, yet the first items to correct were the biases that staff held toward the patients and how to speak more effectively with them. The social and psychological distance between staff and residents had created a sense of unease among the patient population, whereas genuine care and attention were needed to soothe their concerns.

When it comes to speaking to older folks with disabilities that may interfere with comprehension, the general guidance is to break up large sentences into smaller, telegraphed parts and to repeat yourself when necessary. Keep these two things in mind, and you can effectively communicate what you need to say.

Above all, communicate your respect. Even if an older individual appears childlike, remember that they have lived a rich and complicated life. They have handled responsibilities and have things to feel proud of. They have strived, won, lost, and survived. That is worth honoring. With that as a guiding compass, we can’t go wrong.

Note: the above qualities of persons and settings have been altered to protect individual identities. Characteristics from multiple patients and nursing staff have been combined, though the content and overarching message are true reflections of my experience as a mental health provider.

……….

If you’re interested in exploring these ideas more, check out my new book available on Amazon: The Golden Rules of Retirement: A Psychologist’s Guide To Living Life to the Fullest, No Matter Your Financial Situation. Kindle and paperback editions are available now by going to the following link: https://www.amazon.com/Golden-Rules-Retirement

And, stay tuned for details, including release date, upcoming sales, and future books in the Golden Rules series by visiting my website: lifecanbegolden.com/

-Lee Penn, PhD