As the plot unfolded in the season premiere of HBO comedy, Getting On, I noticed the excessive use of “toddlerspeak” directed at elderly patients within the community hospital’s hospice unit. Whenever a physician or nurse was speaking to a patient, they tended to use baby talk—with a high pitch, lilting tone, longer space between words, elongated space around vowels, and simple, shortened words. When speaking to a baby or a toddler, such tones may help children learn language, provide amusement and get their attention. This show’s characters, however, were ones who had lived a long time; they were far older than the providers themselves. In one instance, a physician talked to a patient- a former physician- as if she were an infant.
Some patients suffered dementia, but others were perfectly capacitated. They had lived full lives and continued to enjoy meaningful lives—having raised families, pursued careers, taken care of themselves and others, and made societal contributions. However, they were being spoken to as if they were two years of age.
I wondered whether this blatant disrespect was only a television invention or something real. A New York Times piece in 2008 discussed how not just in medicine, but in many areas, some use terms like “sweetie” and “dear” when speaking with seniors. In a 2010 study and a 2009 study, researcher Kristine Williams found that seniors who are spoken to in “elderspeak” tended to be more resistant to care. Such speech signals that the senior is incompetent- accelerating a downward spiral and enhancing feelings of dependency.
Rather than viewing seniors as vulnerable and frail, we should temper that vision with thinking instead about the full life they have lived.
A physician at a large community hospital told me once that he often talked with senior patients this way. The physician never used terms like “sweetie” or “dear” outside of work, but he found himself using that language among the elderly he treats. His mentors did it, as well. “It’s just part of the culture,” this physician said.
Another friend from a family of physicians and attorneys told me about a loved one recently hospitalized after surgery. A nurse on duty told the patient that the “the boo boo” would hurt for a bit, and that she would have pain from “the ouchie.”
Another friend- a younger senior citizen- told me that she is always referred to as “baby” when she visits her doctor’s office.
During medical school, students learn the often difficult tasks of putting patients at ease and delivering bad news. However, I do not recall any curricula about how to speak specifically with seniors. Given the massive shortage of gerontologists, it is important for all providers- especially those in primary care- to learn to shun “elderspeak.” Such language decreases well-being, and it is demeaning. Patients who have lived full lives deserve to be addressed with respect, understanding and dignity. Infantilizing them through “elderspeak” is detrimental to the goals of medicine and to basic human kindness.
Rather than viewing seniors as vulnerable and frail, we should temper that vision with thinking instead about the full life they have lived. Given the prevalence of this phenomenon, it is something we must all be aware of and avoid.