Patronizing Communication Creates Resistance to Dementia Care

By Rich Shank

Resistance to care is common in older adults with dementia. It can disrupt nursing care and has been estimated to increase the cost of care as much as 30 percent. To explore the potential causes of treatment resistance, researchers at the University of Kansas conducted an observational study of care episodes with 20 nursing home residents with dementia. Their primary interest was to examine the role that Elderspeak (infantilizing communication used by nursing staff) plays in dementia care resistance.

Previous descriptive research has demonstrated that Elderspeak is routinely used in long-term care settings, especially during episodes of care with activities of daily living (ADLs). It is a form of intergenerational communication that features simplistic vocabulary, shortened sentences, slowed speech, elevated pitch and volume, and inappropriately intimate terms of endearment (often devolving into baby-talk).

Residents perceive Elderspeak as patronizing and, wherever used, it has been shown to facilitate communication breakdowns during episodes of care. In brief, negative and patronizing staff communications with residents precipitate the problem behaviors of residents.

This study used psycholinguistic, observational, and behavioral analysis to examine the relationship between staff Elderspeak and resistance to care. The results suggest that care episodes which involve Elderspeak significantly increased the likelihood of treatment resistance.

Problem behaviors that stem from Elderspeak are mainly aggression, withdrawal, vocal outbursts, wandering, and treatment non-compliance.. All of these are commonly misperceived as symptoms of the resident’s condition, rather than as reactions to the conditions of the care environment.

Elderspeak sets off a self-defeating cycle that has negative outcomes for residents and staff. Resistive behaviors disrupt care for both the resident and their co-residents, who often react to such behavior. In turn, these care disruptions add undue stress to nursing home staff. Finally, a highly stressful nursing home environment is commonly associated with burnout and turnover—both known to increase the operating costs of the nursing home.

Staff training should emphasize the importance of respectful communication that is grounded in the individual experiences of the resident. Discovering what the resident finds to be endearing and respectful forms of communication will go a long way toward empowering the staff to overcome what is misperceived as uncontrollable treatment resistance. In turn, it will allow the staff to develop the type of meaningful relationships that lead to successful care episodes.

Source: Kristine N. Williams, Ruth Herman, Byron Gajewski, and Kristel Wilson. 2008. Elderspeak communication: Impact on dementia care. American Journal of Alzheimer’s Disease and Other Dementias. Advanced online publication, June 30.

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