Jennifer Axelson, LCSW, CCM, CLCP
Martha Kern

We’ve all done it.

Whether as a service provider or a family member, we have spoken the wrong way, at the wrong time, about a potentially sensitive topic with a senior.  It may have been our tone or style of speech.  It could have been at a rushed time of day or under a stressful circumstance.  It may have been a topic that deserved more time and planning.

The result — a slammed door, a glowering silence or a flat-out, “No!” – might have been different if the approach had been a bit smoother.

While there is no foolproof method to assure easy acceptance of whatever idea we might be presenting to a senior, there are definite things to consider and avoid in our communications with older individuals:

Elderspeak is a term that describes the countless ways in which younger people insult seniors during conversation with their tone, inflection and manner of speaking.  This style of speech assumes the older person being addressed is hard of hearing, cognitively impaired, equipped with the intellect of a four-year-old or somehow beneath the person talking.

Here are some of the hallmarks of elderspeak:

  • Speaking slowly and/or loudly
  • Over-enunciating words
  • Using a sing-song voice
  • Simplifying syntax or using short sentences
  • Phrasing observations as questions, as in “You’re wearing your blue pants today, aren’t you?”
  • Calling the individual, “honey”, “darling”, “baby” or “cutie”
  • Using “we” instead of “you”, as in “We feel good today, don’t we?”

Above and beyond the insult delivered to a person with this condescending style of speech is damage to the senior’s self-esteem and dignity.  Even those contending with mild to moderate dementia can discern and react to a patronizing tone.

Predictably, elderspeak discourages cooperation and may even shut down the conversation entirely.  Research also shows a correlation between the infantilization of seniors and increased withdrawal and depression.

Assume seniors have the same ability to hear and understand as anyone else.  Speak to them as you would a colleague or neighbor.  Take a respectful tone and consider asking how the person would like to be addressed rather than just calling them by their first name.

If there is a hearing deficit or a problem with comprehension, it will become apparent soon enough.  Only then should the volume of the conversation be incrementally increased, or the complexity of the content simplified.

Disregard of boundaries
Adult children and service providers often come to seniors with an expert recommendation for care or other considerations.  While the expertise may be very real, proposing an unsolicited idea (i.e. moving to a facility, hiring a caregiver) might well be heard by the senior as advice they don’t want or need.

Older individuals know a great deal.  They’ve lived, they’ve worked, they’ve raised families. To intimate that an adult child or service provider “knows what’s good for them” without even asking what their needs and priorities might be is to push the boundaries of respect and “place”.  Competent seniors remain in full control of their own lives and they are likely to remind people of this fact with forceful resistance to whatever is being proposed.

Focus not on what you think is a good idea and instead ask what that senior most values and most wants.  Set aside time to have a long conversation if that’s what results.  Listen.  Don’t rush to fill the silence if responses are slow in coming. These are difficult topics in difficult times for someone whose health is declining, and it can be hard to find the right words to describe new feelings.

Be prepared to get answers that conflict with your ideas.  It’s okay to disagree.  Be an ally whose main objective is to help that senior achieve his/her goals.  In so doing, the foundations of trust are established.  Later, in a real emergency, that trust may make dialogs about care options go much more smoothly.

Assumption of control
The presence of white hair should in no way telegraph that it’s acceptable to make choices, even small ones, for a competent individual.  Instead of making an appointment with a professional without considering the older person’s wishes, ask them if they prefer a particular day or time period.  Offer them a limited array of choices when it comes to meals, clothing, activities and service providers.  Self-determination, even in minor matters, accords appropriate respect on individuals who just happen to be old.

Similarly, it’s inappropriate to speak for an older individual who is present in the room and fully able to speak for him/herself.  Doctors and other service providers are sometimes guilty of speaking to the adult child or care manager who has accompanied a senior to their office, and studies show seniors find this highly irritating.  If an older individual needs help answering a question, they will seek it.

Control is one of the central themes of older age.  As the body loses ground and functionality, the world shrinks a little.  Fewer things are possible.  Many of the day’s activities may involve the assistance of others, and the helpers are the ones who determine when and how things will be done. The exercise of autonomy and control, even in small measures, can help fend off depression and empower individuals who may have lost the full freedom they once enjoyed.

Ignoring feelings
Acknowledging an older person’s feelings is paramount to honest discussion. Frustration, fear, resentment and loneliness may all be factors driving their opinions and desires regarding care.  Understanding the reason behind the “No!” can build empathy and help point the way toward finding solutions that address and mitigate those fears.  While a younger person cannot claim to know what the senior is feeling or going through, a simple, “help me understand” may elicit a torrent of bottled-up emotion and new information about the aging process never before considered.

Honesty about feelings cuts both ways.  Adult children have fears of their own, often revolving around safety.  If a senior can be made to understand that it’s not control that adult children want, but safety and stability, their resistance may soften.  It’s okay to say you’re afraid of a crisis, an accident that could change the course of their lives.  It may also be useful to remind senior parents of the struggles they may have endured with their own parents and how it might have felt for them when a call came in the middle of the night.

Communication can be clouded by so many factors.  Tones of voice, gestures, assumptions, timing and a general failure to understand the issues from the other person’s perspective can derail the most well-intentioned attempts to discuss and solve problems.  It may take more than one attempt to get to a productive conversation. Be patient, speak respectfully, ask questions and tell the truth about your own concerns and emotions. Even if consensus is never achieved, the relationship will be preserved, and trust may become one of its greatest features.

© Lifecare Innovations