Elderspeak and Resistance to Care

“Come on now, Vera, honey,” the nurse said in a high-pitched, sing-song voice, “be a good girl and take this nice candy.”

Vera swung her arm and knocked the tiny cups of pills to the floor.


In their 2009 study, Elderspeak Commnunication: Impact on Dementia Care, Kristine N. Williams, RN, PhD, and her colleagues report that resistiveness to care increases nursing home costs by 30%.   They examined the way nursing staff speak to residents and its impact on the level of cooperation of residents with dementia.  They found that residents became significantly more resistant to care when nursing staff used elements of elderspeak such as:

  • simplistic vocabulary or grammar
  • shortened sentences
  • slowed speech
  • elevated pitch or tone
  • inappropriately intimate terms of endearment
  • collective pronouns (“Are we ready for our bath?”)
  • tag questions (“You want to get up now, don’t you?”)
They found that residents with dementia were more cooperative when spoken to in normal adult talk, and suggest the following research-based strategies in working with residents with dementia:
  • normal talk
  • reorientation
  • distraction
  • positive feedback
  • memory aids




10 thoughts on “Elderspeak and Resistance to Care”

  1. Dr. El,
    It gets me agitated when I hear staff members speaking to residents in other than a normal conversational tone. Another pet peeve of mine is when staff members speak to family members or other staff in front of a resident as if they are not there. Even if I am not sure a resident can answer a question appropriately, I direct the question at the resident (If they can not answer, I would expect the family member to jump in) or , out of respect, I will ask a resident (or tell them) if they mind if I talk to their family member.

    I remember, once, when I brought my mother to the doctor, (who was totally cognitively intact, but frail due to her bad back and cancer), I was asked how her bowel movements were. After a moment of speechlessness, I responded “I don’t know” and turned to my mom and said, “Mom, how are your bowel movements?” You would think a physician and medical professionals would know better, but they don’t. I witness things like this all the time.

  2. This , too, is one of my #1 pet peeves. But, if I am honest with myself, I know that I lapse into “singsong”, too occasionally. I constantly check myself. Sometimes, I think we fall into this cadence because so many of the elders we serve are HOH. For whatever reasons, it does seem to be a difficult for some staff to re learn how to speak to elders and stick to it. Some just have the the intuitive, instinctive “knack” to speak normally. Others,,no matter how much training/practice, with all good intentions, never learn. I think there should be a universal, non verbal, gesture we in health care should use that can communicate to another staff member, “change your tone” when we hear it. Presumably, no one would take offense. It is just a friendly reminder!!! HAHAHA

  3. Sue, I will definitely be agitated as a resident if a young staff member speaks to me as if I were a child, but one of my other pet peeves is when a staff member moves a resident in a wheelchair without telling them what they’re doing. I’ve seen this generate agitated behavior on the part of the resident, and the staff member had no idea they’d set off the behavior.

  4. Genie, I have to check myself occasionally when I find myself shouting to a resident who isn’t hard of hearing, because so many of them are — and their hearing aid is being repaired or at home or the batteries are being ordered, etc, etc. Staff training where the staff members practice talking to each other and report on how they feel with various tones is likely to be effective in teaching how to communicate without using elderspeak, because participants can feel the impact themselves.

  5. Dr. El,
    I absolutely agree, I believe it is important to ask or tell a resident they are being moved even if they do not necessarily have the cognition to understand what is happening, it is a matter of treating the person with respect and dignity. I don’t think most people understand the importance of doing this.

    • When moving a resident, I try to to tap/tickle them, gently with both of my hands/fingers on their shoulders, FIRST. This, alerts them that the chair is going to move. Another cue I give the Residents before transport is , I ask their permission, as in ” Is it OK if you and I go to the dining room together?” I always try to get their permission. Give them the semblance of control. Often times, a Resident seems to be hesitant about “going somewhere” because they are not sure if they are going to get back/picked up. When I assure them that they will. (and, by God, they better get picked up and “”driven”/transported back to their room……must make “good” on that) I can get an “easy Yes” to an invitation!

    • Genie, you bring up the excellent point of not only letting the resident know they’re going to be moved, and asking for permission if possible, but letting them know where they’re going and how they’ll get back. When I meet with a new resident, I tell them who I am, let them know I’d like to talk with them in their room, and that I’ll bring them back to where they are. My invitations are rarely declined.

      Regarding letting residents know they’re going to be moved, I do believe that even very confused or withdrawn residents respond better to being gently alerted to a move prior to it occurring. But even if it didn’t matter to them, it certainly matters to the alert residents who are observing how their peers are being treated and knowing that if they decline, they will be treated similarly.

  6. I’m a little late getting on this wagon, but I think it’s important to approach the resident from the front. Let them see you when you tell them where you’re taking them. If you have to stop en route, position them so they can see what you’re doing. If you suddenly stop and disappear, this is confusing at best and frightening at worst.

    • Tracey, I absolutely agree, but sometimes for expediency’s sake, when you have alot of Residents to move and position for space/seating constraints in a large group, this can be hard to do. I guess they have become “conditioned” to my “from behind” non verbal cue., that they are about to be moved.

    • Genie, one way to follow Teacy’s suggestion when moving lots of resudents in a crowded area is to tell the group from the front of the room that people are going to be moved. Most of them would have figured it out in context, but it’s more respectful and less startling for them to know in advance. This could be combined with your “from behind” nonverbal cue.


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