By Elizabeth Causton, MSW
I would like to share some thoughts about an article that I recently read in the NY Times entitled: “Honey, Sweetie, Dearie: The Perils of Elderspeak” May 20251. I found this to be a critically important and timely discussion about one of a growing number of training programs designed to teach care aides how to
stop using babytalk and address older people as adults.
Common Examples of Elderspeak
Besides inappropriate, overly familiar endearments such as ‘honey, ‘sweetie’, dearie’, other common examples of ‘elderspeak’ as listed in the article include the use of plural pronouns such as, ‘are we ready to take our bath?’; talking loudly and using short sentences spoken with exaggerated slowness, or using words one might use with a toddler like ‘potty’, ‘jammies’, or ‘tummy.’
The CHAT Program: Changing Talk
The specific training program described in the article called “CHAT (for Changing Talk),” was started as a result of research showing that while elderspeak is a common form of communication with older adults in healthcare settings, it perpetuates a negative stereotype of older adults as being frail, incompetent and dependent or ‘childlike’. However, what is perhaps even more concerning is that research that has been carried out in both hospital and nursing home settings has found that
elderspeak can actually contribute to resistant behaviors when used with dementia patients.
When Good Intentions Have Unintended, Harmful Consequences
However, while elderspeak can have a negative impact in healthcare settings, I think it is also important to point out that it is often used by staff with the intention of conveying caring, compassion and perhaps even the message, ‘you are like family to me’. Having said that, elderspeak is a classic example of how a positive intention to show caring can actually have unintended, harmful consequences.
For example, regardless of one’s intentions, when babytalk is used with adults, it defines the relationship in unequal terms.
Babytalk says in effect, ‘I am the adult in this relationship, you are not’ or ‘I am in control, you are not.’
This language creates a power dynamic that is similar to the relationship between a parent and child, which makes it de-meaning when used with another adult. In other words, it diminishes or takes away the unique meaning and identity of the adult who is being addressed in that way. As a result, by denying a person’s adulthood, elderspeak can actually create a loss of identity above and beyond any losses the person may be experiencing as a result of old age or illness.
Preserving Adult Identity in Care: Training and Cultural Shifts
The power of programs similar to the CHAT program described in the article is that they demonstrate that with awareness and positive training change is possible. For example, after going through the training program, there was a significant decrease in elderspeak among staff at participating nursing homes, which in turn correlated with a similar reduction in resistant behaviors among their residents with dementia. Having seen these results, even staff who typically used elderspeak to convey affection, agreed that they could change.
However, as pointed out in the article, even without a formal training program, healthcare facilities could make efforts to reduce elderspeak by creating guidelines for staff to ask patients and residents, or their family members, how they would prefer to be addressed and then to chart that in order to maintain consistency of practice. If that information was unavailable for some reason, the default position could be for staff to use the individual’s given name. This simple change could acknowledge residents’ adulthood, while preventing scenarios in which a resident or family member actually resented the ‘babytalk’ but remained silent so as not to alienate the staff, creating unnecessary tension in that relationship.
Adults with Care Needs are Not Children
I think that reducing the use of elderspeak in healthcare ultimately requires a collective understanding that patients and residents who need help with eating and toileting are not children. Similarly, adults with dementia who may no longer be able to connect with or share their lived history are still not children, their lived history is not erased or made meaningless by the disease.
Given this, the role of caregivers seeking to provide compassionate, respectful care must be to actively preserve and protect the adult identity of patients and residents through both their words and actions.
Elizabeth Causton, MSW.
Reference
1 Paula Span, ‘Honey, Sweetie, Dearie: The Perils of Elderspeak’, Published May 9, 2025. Accessed 19/06/2025 at https://www.nytimes.com/2025/05/03/health/elderly-treatment-aides.html
