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Alzheimer's Patients React Poorly to 'Elderspeak'

Talking to them like children brings out more resistance, study found

MONDAY, July 28 (HealthDay News) -- Alzheimer's patients may often become upset and even act out when nurses or other caregivers use "baby talk" to converse with them, a new study shows.

Researchers who taped the interactions of nursing home staff and people with moderate Alzheimer's found that the residents often became more agitated and resistant to care if they were addressed as infants.

"People who have dementia are trying to maintain their sense of being a person. And if their concept of being a person is that they are a competent person, and someone is talking to them like they are an infant, that might be distressing," speculates lead researcher Kristine Williams, an associate professor at the University of Kansas School of Nursing.

The findings were to be presented Monday at the Alzheimer Association's International Conference on Alzheimer's Disease, in Chicago.

Nursing experts have known for years that family caregivers and professional nursing staff alike tend to lapse into infantilizing speech, what they call "elderspeak," when dealing with the elderly or infirm. This type of speech involves an overly caring but controlling tone of voice, shortened sentences, repetition, the use of inappropriately intimate terms of endearment ("sweetie," "dear"), and a tendency to treat the person in a childlike or highly dependent manner.

"They also tend to alter the pronouns, so they might say, 'Are we ready for our bath?' That really gives the message that the person isn't able to act independently, instead of, 'Are you ready for me to help you with your bath?'," Williams explained.

"What, theoretically, we think is going on is that younger people have stereotypes of older adults as being less able to communicate, less competent in a lot of different areas," she said. According to Williams, the tendency of a caregiver to use "elderspeak" rises with the perceived level of infirmity in the patient.

Experts have long noted that mentally competent elderly patients in hospitals and nursing homes are irritated by "elderspeak." But would the same be true for Alzheimer's patients with dementia?

To find out, Williams' team videotaped the interactions of nurses and nursing assistants tending to the daily needs of 20 nursing home residents. The residents ranged between 69 and 97 years of age, and had moderate levels of dementia.

The researchers used a measure called the Resistiveness to Care Scale to gauge the intensity of behaviors that tended to disrupt care. This "resistiveness" included actions like grabbing onto persons or objects, turning away, pulling the limbs tightly to the body, saying no or crying out, hitting or kicking.

Whenever such behaviors occurred, the researchers rewound the tape seven seconds to see what type of communication (if any) might have precipitated it.

"What we found was that they were more likely to be resistive to care if the nurses were using the 'elderspeak' communication compared to the normal adult-to-adult kind of talk," Williams said.

"There's the suggestion that these people are unable to communicate that their needs aren't being met. And because they can't communicate verbally, they may respond in these other nonverbal ways," Williams said. The "need" in question could be as simple as the desire to be thought of as an adult person worthy of respect, she added.

So, what should family members do if they witness "elderspeak" in an assisted-care setting? Lecturing staff might not be the smartest route to take, Williams said. However, a gentle reminder of just who the patient or resident is might help.

"Try and tell them a little bit about your loved one, that they were a high-functioning adult," she said. "To get them thinking more of the person in terms of that competent adult framework. That might be a better approach."

Sam Fazio, director of Medical and Scientific Relations at the Alzheimer's Association, agreed. "[Caregivers] really have to know who that person's been their whole life, and not just define them in terms of their disease or their symptoms," he said.

The result, according to the findings from the Kansas study, should benefit both patient and caregivers alike.

"People are always saying, 'Oh, I can't do that because it's going to take more time and I have too many people to take care of,'" Fazio said. "But this showed us that the other way of doing things was causing even more time and care."

With the number of people with Alzheimer's expected to rise to more than 106 million worldwide by 2050, maximizing communication between staff and patients will be increasingly important for nursing staff everywhere, Williams said.

More information

There's much more on Alzheimer's disease at the Alzheimer's Association.

SOURCES: Kristine Williams, R.N., Ph.D., associate professor, University of Kansas School of Nursing; Sam Fazio, Ph.D., director, medical and scientific relations, Alzheimer's Association, Chicago; July 28, 2008, presentation, International Conference on Alzheimer's Disease, Chicago

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